BLD-2021-1362_SignedPermit.pdfBUILDING PERMIT
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 22436 PALM AVE Cupertino
APN: 357 04 074
PERMIT NO: BLD-2021-1362
OWNER'S NAME: MITTAL ANANT AND ANUSHREE
OWNER'S PHONE: 408-799-9089
CONTRACTOR: J M HEATING & AIR CONDITIONING, 7454 BROOKDALE COURT DUBLIN
CONTRACTOR PHONE:
DATE ISSUED 7/19/2021 2:09:08 PM
ISSUED BY: KDUNBAR
VALUATION: $12030
JOB DESCRIPTION
ADD ON. FAU/COIL IN GARAGE, 80% AFUE, 90K BTU. AC IN SIDE YARD, 14 SEER, 4 TON. ADD AC DISCONNECT, WHIP TO CONDENSER AND 220V
DUCT RUNS
FAU CHANGE OUT WITH AC/COIL
30/40 AMP CIRCUIT. REPLACE 2
LICENSED CONTRACTOR DECLARATION
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
10/31/2022
I hereby
force
I hereby
J M HEATING & AIR CONDITIONING
CLASS:
WARM -AIR HEATING%2C VENTILATING
NO: 923438
DATE:
affirm that I am licensed
and effect.
affirm under penatiy of
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.
with such provisions or this
AND AIR-CONDITIONING
under the provisions of Chapter
perjury one of the following three
of consent to self -insure
Compensation Insurance,
of the work for which this
If, after making this certificate
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
Chapter 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
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
Renovator will be responsible for this project.
Firm Certification No:
Firm is required for this project.
An EPA Lead -Safe Certified
Firm Name:
No EPA Lead -Safe Certified
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
and state that the above
representatives of this city
liabilities, judgements,
will comply with all non -point
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
construction,
harmless the
the applicant
Signature:
have read this application
and hereby authorize
City of Cupertino against
understands and
/1:///4.
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.