B-2018-1023 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1023
10305 EL PRADO WAY APT A CUPERTINO,CA(342 30 015)1 10305 EL PRADO WAY A&H HEATING&AIR
APT B CUPERTINO,CA(342 30 015) CONDITIONING
SERVICE INC
SAN JOSE,CA 95110
OWNER'S NAME:Mak Tony K And Lan Pan DATE ISSUED:06/15/2018
OWNER'S PHONE: PHONE NO:(408)279-0722
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C20 Lic.#304472 X BLDG_ELECT_PLUMB
Contractor A&H HEATING&AIR CONDITIONING SERVICE INC Date
0 513112 01 9 X MECH X RESIDENTIAL_COMMERCIAL
1 hereby affirm that I am licensed under the provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my JOB DESCRIPTION:
license is in full force and effect. INSTALL(2)AC UNIT-(UNIT A-UNIT B)
I hereby affirm under penalty of perjury one of the following two declarations:
1. 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
nee of the work for which this permit is issued.
' nand will maintain Worker's Compensation Insurance,as provided for by
eetlan 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$11000.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above APN Number: Occupancy Type:
Information Is correct.I agree to comply with all city and county ordinances 34230 015
and state laws relating to building construction,and hereby authorize
representatives of this city to enter upon the above mentioned property for
Inspection purposes.(We)agree to save Indemnify and keep harmless the PERMIT EXPIRES IF WORK IS NOT S'TAR'TED
City of Cupertino against liabilities,judgments,costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue against said City in consequence of the granting of this permit.
Additionally,the applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source regulations per the Cup FIiIT 9,unlcipil Code,Section 9,18.
Issued by:Jasmine At
Signature te 06/14/2018 Date:06/15/2018
OWNER-BUILDER DECLARATION RE-ROOFS•
I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.Ifs of is
following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1. I,as owner of the property,or my employees with wages as their sole inspection.
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code) Signature of Applicant:
z I,as owner ofthe property,am exclusively contracting with licensed Date:06/14/2018
contractors to construct the project(Sec.7044,Business&Professions Code).
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 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 Cade,for the HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
z. I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534.1 will
Section 3700 of the Labor Code,for the performance of the work for which this maintain cmnpliznce with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous
a. i certify that in the performance of the work for which this permit is issued,I ruateriai.Additionally,should I use equipment or devices which emit hazardous
shall not employ an ner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
p y y person in any men 7 will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Worker's Compensation laws of California If,after making this certificate of the Health&SafeMtna 2550 '•753,and 25534.
exemption,I become subject to the Workr's Compensation provisions of the LaborCode,I must forthwith comply with such provisions or this permitshall Owner or authorized agen —
be deemed revoked. Date:06/14/2018
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above Information is I hereby affirm that there Is a construction lending agency for the performance
correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit Is Issued(Sec.3097,Civ C.)
relating to building construction,and hereby authorize representatives of this city Lender's Name
to enter upon the above mentioned property for inspection purposes. (We)agree
to save Indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address
judgments,casts,and expenses which may accrue against said City in
consequence of the granting of this permit.Additionally,the applicant understands ARCHFFECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records.
God.,Section 9.18.
Licensed
Signature Date 06/1412018 Professional