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B-2019-1121 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-1121 11570 LAKE SPRING CT CUPERTINO,CA 95014-5120(366 54 035) A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC 965 RIDGE LADE BLVD 201 MEMPHIS, TN 38120 OWNER'S NAME: DATE ISSUED:06/24/2019 OWNER'S PHONE: PHONE NO:(408)283-9536 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class WARM-AIR HEATING,VENTILATING AND AIR-CONDITIONING Lic.#742039 X BLDG _ELECT _PLUMB Contractor A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC X MECH X RESIDENTIAL—COMMERCIAL Date 10/31/2019 I hereby affirm that I am licensed under the provisions of Chapter 9(commencing JOB DESCRIPTION: with Section 7000)of Division 3 of the Business&Professions Code and that my REPLACE SPLIT SYSTEM license is in full force and effect. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$15000.00 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION APN Number: Occupancy Type: I certify that I have read this application and state that the above 366 54 035 information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for PERMIT EXPIRES IF WORK IS NOT STARTED inspection purposes. (We)agree to save indemnify and keep harmless the WITHIN 180 DAYS OF PERMIT ISSUANCE OR City of Cupertino against liabilities,judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. 180 DAYS FROM LAST CALLED INSPECTION. Additionally,the applicant understands and will comply with all non-point source RE ROOFS. All-roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of the installed without first obtaining an inspection,I agree to remove all new materials for following two reasons: inspection. 1. I,as owner of the property,or my employees with wages as their sole compensation,will do the work,and the structure is not intended or offered for Signature of Applicant: sale(Sec.7044,Business&Professions Code) Date:6/24/19 2. I,as owner of the property,am exclusively contracting with licensed 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 HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will 2. I have and will maintain Worker's Compensation Insurance,as provided for by maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Section 3700 of the Labor Code,for the performance of the work for which this Health&Safety Code,Section 25532(a)should I store or handle hazardous permit is issued. material. Additionally,should I use equipment or devices which emit hazardous 3. I certifythat in the performance of the work for which this permit is issued I air contaminants as defined by Labor Code,I must forthwith comply with such provisions or this permit shall Date:6/24/19 be deemed revoked. CONSTRUCTION L DING AGENCV APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance I certify that I have read this application and state that the above information is of work's for which this permit is issued(Sec.3097,Civ C.) correct. I agree to comply with all city and county ordinances and state laws Lender's Name relating to building construction,and hereby authorize representatives of this city 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 understand my plans shall be used as public records.