B-2018-0593 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0593
10396AMISTAD CT CUPERTINO,CA 95014-2606(34245012) THERMATECHINC
SAN JOSE,CA 95125
OWNER'S NAME: DATE ISSUED:04/11/2018
OWNER'S PHONE:408-207-6353 PHONE NO:( -
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C_20 Lic.#913806
Contractor THERMATECH INC Date 04/30/2020 X BLDG_ELECT_PLUMB
[hereby affirm that I am licensed trader the provisions ofChapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL
X—
with Section 7000)of Dfvision 3 of Ore Business&Professions Code and that my
license is in full force and effect JOB DESCRIPTION:
REPLACE EXISTING FURNACE(SAME LOCATION);ADD AC UNIT
I hereby affirm under penalty of perjury one of the fallowing two declarations: (SIDE OF HOUSE)
r. I have and will maintain a certificate of consent 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 per is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the tabor Code,for the performance of the work for which this
permit is issued Sq.k't Floor Are: Valuation:$6500.00
APPLICANT CERTIFICATION
I certify that I have read this application and slate that the above - - -
information is correct.I agree to comply with all city and county ordinances APN Number: Oceupitury Type:
and state laws relating to building construction,and hereby authorize 34245 Ott
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 Inconsequence of the granting this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all ll non-point
source regulations,
Date 04/11/2018 Issued by:Jasmine Archbald
Date:04/11/2018
O W NER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If.roof is
r. 1,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(Sec.7044,Business&Professions Code)
2. 1,as owner cribs property,am exclusively contracting with licensed Signature of Applicant
contractasto construct the project(Sec.7044,Business&Professions Code), Date:04/11/2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS'1'O BE CLASS"A"OR BETTER
1 have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance ofdre work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. 1 have and will maintain Worker's Compensation Insurance,as provided fur by I face,end the hazardous nmteNals requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.twill
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. 1 certify that to the performance of the work for which this permit is issued,I ' Health&Safety Code,Section 25532(4)should I store m-handle hazardous
shall not employ n in an Wanner so as to become subject to the materinl.Additionally,should I use equipment or devices which emit hazm-doas
p y any on la y 1 -contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California,If,slier 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 C Sections 25505,25 33,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked, Owner or authorized agent:
APPLICANT CERTIFICATION Date:94111/2018
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 04/11/2018 Licensed
Professional