BLD-2019-1548BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 21491 COLUMBUS AVE Cupertino
APN: 362 04 012
PERMIT NO: BLD-2019-1548
CONTRACTOR:
AB/JDD PLUMBING HEATING & AIR CONDITIONING INC, 390 S WHITE ROAD SAN JOSE
CONTRACTOR PHONE:
4088405885
DATE ISSUED 12/10/2019 2:42:51 PM
ISSUED BY: KDUNBAR
VALUATION: $2950
I
JOB DESCRIPTION
INSTALL SEWER LATERAL; BACK -FLOW PREVENTER
LICENSED CONTRACTOR DECLARATION
INC
AIR-CONDITIONING, C36 PLUMBING
the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
AB/JDD
LICENSED
C20
LICENSED
544427
EXP
10/31/2020
I hereby
force
I hereby
PLUMBING HEATING & AIR CONDITIONING
CLASS:
WARM -AIR HEATING%2C VENTILATING AND
NO:
DATE:
affirm that I am licensed under
and effect.
affirm under penatiy of perjury
I have and will maintain a certificate
for which this permit is issued.
I have and will maintain Worker's Compensation
I certify that in the performance of
laws of California. If, after
with such provisions or this permit
one of the following three
of consent to self -insure
Insurance,
the work for which this
making this certificate
shall be deemed revoked.
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's
of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
requirements under
9.12 and the Health
Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials
the Cupertino Municipal Code, Chapter
V
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
Sections 25505, 25533, and 25534.
for this project.
Firm Certification No:
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety Code,
An EPA Lead -Safe Certified Renovator will be responsible
Firm Name:
No EPA Lead -Safe Certified Firm is required for this project.
Certified
v
CONSTRUCTION LENDING AGENCY
there is a construction lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Lender's Address:
I hereby
Yes
affirm
under penalty of perjury that
No
V
Lender's
Name:
APPLICATION CERTIFICATION
and state that the above
of this city
judgements,
with all non -point
.
—
Every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 365 days after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period
of 365 days after the time the work is commenced.