B-2018-1800 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-1800
10144 PARKWOOD DR APT 3 CUPERTINO, CA (326 27 037) THERMAL
MECHANICAL
SANTA CLARA, CA
95054
OWNER'S NAME: DATE ISSUED: 10/31/2018
OWNER'S PHONE: PHONE NO; (408) 988-8744
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO'
License Class C4, C10, C20 C38 Lic. #256057
Contractor THERMAL MECHANICAL Date 01/31/2020 X BLDG X ELECT X PLUMB
I hereby affirm that I am 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:
I hereby affirm under penalty of perjury one of the following two declarations: BLDG 25 UNIT # 3 - (N) AC UNIT; REPLACE FURNACE (SAME
1. I have and will maintain a certificate of consent to self-insure for Worker's LOCATION); (N) WASHER/DRYER HOOK-UPS; REPLACE
Compensation, as provided for by Section 3700 of the Labor Code, for the ELECTRICAL PANEL (70 AMP) (SAME LOCATION); (N) GAS LINEREPL FOR STOVE; REPLACE OUTLETS 10 '
read this application-and state that the above
information is correct. I agree to comply with all city and county ordinances A:PN Number: Occupancy Type:
and state laws relating to building construction, and hereby authorize 326 27 037
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
may accrue against said City in consequence of the granting of this permit. WORK IS NOT STARTED
Additionally, the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations pe��,e Cupertino Municipal Code, Section 9. 18. 180 DAYS FROM LAST CAL
MLED INSPECTION,
Signature .
I hereby affirm that I am exempt from the Contractor'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. 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 the structure is not intended or offered for inspection,
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code). Date: 10/31/2018
I hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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. I 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 Health & Safety Code, Sections 25505, 25533, and 25534. I will
pennit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3. I certify that in the performance of the work for which this pen-nit 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
Worker's Compensation laws of California, If, after .making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I
exemption, I become subject to the Worker's Compensation provisions of the
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
.�.
Labor Code, I must forthwith comply with such provisions or this permit shall the Health & Safety
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 ARCRITECT'S DECLARATION
Code, Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 10/31/2018 Licensed
Professional