B-2018-1395 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1395
22330 HOMESTEAD RD APT 304 CUPERTINO,CA 95014-0138(326 59 057) RESIDENTIAL
HEATING AND AIR
CONDITIONING INC
CAMPBELL,CA 95008
OWNER'S NAME: DATE ISSUED:08/20/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C20 Lie.£1705554
Contractor RESIDENTIAL HEATING AND AIR CONDITIONING INC Date X BLDG_ELECT_PLUMB
04/30/2019 X MECH X RESIDENTIAL_COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my JOB DESCRIPTION:
license Is in fail force and effect. REPLACE A/C UNIT(SAME LOCATION)
I hereby affirm under penalty of perjury one of the following two declarations:
t. I hove and will mairwin a c.nificate of consent to self-insure 1'or 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.
�
is issued.
PPLICANT CERTIFICATION
th�aPpjicatiompYN Number: Ocen 1
I certify that I have read and state that the above is ney'ype:
information is correct.I agree to comply with all city and county ordinances 326 59 057
and state laws relating to building construction,and hereby authorize
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the PERMIT EXPIRES IF WORK IS NOT STARTED
City of Cupertino against liabilities,judgments,costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue against said City in consequence of the granting of this permit.
Additionally,the applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source
RE-ROOFS:
1 hereby affirm Limit am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any raofmg materiel being installed.Ira roof is
following two reasons: installed without first obtaining an inspection,I agree to remove all new material,for
1. 1,as owner of the property,or my employees with wages as their sole inspection.
compensation,will do the work,and the structure is not intended or offered for
sale(Scc,7044,Business&Professions Code) Signature of Applicant
x. I,as owner of the property,am exclusively contracting with licensed Date:8-20-2018
coabractors to construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"Olt BETTER
t. I have and will maintain a Ccrtihcete of Consent to self-insure for Worker',
Compensation,as provided for by Section 3700 of the Labor Code,for the HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
z I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534.1 will
Section 3700 of the Labor Code,for hie performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous
1. 1 certify that in the performance of the work for which this permit is issued,I material.Additionally,should I use equipment or devices which emit hazn-dous
shall not employ any person in any manner so as to become subject to the air cnumminants as dented by the Bary Area Air Quallty Management District I
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Worker',Compeasatimi laws of California.If,after making this certificate of the Health&Safety
I certify that I have read this application and state that the above information Is I hereby affirm that there Is a construction lending agency for the performance
correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(Sec.3097,Civ C.)
relating to building construction,and hereby authorize representatives of this city Lender's Name
to enter upon the above mentioned property for inspectlon purposes. (We)agree
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address
judgments,costs,and expenses which may accrue against said City in $�
consequence of the granting of this permit.Additionally,the applicant understands ARCHITECT'S DE LAR '1'L1N
and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public recor'
Code,Section 9.18,
Licensed
Signature Date 8-20-2018 Professional