B-2019-0092 CITY OF CUPERTINO BUILDING PERMIT
6 U9 DSING ADDRESS:
S:CUPERTINO, CONTRACTOR: PERMIT NO:B-2019-0092
BUILDING ADDRESS:
INO,CA 95014-4645(375 40 012) A-1 HEATING AND
COOLING INC
SAN JOSE,CA 95710
OWNER'S NAME: DATE ISSUED:01/14/2019
OWNER'S PHONE: PHONE NO:(408)283-9915
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-20 Lic.#966809
Contractor A-1 HEATING AND COOLING INC Date 07(31/2020 X BLDG ELECT X PLUMB
X MEC$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
license is in full force and effect. JOB DESCRIPTION:
INSTALL(N)WALL MOUNTED HEATER;INSTALL(N)(10 FT)GAS
I hereby affirm under penalty of perjury one of the following two declarations: LINE TO WALL MOUNTED HEATER
1, I 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 of the work for which this permit is issued.
Q:.
permit is issued. Sq.Ft Floor Area: Valuation:$4000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state 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 375 40 012
representatives of this city to enter tjpon 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,Section 9,18. 180 DAYS FROM LAST CALLED INSPECTION.
•
Signaturev� Date 1/14/2019 Issued by:Kim Dunbar
Date:01/14/2019
OWNER-BUILDER DECLARATION
I hereby affirm that I ant exempt from the Contractor's L.icense 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,ori my employees withwages 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)
z. 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:1/14/2019
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. 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 of the work for which this pennit 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
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 i i any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
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,Sections 25505,25 3,and 25534.
comply with such provisions or this permit shall
Labor Code,I must forthwith
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 1/14/2019
I certify that I have read this application and state that the above information is CONSTRUCTION
)
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. I understand my plans shall be used as public records.
Licensed
Signature Date 1/14/2019 Professional