B-2018-0832 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS; CONTRACTOR: PERMIT NO:B-2018-0832
21150 RAINBOW DR CUPERTINO,CA 95014-4900(366 52 002) ARANDA AIR
HEATING AND AIR
CONDITIONING
SAN JOSE,CA 95173
OWNER'SNAME: DATE ISSUED:05/15/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC=20 Lic.#93185
5
Contractor ARANDAAIR HEATING AND AIR CONDITIONING Date 04/30/2019 X BLDG ELECT—PLUMB
I herebyaffirm that I am licensed under the provisions of Chapter 9 X MECH X RESIDENTIAL_COMMERCIAL
a r p p (commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE FURNACE(SAME LOCATION);REPLACE AC UNIT
I hereby affirm under penalty of perjury one of the fallowing two declarations: (SAME LOCATION)
t. I have and will maintain a certificate of eansent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
.performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Flour Arca: Valuation:$11000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 366 52 002
representatives of this city to enter upon the above mentioned property for
Inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN ISO DAYS OF PERMIT ISSUANCE 012
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPEC'T'ION.
Signature Date 0&1&2018 Issued by:Kim Dunbar
Data:05/15/2018
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt IYom the Contractor's License Law for one of the RE-ROOFS,
follmving in.reasans; All roofs shall be inspected prior to any roofing material being installed.If.roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection,
sale IScc.7044,Business&Professions Cade)
z I,asownerofthe property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(See.7044,Business&Professions Code), Date:05-15-2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"Olt BETTER
i. I have and will maintain a Certificate of Consent to self-Insure for Worker's
Compensation,as provided for by Section 3700 of tho Labor Cade,for the
performance ofthe work for which this permit is issued HAZARDOUS MATERIALS DISCLOSURE
it. I have and will maintain Worker's Compensation Insurance,as provided for by 1 hove read the hazardous ni lots requirements under Chapter 6.95 of the
Scctimi 3700 of the Labor Code,for the performance of the work for which this Calif.,.,].Health&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. 1 certify that in the performance of the work far which this permit is issued,I Health&Safety Cade,Section 25532(a)should I stare or handle hazardous
shall not employ any person in any manner so as to become subject to the nrateriul.Additionally,should I use equipment or devices which craft hazardous
air conhunfnants as defined by the Bay Area Ali Quality Management District I
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shell
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:05-15-201 B
1 certify that I have read this application and state that the above information is CONSTRUCTA
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there Is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against sold City in Lender's Address
consequence of the granting of this permit.Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Data 05-15-2018 Licensed
Professional