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BLD-2021-0504BUILDING PERMIT CITY HALL 10300 Torre Avenue • Cupertino, CA 95014-3255 PHONE 408-777-3228 WWW.CUPERTINO.ORG BUILDING ADDRESS: 5926 SUTTON PARK PL Cupertino APN: 375 35 032 PERMIT NO: BLD-2021-0504 OWNER'S NAME: OWNER'S PHONE: Not Provided CONTRACTOR: M B K T CORP, 2372 QUME DR SUITE A SAN JOSE CONTRACTOR PHONE: 4087637428 DATE ISSUED 3/12/2021 7:59:31 AM ISSUED BY:VALUATION: $3500 JOB DESCRIPTION Replace existing furnace with Amana 80% AFUE Single Stage Furnace LICENSED CONTRACTOR INFORMATION CONTRACTOR: M B K T CORP LICENSED CLASS: B GENERAL BUILDING CONTRACTOR, C10 ELECTRICAL, C27 LANDSCAPING, C36 PLUMBING LICENSED NO: 863274 EXP DATE: 03/31/2021 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penatly of perjury one of the following three declarations: 1 I have and will maintain a certificate of consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2 I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 3 I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, l must forthwith comply with such provisions or this permit shall be deemed revoked. I understand and agree that I am electronically signing and filing this application and that checking the box below has the same legal effect as manual signature. I also understand that I have the option of filing a paper copy of this application with a manual signature but have chosen instead to file this application electronically.