B-2018-1147 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1147
10220 PARKWOOD DR APT 3 CUPERTINO,CA 95014-1538(326 27 037) THERMAL
MECHANICAL
SANTA CLARA,CA
95054
OWNER'S NAME:Avery Glard rook Up DATE ISSUED:07/13/2018
OWNER'S PHONE: PHONE NO:(408)988-8744
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C4.C10 C20.C36.&C38 Lie.#256067
Contractor THERMAL MECHANICAL Date 01/31!2020 X BLDG X ELECT X PLUMB
1 hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MUCH 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:
BLDG 59 UNIT 43-(N)AC UNIT;REPLACE FURNACE(SAME
I hereby affirm under penalty of perjury one ofthe following live declarations: LOCATION);(N)WASHER/DRYER HOOK-UPS;REPLACE
i. I have and will maintain a certificate of consent to self-insure£or Worker's ELECTRICAL PANEL(70 AMP)(SAME LOCATION);(N)GAS LINE
Compensation,as provided for by Section 3700 of the Labor Code,for the FOR STOVE;REPLACE OUTLETS(10);REPLACE LIGHT
performance of the work for which this permit is issued. (BATHROOM);(N)(1)EXHAUST FAN(BATHROOM)
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 Floor Area: Valuation:$20000.00
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above
information is correct.I agree to comply with all elty and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 32627 037
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 ly 'lh 811 non-point
source regulations per the Cupertino Munici C action 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature ate 07/13/2018 Issued by:Kim Dunbar
Date:07/13/2018
OWNER-BUILDER DECL
I hereby affirm that I am exempt from Bre Contracto's License Low for one of the RE,R0011
fallowing two reasons: All roofs shall be 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,I agree to remove all new materials for
compensation,will do the work,and due structure is not intended ar offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sce.7044,Business&Professions Code), Date:07/13/2018
I hereby affirm under penalty 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 ofthe work forwhich this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. 1 have and will maintain Worker's Compensation Insurance,as provided for by I lmve read the hazardous materials requirements Ruder Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Ilealth&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued, maintain compliance with the Cape,it..Municipal Code,Chapter 9.12 and the
a. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I sto a o-handle hazardous
shall not employ any personin any manner so as to become subject to the material.Additionally,should I use equipment at-devices which emit hazardous
air contaminants as defined by the Bay Area Ai-Quality Management District 1
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance withZCdSeflon's
rtinMunicipal a Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety 25505 ,n 25534.
Labor Code,l must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agen.
APPLICANT CERTIFICATION Date:0 711 312 01 8
1 certify that I have read this application and state that the above Information is CONSTRUCTION LENINC AGENCY
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 properly 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 Date 07!13/2018 Licensed
Professional