B-2018-1101 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1101
20598 SUNRISE DR CUPERTINO,CA 95014-2961(359 10 040) A&H HEATING&AIR
CONDITIONING
SERVICE INC
SAN JOSE,CA 95110
OWNER'S NAME: DATE ISSUED:06/29/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class WARM-AIR HEATING,VENTILATING AND AIR-CONDITIONING
Lie.*04472 X BLDG—ELECT_PLUMB
DontractorA&H HEATING&AIR CONDITIONING SERVICE INC Date X MECH X RESIDENTIAL_COMMERCIAL
05/31!2019
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing JOB DESCRIPTION:
with Section 7000)of Division 3 of the Business&Professions Code and that my REPLACE FURNACE(SAME LOCATION-ATTIC);INSTALL(N)AC
license is In fall force and effect. UNIT
I hereby affirm under penalty of perjury one of the following two declarations:
r. 1 have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as in for by Section 3700 of the Labor Code,for the
o
oftework for which this permit is issued.
d will maintain Worker's Compensation sssumuce,as provided for bySq.F[Floor Area: Valuation:$12233.00
700 of the Labor Code,for the performance of the work for which thispissued.
APPLICANT CERTIFICATIONAPN Number: Occupancy Type:
I certify that I have read this application and state that the above 359 10 040
information is correct.I agree to comply with all city and county ordinances
and state laws relating to building construction,and hereby authorize
representatives of this city to enter upon the above mentioned property for PERMIT EXPIRES IF WORK 1S NOT STARTED
inspection purposes.(We)agree to save indemnify and keep harmless the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
City of Cupertino against liabilities,judgments,costs,and expenses which
may accrue against said City in consequence of the granting of this permit. 180 DAYS FROM LAST CALLED INSPECTION.
Additionally;the applicant understands and will comply with all non-point
source regulations per the CVper irto Municipal Code,Section 9.18.
I Issued by:Kim Dunbar
� Date:06/29/2018
Signature;� � Date 06-29-2018
RE-ROOFS-
OWNER-BUILDER DECLARATION All ..is shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt]ram the Contractor's License Law for one of the installed without first obtaining an inspection,I agree to remove all new materials for
following two reasons: inspection.
1. I,as owner of the property,or my employees with wages as their sole
compensation,will do the work,and the structure is not intended or offered for Signature of Applicant:
sale(See.7044,Business&Professions Code) Date:06-29-2018
z. 1,as owner of the property,am exclusively contracting with licensed
eommatom to construct the project(Sec,7044,Business&Professions Cade). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the fallowing three declarations:
r. I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Cade,Sections 25505,25533,and 25534.I will
z. I have and will maintain Worker's Compensation Insurance,as provided for by maintain compliance with the Cupertino Municipal Code,Chapter 9,12 and the
Section 3700 of the Labor Code,for the performance of the work for which this Health&Safety Code,Section 25532(a)should I store or handle hazardoom
permit is issued. material.Additionally,should I use equipment or devices which emit hazardous
s. 1 certify that in the performance of the work for which this permit is issued,I air conmmim nts as defined by the Bay Area Alr Quality Management District I
shall not employ any person in any manner so as to become subject to the wilt maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
the health&Safw7Me,
ctions 25505 533,and 25534.
Worker's Compensation laws of California.IF,after making this certificate of
exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall Owner or authorized age _
be deemed revoked. Date:06-29-2018
CONS'I'RUC'fION LENDING ACFN Y
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance
I certify that I have read this application and state that the above Information is of work's for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws Lender's Name
relating to building construction,and hereby authorize representatives of this city
to enter upon the above mentioned properly for Inspection purposes. (We)agree Lender's Address
to save indemnify and keep harmless the City of Cupertino agalned liabilities,
Judgments,costs,and expenses which may accrue against Said City in ARCHITECT'S DECLARATION
consequence of the granting of this permit.Additionally,the applicant understands I understand my plans shall be used as public records.
and will comply with all non-point source regulations per the Cupertino Municipal
Code,Section 9.18. Licensed
Professional