B-2018-1082 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1082
6355 ATHERWOOD AVE CUPERTINO,CA 95014-4615(369 16 007) ATKINSON
CLIMATROLLERS INC
SAN JOSE,CA 95112
OWNER'SNAME:SHROFF VIPUL D AND SHAH AMISHA TRUSTEE DATE ISSUED:06/27/2018
OWNER'S PHONE: PHONE NO:(408)294-6290
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class&24 Lic.#258640
Contractor ATKINSON CLIMATROLLERS INC Date 12/31/2018 X BLDG ELECT_PLUMB
I hereby affirm that I am licensed under the provisions at'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 fall force and effect. JOB DESCRIPTION:
(N)AC UNIT-BACKYARD
1 hereby affirm under penalty of perjury one of the following two declarations:
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
favi nonce of the work fmwhich this permit is issued.
zp I 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 Flan,-Area: Valuation:$8126,00
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: Ocmrpancy Type;
and state laws relating to building construction,and hereby authorize 369 16 007
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 consequenge-tlf the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,t pplicant understands a�wlll c0 ply with all non-point
source regal do apart
he u er.in icipal Co Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 06/27/2018 Issued by:Jasmine Archbold
Date:06/27/2018
OWNER-BUILDER DECLARATION
I hereby aRirnr that I am exempt from the Contractor's License Law tor one of the RE-ROOFS:
following two reusmrs: All roofs shall be inspected prior to any mofug material being installed.Its roof is
r. 1,as owner of the property,or my employees with wages as their sole installed without first obtaining aiinspection,I agree to remove all new materials for
emopensu mn,will do the work,and the sh acture is not intended or offered for inspection.
sale(See 7044,Business&Professions Code)
—l,_asmvrrern£tho_prrpzrtyram_exclusively-conn acting with_licensed Signa r -ofApplicant
contractors to construct the project(See.7044,Business&Professions Code). Date:06/27/2018
I hereby affirm under pera ty of perjury one of the following 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 25534.1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. 1 certify that in the performance of the work for which this permit is issued,I Hmrith&Safety Code,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.Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Ihry Area Air Quality Man rgement-D{sit ct i
Worker's Compensation Taws of California,If,after making this certificate of will maintain compliance with the erth"Municipal Code his
9.12• d
exemption,l become subject to the Worker's Compensation provisions of the the Health&Safety C S cthou,2550 2 r13, `
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 ARCI II'1'h7CT'S DECLARATION
Code,Section 9.113. I understand my plans shall be used as public records.
Signature Data 00!27/2018 Licensed
Professional