B-2018-1234 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR; PERMIT NO:B-2018-1234
7540 BARNHART PL CUPERTINO,CA 95014-5239(36624026) ON-TIMBAIR
CONDITIONING&
HEATING INC
PLEASANTON,CA
94588
OWNER'S NAME:KAO ALICE CHUN-HWEI DATE ISSUED:07/23/2018
OWNER'S PHONE: PHONE NO:(925)598-1911
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C20 Lin.#817040
Contractor ON-TIME AIR CONDITIONING&HEATING INC Date 09/30/2019 X BLDG ELECT_PLUMB
I hereby affirm that 1 am licensed kinder 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:
REPLACE AC UNIT(SAME LOCATION)
I hereby affirm under penalty of perjury one of the following two declarations:
t. I have and will maintain a certificate of consent to self-insure fmWorker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
1 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 Flom Area: Valuation:$8900.00
APPLICANT CERTIFICATION
I certify that I have read this application and stale that the above -
information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 36624 026
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,Sec'n-918_ 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 7-23-2018 Issued by:Kim Dunbar
Date:07/23/2018
OWNER-BUILDER DECLARATION
I hereby.111ra that I am exempt from the Contractor's Liccuse Law for okie of the RE-ROOFS
fallowing two reasons: All roofs shall be inspected prier to any roofing material being installed.If n roof is
r. 1,as owner of the property,or my employees with wages as their sole installed without fust obtaining an inspection,l agree 10 remove all new materials for
compensation,will do the.work,and the shvctne is not intended or offered for inspection.
sale(See.7044,Business&Prolesslons Code)
z. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant
contractors to consnxict the Project(Sec.7044,Business&Professions Code). Date:7-23-2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. I have and will maintain a Certificate of Conscnt to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance ofthe work for which this.permit is issued. - HAZARDOUS MATERIALS DISCLOSURE
1. 1 have and will maintain Worker's Compensation Insurance,as provider)fur by 1 have read the hazardous materials requirements under Chapter 6.95 attic
Section 3700 or the Labor Corte,for[Ire performance of the work far 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
s. I certify that in the performance of the work for which this permit is issued,I Health&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 dented 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,SpsPlofi3 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 CERTIFICATION Date:7-23-2018
I certify that I have read this application and state that the above information Is CONSTRUCTION LENDING 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 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 ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Dale 7-23-2018 Licensed