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BLD-2020-0721BUILDING PERMIT CUPERTINO CITY HALL 10300 Torre Avenue • Cupertino, CA 95014-3255 PHONE 408-777-3228 WWW.CUPERTINO.ORG BUILDING ADDRESS: 10846 LINDA VISTA DR Cupertino APN: 356 14 049 PERMIT NO: BLD-2020-0721 CONTRACTOR: RANDO AAA HVAC INC, 1712 STONE AVE #1 SAN JOSE CONTRACTOR PHONE: DATE ISSUED 8/7/2020 11:15:54 AM ISSUED BY: JASMINE ARCHBOLD VALUATION: $8950 JOB DESCRIPTION A/C AND DUCTS REPLACE (E) FURNACE, LICENSED CONTRACTOR DECLARATION 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full CONTRACTOR: RANDO LICENSED C20 LICENSED 768871 EXP 09/30/2021 I hereby force I hereby AAA HVAC INC CLASS: WARM -AIR HEATING%2C NO: DATE: affirm that I am licensed and effect. affirm under penatiy I have and will maintain for which this permit I have and will maintain I certify that in the performance laws of California. with such provisions VENTILATING AND AIR-CONDITIONING under the provisions of Chapter of perjury one of the following a certificate of consent to self -insure is issued. Worker's Compensation Insurance, of the work for which this If, after making this certificate or 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. or devices which emit hazardous air contaminants Code, Chapter 9.12 and the Health & Safety Code, EPA LEAD -SAFE DISCLOSURE for this project. Firm Certification No: 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 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 Signature: have read and hereby City of Cupertino understands this application and state that the authorize representatives of this city against liabilities, judgements, and will comply with all non -point 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.