BLD-2021-1776BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 19500 PRUNERIDGE AVE APT 3310
CUPERTINO
APN: 316 06 059
PERMIT NO: BLD-2021-1776
OWNER'S NAME: IAC AT CUPERTINO LLC
OWNER'S PHONE: 619-410-3154
CONTRACTOR: AQUINAS HVAC INC, 1177 NORTH 15TH STREET SAN JOSE
CONTRACTOR PHONE:
DATE ISSUED 9/13/2021 3:37:26 PM
ISSUED BY: phuongd
VALUATION: $4000
JOB DESCRIPTION
2 TON A/C AND AIR HANDLER "LIKE FOR LIKE" CHANGE OUT
BLDG 3 UNIT 310 - CHANGE
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
07/31/2022
I hereby
force
I hereby
AQUINAS HVAC
CLASS:
WARM -AIR HEATING%2C VENTILATING
NO: 1042033
DATE:
affirm that I am licensed
and effect.
affirm under penatiy
I have and will maintain
for which this permit is
I have and will maintain
I certify that in the performance
laws of California.
with such provisions
INC
AND AIR-CONDITIONING
under the provisions of Chapter
of perjury one of the following three
a certificate of consent to self -insure
issued.
Worker's Compensation Insurance,
of the work for which this permit
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
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
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
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
Bolton & company
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
construction,
harmless the
the applicant
Signature:
have read
and hereby
City of Cupertino
understands
this
authorize
application and state that the above
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.