B-2018-1078 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1078
7666 PEACH BLOSSOM DR CUPERTINO,CA 95014-5249(366 11 116) ON-TIME AIR
CONDITIONING&
HEATING INC
PLEASANTON,CA
94588
OWNER'SNAME: DATE ISSUED:06/26/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class E2Q Lia#817040
Contractor ON-TIME AIR CONDITIONING&HEATING INC Dale 09/30/2019 X BLDG—ELECT—PLUMB
I hereby affirm that I nm licensed under the provisions of Chapter 9(commencing 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 DUCT ENTIRE HOUSE
1 hereby affirm under penalty of perjury one ofthe fallowing two declarations:
r. 1 have and will maintain a certificate of consent to self-inama for Worker's
Compensation,as provided for by Section 3700 ofthe 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 ofthe Labor Code,top the perfoinumm ofthe work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$6245,00
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: Occupmrcy Type:
and state laws relating to building construction,and hereby authorize 366 It 116
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.
Signaturer Date 6 20 2018 - Issued by:Kim Dunbar
Date:06/26/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of theRE-ROOFS•
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If o roof is
r. 1,as owner ofthe properly,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 structur e.is not intended or offered for inspection.
s"I'(See.7044,Business&Professions Code)
2, 1,as owner ofthe property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sec.7044,Business&Professions Code). Date:6-20-2018
1 hereby affirm nuclei-penalty of perjury one ofthe 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 Walker's
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
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous mkrtat hils 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 25534.1 will
permit is issued. maintain compliance with the Cufau Ron Municipal Code,Chapter 9,12 and the
s. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Cade,Section 25532(a)should I store or handle hamnrdous
shall not employ any person in any m nen so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
°° air contaminants as defined by the Bay Area Air 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 ofthe the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must fordrwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:6-20-2018
1 certify that I have read this application and state that the above information is CONSTRUCTION
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 Dale 6-20-2018 Licensed