BLD-2020-1339BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10510 MADERA DR Cupertino
APN: 326 35 053
PERMIT NO: BLD-2020-1339
CONTRACTOR: ON -TIME AIR CONDITIONING & HEATING INC, 7020 COMMERCE DR PLEASANTON
CONTRACTOR PHONE:
DATE ISSUED 9/22/2020 6:14:20 PM
ISSUED BY: haleym
VALUATION: $15683
JOB DESCRIPTION
AC - SIDEYARD
REPLACE FURNACE IN CLOSET; REPLACE
LICENSED CONTRACTOR DECLARATION
HEATING INC
AIR-CONDITIONING,
the provisions of
one of the following
of consent to
Insurance,
the work for which
making this certificate
shall be deemed
C36 PLUMBING, C-2 INSULATION AND ACOUSTICAL
Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LICENSED
C20
LICENSED
EXP
09/30/2021
I hereby
force
I hereby
ON -TIME AIR CONDITIONING &
CLASS:
WARM -AIR HEATING%2C VENTILATING AND
NO: 817040
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
three
self -insure
as
this permit
of
revoked.
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Co lie, for the performance of the
work
provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
is issued, I shall not employ any person in any manner so as to become subject to the Worker's
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
9.12 and the
under Chapter
Health
as
Code, Sections
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
defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
25505, 25533, and 25534.
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety
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
liabilities,
comply
and state that
of this
judgements,
with all non -point
.