BLD-2020-0045BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 22105 LINDA VISTA PL Cupertino
APN: 356 08 013
PERMIT NO: BLD-2020-0045
CONTRACTOR:
ATKINSON CLIMATROLLERS INC, 1 171 NORTH 4TH STREET SAN JOSE
CONTRACTOR PHONE:
DATE ISSUED 1/8/2020 1:14:42 PM
ISSUED BY: JARCHBOLD
VALUATION: $7000.00
JOB DESCRIPTION
LOCATION
REPLACE FURNACE SAME
LICENSED CONTRACTOR DECLARATION
-AIR HEATING%2C VENTILATING AND AIR-CONDITIONING, C38 REFRIGERATION, Cl 0 ELECTRICAL
9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
ATKINSON
LICENSED
C-4 BOILER%2C
LICENSED
258540
EXP
12/31/2020
I hereby
force
I hereby
CLIMATROLLERS INC
CLASS:
HOT WATER HEATING
NO:
DATE:
affirm that I am licensed
and effect.
affirm under penatiy of
I have and will maintain a
for which this permit is issued.
I have and will maintain Worker's
I certify that in the performance
laws of California.
with such provisions or
AND STEAM FITTING, C20 WARM
under the provisions of Chapter
perjury one of the following
certificate of consent to self -insure
Compensation Insurance,
of the work for which this
If, after making this certificate
this permit shall be deemed revoked.
three 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
Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements under
the Cupertino Municipal Code, Chapter 9.12 and the Health
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
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 there is a construction
No
V
Lender's
Name:
APPLICATION CERTIFICATION
and state that the
representatives of this city
against liabilities, judgements,
will comply with all non -point
above information is correct. I agree to comply with all city and county ordinances and state laws relating to building
to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
source regulations per the Cupertino Municipal Code, Section 9.18.
I certify that I
construction,
harmless the
the applicant
:
have read
and hereby
City of
understands
this application
authorize
Cupertino
and
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.