BLD-2021-1529BUILDING PERMIT
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10255 PARKWOOD DR APT 7 CUPERTINO
APN: 326 27 036
PERMIT NO: BLD-2021-1529
OWNER'S NAME: AVERY GLENBROOK LP
OWNER'S PHONE: 6509618330
CONTRACTOR: THERMAL MECHANICAL, 425 ALDO AVE SANTA CLARA
CONTRACTOR PHONE:
DATE ISSUED 9/1/2021 2:27:29 PM
ISSUED BY: haleym
VALUATION: $10000
JOB DESCRIPTION
(SAME LOCATION); (N) WASHER/DRYER HOOK-UPS; REPLACE ELECTRICAL PANEL (70 AMP) (SAME LOCATION); (N) GAS LINE FOR
(BATHROOM); (N) EXHAUST FAN (BATHROOM)
BLDG 42 UNIT # 7 - (N) AC UNIT; REPLACE FURNACE
STOVE; REPLACE OUTLETS (10); REPLACE LIGHT
LICENSED CONTRACTOR DECLARATION
C-4 BOILER%2C HOT WATER HEATING AND STEAM FITTING, C10 ELECTRICAL, C38 REFRIGERATION, C36 PLUMBING
of 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
01/31/2022
I hereby
force
I hereby
THERMAL MECHANICAL
CLASS:
WARM -AIR HEATING%2C VENTILATING AND AIR-CONDITIONING,
NO: 256057
DATE:
affirm that I am licensed under the provisions
and effect.
affirm under penatiy of perjury one of
I have and will maintain a certificate of
for which this permit is issued.
I have and will maintain Worker's Compensation
I certify that in the performance of the work
laws of California. If, after making
with such provisions or this permit shall
the following three
consent to self -insure
Insurance,
for which this permit
this certificate
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
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
under Chapter
9.12 and the Health
6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements
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 as
Code, Chapter 9.12 and the Health & Safety Code, Sections
EPA LEAD -SAFE DISCLOSURE
be responsible for this project.
Firm Certification No:
for this project.
An EPA Lead -Safe Certified Renovator will
Firm Name:
No EPA Lead -Safe Certified Firm is required
Certified
V
CONSTRUCTION LENDING AGENCY
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 that there
No
V
Lender's
Name:
APPLICATION CERTIFICATION
state that the above
of this city to
judgements, costs,
all non -point source
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
construction, and
harmless the City
the applicant
Signature:
read this application and
hereby authorize representatives
of Cupertino against liabilities,
understands and will comply with
/
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.