B-2018-1036 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1036
10463 SCENIC CT CUPERTINO,CA 95014-2765(357 07 Ol4) RESCUE AIR SERVICE
INC
SAN JOSE,CA 95120
OWNER'S NAME: DATE ISSUED:06/18/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC=20 Lic.#112 620
Contractor RESCUE AIR SERVICE INC Date 11/30/2019 X BLDG ELECT_PLUMB _
I hereby xfFlrm that I am licensed made,-the provisions of Chapter 9(commencing X MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE(2)FURNACE-SAME LOCATION;INSTALL(2)NEW AC
I hereby affirm under penalty of perjury one of the following two declarations: UNITS-SIDE OF THE HOUSE
n. 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
1 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:$14360.00
APPiJCANq'CERTIFICATION
I certify that I have read this s pplicallon Made 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 357 07 014
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.
Signature „-, Date 06/18/2018 Issued by:Jasmine Archbold
Date:06/18/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two rens...: All roofs shall be inspected prior to any roofing material being installed.If a roof is
i I,as owner of the property,or any employees with wages as their sole installed without first obtaining an inspection,l agree to remove all new materials for
compensation,will do the work,and the shzteture knit intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed Signature ofApplicaut:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:06/18/2018
I hereby affirm under penalty of perjury one of the fallowing three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 permit is issued, HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials 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.I will
Permit is issued. maintain compliance with the Cupertino Municipal Cade,Chaptm•9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Cade,Section 2S532(a)should I store or handle hazardous
shall not employ material Additionally,should I use equipment m'devices which emit hazardous
p y any person in any manner so as to became subject to the air contaminants as defined by fire Bay Area Air Quality Management District 1
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cade,Sections 255D5 255 3,and 25534.
Labor Code,l..at forthwith comply with such provisions or this permit shall
be deemed revoked. Ownero a authorized agent: "�`�'
APPLICANT CERTIFICATION Date:06/18/2018
1 certify that I have read this application and state that the above information is CONSTRUCTION f,RND[NG 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 properly 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 ARCHI'1'EC'P'8 DECLARATION
Code,Section 9.16. I understand my plans shall be used as public records.
Signature Date 06/18/2018 Licensed
Professional