B-2019-0228 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0228
10344 DENISON AVE CUPERTINO,CA 95014-2429(316 29 066) ARS AMERICAN
RESIDENTIAL
SERVICES OF
CALIFORNIA INC
965 RIDGE LADE
BLVD 201 MEMPHIS,
TN 38120
OWNER'S NAME: DATE ISSUED:02/08/2019
OWNER'S PHONE: PHONE NO:None
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-20 Lic.#742039
Contractor ARS AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC X BLDG _ELECT _PLUMB
Date 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 full force and effect. REPLACE FURNACE LIKE FOR LIKE-SAME LOCATION IN
CLOSET
I hereby affirm under penalty of perjury one of the following two declarations:
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.
j z( I 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 Sq.Ft Floor Area: Valuation:$6238.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above APN Number: Occupancy Type:
information is correct.I agree to comply with all city and county ordinances 316 29 066 �
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 regulajions per the Cupertino Municipal Code,Section 9.18.
(� Issued by:Jasmine Archbold
Signalidr> � 02/08/2019 Date:02/08/2019
OWNER-BUIL a .R DECLARATION RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed,If a roof is
following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1. I,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(Sec,7044,Business&Professions Code) Signature of Applicant:
2. I,as owner of the property,am exclusively contracting with licensed Date:02/08/2019
contractors to construct the project(Sec.7044,Business&Professions Code).
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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
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 the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Health&Safety Code,Section 25532(a)should I store or handle hazardous
permit is issued.
a, I 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 hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
shall not employ any person in any manner so as to become subject to the will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Worker's Compensation laws.of California. If,after making this certificate of the Health&Safety
,
•
be deemed revoked. Date:02/08/2019 7/
APPLICANT CERTIFICATION CONSTRUCTION ENDING A CY
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 G.)
relating to building construction,and hereby authorize representatives of this city Lender's Name
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Address
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in ARCHITECT'S DECLARATION
consequence of the granting of this permit. Additionally,the applicant understands I understandplans shall be used public records.
and will comply with all non-point source regulations per the Cupertino Municipal my as