B-2018-0786 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0786
22385 SANTA PAULA AVE CUPERTINO,CA 95014.2715(357 04 073) RELIABLE AIR
MECHANICAL
SAN JOSE,CA 95136
OWNER'S NAME: DATE ISSUED:05/08/2018
OWNER'S PHONE: PHONE NO:(408)266-7267
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC=20 Lie.#R54400
Contractor RELIABLE AIR MECHANICAL Date 11/30/2018 X BLDG ELECT_PLUMB
1 herebyI'Iirm that I am licensed under the provisions of Chapter 9 X MECH X RESIDENTIAL_COMMERCIAL
a 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-GARAGE
I hereby affirm under penalty a]perjury one of the]'allowing two declarotiali INSTALL(N)A/C UNIT-BACK OF THE HOUSE
t. 1 have and will maintain a certificate of causent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,rot the
/
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 Floor Area: Valuation:$5200.00
APPLICANT CERTTFTCATION
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: Oceapnnoy Type:
and state laws relating to building construction,and hereby authorize 357 04073
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 180 DAYS OF PERMIT ISSUANCE OR
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 INSPECTION.
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Signature� Data D510812018 Issued by:Jasmine Archbold
Date:05/08/2018
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of the RR-ROOFS:
following two reasons: All roofs shall be inspected In to any roofing material being installed.If a roof is
t. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inapection,I agree to remove all new materials for
compensation,will do the work,and the bachne is not intended or offered for Inspection.
sale(Sce.7044,Business&Professions Code)
e. I,as owner of the propoity,ana exclusively contenting with licensed Signature ofApplieane
contractus to construct the project(Seo 7044,Business&Professions Code), Date:05/08/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. I have and will maintain a Certificate of Consent to self-insure for Workei°
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided far by I have read the hazardous nrntertals requirements under Chapter 6.95 of the
Section 3700 of the Labor Cade,for the performance of the will for which this California Hari&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should 1 store or handle hazardous
shall not employ material.Additionally,should I use equipment or devices which emit hazardous
p y nny on laws
in any manner so as to become subject ti the air contaminants as defined by the Bay Area Air Quality Nlanagen3ent District 1
Worker's Compensation laws a£California, ff,atter making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I beoome subject to the Worker's Compensation previsions of the the Health&Safedu 9•tl ns 25505,25 3,and�7,5534.
Labor Code,I must forthwith comply with such provisions or this permit shall <!:r
be deemed revoked, Owner or authorized age
APPLICANT CERTIFICATION Date:05/08/2018
I certify that I have read this application and state that the above information Is CONSTRUCTION LENDING AGENCY
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 said 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 Date 05/08/2018 Licensed
Professional