B-2018-1138 CITY OF CUPERTINO BUILDING PERMIT
BU ILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2018-1138
1455 ASTER LN CUPERTINO,CA 95014-5217(366 24 002) RELIABLE AIR
MECHANICAL
SAN JOSE,CA 95136
OWNER'SNAME:LAI YUNG-TE AND CHARN-JANETRUSTEE DATE ISSUED:07/06/2018
OWNER'S PFIONE: PHONC NO:(408)266-7267
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Q_%4 Lic.#954400
Contractor RELIABLE AIR MECHANICAL Date 11/30/2018 X BLDG—ELECT—PLUMB
1 hereby affirm that 1 am licensed under 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:
REMOVEAND REPLACE FURNACEAND A/C(LIKE FOR LIKE).
I hereby affirm under penalty of perjury one of the following two declarations:
t. I have and will maintain acertificatc of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 a£the 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 far by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.n Floor Area: Valuation:$11178.00
APPLICANT CERTIFICATION
I certify that I have read this appllcatlon and state that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and stale laws relating to building construction,and hereby authorize 366 24 002
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 WORT{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 7 6 18 Issued by:SEAN HATCH
Date:07/06/2018
OWNER-BUILDER DECLARATION
I hereby affirm that am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall he inspected prior to any roofing material being installed.If a roof is
r. I,as owner of the property,or my 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 structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed Signature ofApplicaut
contractors to construct the project(Sce.7044,Business&Professions o DKte<7 618
1 hereby affirm tinder penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
i. 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 die 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 Code,Chapter 9.12 and the
a. I certify that in the performance ofthe work for which this permit is issued,I Health&Safety Cade,Section 25532(a)should I store or-handle hazardous
shall not employ any person in any manner so as to become subject to the material. az
Additionally,should 1 use equipment at devices which emit hardous
air contaminants as defined by the 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 Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIRICATION Data:Z.6,18
I certify that I have read this application and State that the above information is CONSTRUCTION&DING AGENCY
correct.I agree to comply with all city and county ordinances and state laws 1 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 permlt 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 thls 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.
Licensed
Signature Date 7.6 is Professional