BLD-2020-1097BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 1117 YORKSHIRE DR Cupertino
APN: 362 07 014
PERMIT NO: BLD-2020-1097
CONTRACTOR:
ON -TIME AIR CONDITIONING & HEATING INC, 7020 COMMERCE DR PLEASANTON
CONTRACTOR PHONE:
DATE ISSUED 8/10/2020 11:47:43 AM
ISSUED BY: KDUNBAR
VALUATION: $25251.00
JOB DESCRIPTION
(2) AC UNITS - BACKYARD
REPLACE (2) FURNACES - CLOSET; REPLACE
LICENSED CONTRACTOR DECLARATION
AIR-CONDITIONING, C36 PLUMBING, C-2 INSULATION AND ACOUSTICAL
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
ON -TIME
LICENSED
C20
LICENSED
817040
EXP
09/30/2021
I hereby
force
I hereby
AIR CONDITIONING & HEATING INC
CLASS:
WARM -AIR HEATING%2C VENTILATING AND
NO:
DATE:
affirm that I am licensed under the
and effect.
affirm under penatiy of perjury one
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 the
laws of California. If, after
with such provisions or this permit shall
of the following three
of consent to self -insure
Insurance,
work for which this
making this certificate
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
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 requirements
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.
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety Code,
EPA LEAD -SAFE DISCLOSURE
will be responsible for this project.
Firm Certification No:
for this project.
An EPA Lead -Safe Certified Renovator
Firm Name:
No EPA Lead -Safe Certified Firm is required
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
state that the above
of this city
judgements,
with all non -point
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 have read this application and
construction, and hereby authorize representatives
harmless the City of Cupertino against liabilities,
the applicant understands and will comply
Signature:
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.