BLD-2020-1147Firefox about:blank
CITY OF
BUILDING PERMIT
CITY HALL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
PHONE 408-777-3228
CUPERTINO WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10600 STOKES AVE APN: 326-09a02
PERMIT NO: BLD-2020.1147
OWNER'S NAME:
OWNER'S PHONE: NONE
CONTRACTOR: AIRS PLUMBING SYSTEMS INC
CONTRACTOR PHONE:408-375-ooss
DATE ISSUED: 10 14 2020 ISSUED BY: SEAN HATCH VALUATION: 69.85000
JOB DESCRIPTION: RELOCATE FURNACE TO ATTIC; (N) AIR DUCTS (200 LF).
LICENSED CONTRACTOR'S DECLARATION:
NO: 901246 EXP DATE: 7.31.20
7000) of Division 3 of the Business & Professions
CONTRACTOR: AIR & PLUMBING SYSTEM LICENSED CLASS: C20 LICENSED
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section
Code and that my license is in full force and effect.
as provided for by Section 3700 of the
I hereby affirm under penalty of perjury one of the following three declarations:
0 I have and will maintain a certificate of consent to self -insure for Worker's Compensation,
Labor Code, for the performance of the work for which this permit is issued.
Section 3700 of the Labor Code, for the
not employ any person in any manner so as to
this certificate of exemption, I become subject to
with such provisions or this permit shall be
VI have and will maintain Worker's Compensation Insurance, as provided for by
performance of the work for which this permit is issued.
0 I certify that in the performance of the work for which this permit is issued, I shall
become subject to the Worker's Compensation laws of California. If, after making
the Worker's Compensation provisions of the Labor Code, I must forthwith comply
deemed revoked.
HAZARDOUS MATERIALS DISCLOSURE
& Safety Code, Sections 25505, 25533, and 25534. I
\9 I have read the hazardous materials requirements under Chapter 6.95 of the California Health
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or
air contaminants as defined by the Bay Area
Chapter 9.12 and the Health & Safety Code,
handle hazardous material. Additionally, should I use equipment or devices which emit hazardous
Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,
Sections 25505, 25533, and 25534.
EPA LEAD -SAFE DISCLOSURE
No:
0 An EPA Lead -Safe Certified Renovator will be responsible for this project.
Certified Firm Name: Firm Certification
VNo EPA Lead -Safe Certified Firm is required for this project.
CONSTRUCTION LENDING AGENCY
of the work which this permit is issued
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance
(Section 3097, Civil Cody).
0 YesTo
Lender's Name:
Lender's Address:
APPLICATION CERTIFICATION
with all city and county ordinances and state
the above mentioned property for inspection
judgements, costs, and expenses which may
understands and will comply with all non -point
I certify that I have read this application and state that the above information is correct. I agree to comply
laws relating to building construction, and hereby authorize representatives of this city to enter upon
purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities,
accrue against s. ". - . - s • . -. - . - • . - • . a s a • • this permit. Additionally, the applicant
source regulati. son 9.18.
Signature Date 10/14/2020
IS COMMENCED WITHIN 365 DAYS AFTER ITS ISSUANCE,
365 DAYS AFTER THE TIME THE WORK IS COMMENCED.
EVERY PERMIT ISSUED SHALL BECOME INVALID UNLESS THE WORK ON THE SITE AUTHORIZED BY SUCH PERMIT
OR IF THE WORK AUTHORIZED ON THE SITE BY SUCH PERMIT IS SUSPENDED OR ABANDONED FOR A PERIOD OF
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