BLD-2020-1238BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: undefined
APN: 316 29 022
PERMIT NO: BLD-2020-1238
CONTRACTOR: ON -TIME AIR CONDITIONING & HEATING INC, 7020 COMMERCE DR PLEASANTON
CONTRACTOR PHONE:
DATE ISSUED 8/17/2020 6:51:36 PM
ISSUED BY: KDUNBAR
VALUATION: $25459
JOB DESCRIPTION
(GARAGE); REPLACE AC UNIT & COIL
REPLACE FURNACE SAME LOCATION
LICENSED CONTRACTOR DECLARATION
C36 PLUMBING, C-2 INSULATION AND ACOUSTICAL
9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LICENSED
LICENSED
EXP
I hereby
force
I hereby
ON -TIME AIR CONDITIONING
CLASS: C20 WARM -AIR HEATING%2C
NO: 817040
DATE: 09/30/2021
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
I certify that in the performance
laws of California. If,
with such provisions or this permit
& HEATING INC
VENTILATING AND AIR-CONDITIONING,
the provisions of Chapter
one of the following
of consent to self -insure
Compensation Insurance,
of the work for which this
after making this certificate
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
requirements under
Chapter 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,
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:
is required for this project.
An EPA Lead -Safe Certified Renovator
Firm Name:
No EPA Lead -Safe Certified Firm
Certified
v
CONSTRUCTION LENDING AGENCY
that 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
No
V
Lender's
Name:
APPLICATION CERTIFICATION
representatives
comply
and state that the
of this city
liabilities, judgements,
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 have read this application
construction, and hereby authorize
harmless the City of Cupertino against
the applicant understands and will
Signature:
./
.