BLD-2021-0970_SignedPermit.pdfBUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10280 PARKWOOD DR APT 4 CUPERTINO
APN: 326 27 036
PERMIT NO: BLD-2021-0970
OWNER'S NAME: AVERY GLENBROOK LP
OWNER'S PHONE: Not Provided
CONTRACTOR: THERMAL MECHANICAL, 425 ALDO AVE SANTA CLARA
CONTRACTOR PHONE:
DATE ISSUED 6/3/2021 10:59:13 AM
ISSUED BY: KDUNBAR
VALUATION: $10000
JOB DESCRIPTION
UNIT; REPLACE FURNACE (SAME LOCATION); (N) WASHER/DRYER HOOK-UPS; REPLACE ELECTRICAL PANEL (70 AMP) (SAME LOCATION); (N) GAS LINE FOR
(10); REPLACE LIGHT (BATHROOM); (N) EXHAUST FAN (BATHROOM)
BLDG 8 UNIT # 4 - (N) AC
STOVE; REPLACE OUTLETS
LICENSED CONTRACTOR DECLARATION
BOILER%2C HOT WATER HEATING AND STEAM FITTING, C10 ELECTRICAL, C38 REFRIGERATION, C36 PLUMBING
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
01/31/2022
I hereby
force
I hereby
THERMAL
CLASS:
WARM -AIR HEATING%2C
NO: 256057
DATE:
affirm that I am
and effect.
affirm under penatiy
I have and will maintain
for which this permit
I have and will maintain
I certify that in the
laws of
with such provisions
MECHANICAL
VENTILATING AND AIR-CONDITIONING, C-4
licensed under the provisions of Chapter
of perjury one of the following three
a certificate of consent to self -insure
is issued.
Worker's Compensation Insurance,
performance of the work for which this
California. If, after making this certificate
or this permit shall 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
6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements under Chapter
the Cupertino Municipal Code, Chapter 9.12 and the Health
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
this project.
Firm Certification No:
An EPA Lead -Safe Certified Renovator will be responsible for
Firm Name:
No EPA Lead -Safe Certified Firm is required for this project.
Certified
V
CONSTRUCTION LENDING AGENCY
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 there is a construction
No
V
Lender's
Name:
APPLICATION CERTIFICATION
information is correct. I agree to comply with all city and county ordinances and state laws relating to building
enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
regulations per the Cupertino Municipal Code, Section 9.18.
I certify that I have read
construction, and hereby
harmless the City of Cupertino
the applicant understands
Signature:
Ke
this application and state that the above
authorize representatives of this city to
against liabilities, judgements, costs,
and will comply with all non -point source
Every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 365 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.