B-2019-0231 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0231
10356 NORWICH AVE CUPERTINO,CA 95014-2446(316 29 096) ATKINSON
CLIMATROLLERS INC
DBA VALLEY
HEATING,COOLING&
ELECTRICA L
1171 NORTH 4TH
STREET SAN JOSE,CA
95112
OWNER'S NAME: DATE ISSUED:02/08/2019
OWNER'S PHONE: PHONE NO:(408)294-6290
LICENSED CONTRACTOR' DECLARATION BUILDING PERMIT INFO:
License Class C20 Lic.#258540
Contractor ATKINS° CLIMATROLLERS INC DBA VALLEY HEATING.COOLING X BLDG _ELECT _PLUMB
&ELECTRICA L Date 12/31/2020 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 SAME LOCATION
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.
2. I have and will maintain Wprker'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:$3000.00
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 29 096
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 regulations
Date 2-8-2019 Date:02/08/2019
OWNER-BUILDER DECLARATION
RE-ROOFS:
All roofs shall be inspected prior to anyroofingmaterial'beinginstalled.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of the P
following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
i. 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:2-8-2019
contractors 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"OR BETTER
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
2, I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I 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
permit is issued: Health&Safety Code,Section 25532(a)should I store or handle hazardous
3. 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 i�t 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 Code,Sections 25505,25533,and 25534.
exemLabor Cod,I becI amf subjectitt the Worker's Compensation this of the ��
Labor Code,I must forthwith comply with such provisions or this permit shall Owner or authorized agent:
be deemed revoked. { Date:2-8-2019
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that 1 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 Name
to enter upon the above mentioned property for inspection 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 DECLARATION
I understand my plans shall be used as public records.