B-2018-1222 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:11-2018-1222
1080 S STELLING RD CUPERTINO,CA 95014-5019(362 27 036) ATKINSON
CLIMATROLLERS INC
SAN JOSE,CA 95112
OWNER'SNAME:DHULIPALA SUBRAHMANYAM AND SUBBALAKSHMI TRU DATE ISSUED:07/19/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class L24 Lic.#258540
Contractor ATKINSON CLIMATROLLERS INC Date 12/31/2018 X BLDG ELECT_PLUMB
1 hereby affirm that 1 nm 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:
INSTALL(N)AC UNIT-BACKYARD
1 hereby affirm under penalty of perjury one of the following two declarations:
I. 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
piqperformance 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 Floor Area: Valuatim,$8328.00
APPLICANT CERTIFICATION
I certify that I have read this application and slate that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and slate laws relating to building construction,and hereby authorize 362 27 036
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,thea licant understands and will comply with all non-point
source section 9.16. 180 DAYS FROM LAST CALLED INSPECTION.
Signature to 07/19/2018 Issued by:Jasmine Archbold
Date:07/19/2018
OWNER- MIL DER DECLARATION
I hereby affirm that I ant exempt front the Cont-etar's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. 1,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,1 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. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sec.7044,Business&Professions Code). Date:0711 9/2 0 1 8
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOK COVERINGS TO BE CLASS"A"OR BETTER
I. I have cud 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
perfomtance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided Por 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 Cade,Chapter 9.12 and the
e. l certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I stn a ur handle hazardous
shall not employ in an s to become sub'eet to the material,Additionally,should I use equipment or devices which emit hazardous
p y ary person y manner so a 1 air conhunfnants as defined by the Bay e�r ea Air Quaff y-Managarma t-ghdriet I
Worker's Compensation laws of California,If,after making this certif cote of will maintain compliance with the CJI{eq'tino Mind at Code,Chapter 9.121a d
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:0711912018
1 certify that I have read this application and state that the above information is CONSTRICTION LENDING 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 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'SDECLARAT'ON
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 07/19/2018 Licensed
Professional