B-2018-1090 CITY OF CUPERTINO BUILDING PERMIT
BU ILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1090
22898 CRICKET HILL RD CUPERTINO,CA 95014-2635(342 35 015) BAY AREA CLIMATE
CONTROLLLC
HAY WARD,CA 94545
OWNER'S NAME:Vurele Sreedhar And Edumou Krislmavem T DATE ISSUED:06/2MO18
OWNER'S PHONE: PHONE NO:(5 10)477-6793
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C20 Lia#962160
Contractor BAY AREA CLIMATE CONTROL LLC Dale 06130/2019 X BLDG—ELECT_PLUMB
1 hereby affirm that 1 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 farce aad effect. JOB DESCRIPTION:
INSTALL(N)AC UNIT-BACKYARD
I hereby affirm under penalty of perjury one of the following two declarations:
1. 1 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.
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 Firer Ar ea: Valuation:$6650.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupaacy'Iype:
and state laws relating to building construction,and hereby authorize 342 35 015
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 06/28/2018 Issued by:Jasmine Archbald
Date:06/28/201$
LDER D LARh'Pf'O
I hereby affirm that I am exempt from the Contractor's License Law for one of theRE-ROOFS:
]'allowing two reasons: All roofs shall be inspected prior to any roofing material being installed.If a root'is
r. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials fm
compensation,will do the work,and the structure is not intended of offered for inspection.
sale(Sec.7044,Business&Professions Code)
z 1,asowner of the property,am exclusively contracting with licensed Signature ofAppleaue
onto.t.-te—extinet-(lie-project-(Sec.-7044,,Business&-Professions-C de) Dote-
I hereby affirm undor pemdty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 1 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
2, 1 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 Ilealrh&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I stare or handle hazardous
shall not employson in an manner so as to become subject to the material.Additionally,should 1 use equipment or devices which emit hazardous
any pm' y J r contaminants as defined by the Bay Area At,Quality Management District I
Worker's Compensation laws of California.N,,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I becorne subject to the Worker's Compensation provisions o£the the Health&Safety Cade,Sections 25505,25533,aad 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall _---
be deemed revoked. Owner or authorized agent:
APPLICANT GERTIFIGATIDN Date:06/28/2018
I certify that I have read ttiis application and slate that the above Information is CO
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a c cuati n 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 ARCIiI'I''C't'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
SignatureLicensed
Date 06/28/2018
Professional