The URL can be used to link to this page

12070003 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1155 STAFFORD DR CONTRACTOR:ABC COOLING&HEATING PERMIT NO: 12070003 OWNER'S NAME: III 17ENG AND WANG Yl 31845 HAYMAN ST DATE ISSUED:07/02/2012 OWNER'S PHONE: 4082552885 HALYARD,CA 97537 PHONE.NO:(510)471-8181 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class ZO Lie:#— 382333- r r r /^ - MECH RESIDENTIAL COMMERCIAL Contractor &C (.AD11\ r4 t I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALLATION OF NEW A/C AND 230 VOLT CIRCUIT ' (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 penalty of perjury one of the following two declarations: 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. 1 have and will maintain Worker's Compensation Insurance,as provided for by Sq.FI Floor Area: Valuation:$4865 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36206022.00 Occupancy Type: APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is correct.l agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City ofCupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply- �� ! with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: RG Date: 7 L 9.18. Signature �� "' RE-ROOFS: ❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed If a roof is installed without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation. Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penally of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE: declaralions: 1 have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safely Code.Sections 25505,25533,and 25533. 1 will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should 1 store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the.Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District 1 will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 1lealth&Safety Code,Sections 25505,25533,and 25537. 1 certify that in the performance of the work for which this permit is issued,)shall not employ any person in any manner so as to become subject to the Worker's Ow/n�Sj roL_authortz age - Compensation laws of California. If,alter tanking this certificate of exemption,I I4��r .!//i Date: —z—12 become subject to the Worker's Compensation provisions of the Labor Code,1 must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name correct 1 agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accme against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records, with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date Home • =C Ml MD JUL 02 2012 Dff: J Cl • -M �. t C �l G �ti N r ink OFFICE � v i GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333• building a(,.cuoer ino.org MISC PLUMBING FCIIANICAL IILECrR ICA 1. ^ MISCELLANEOl1S 1'ROJF(FADDRE.SS \\/`� _ \ ^� APNn )- g 010 — v / Z OWNERNAME 1�✓ - \J coon F-MAII. c� STRFFrADORI-SS CITV, STATE.%IP FAX Ct 0N'I'ACI' NAME ` +r • Y\ P�1l,L'l 1� \ \ IFSLVL `K �rp`l.l `\W\\Yti STRr.P]',\DDRESS \ \V arY.`SSTnI TF. '/.IPrt� �/( L(S 1�\ULO\ ❑ O\YNER ❑ MNRR-Irt11LDER ❑ OWNER AGENT ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCIIITECT ❑ ENGINEER ❑ Ini 1!L0I1IiR ❑ 1119:\SI ('ON'TRACIOHS,\\Ili IICE'$- 'U 6E LICIiNSIi IN' O ItUS.I'll's COXIPANN'SAW. E-MA sIRI:FrnuDHl:ss�( � �SL�S AR(-1111 Y.(l/FN(iXF.ER NANIli LICENSE NUMBER BUS.LIC n (O\IPANNNAME F.-\I,\II, IAN S'I'REIi'r ADDHr.SS CITY.STATE,/.I P I'I IONI[ ISI:O1= ❑SYDur DUPLEN (1^1ULTI-FAMILY PROIECTINWILDLAND ❑ N'Es PROM CT IS ❑ N'ES IN TIIE IILDO AN ❑ N'ES BUILDING. ❑('ONI\IIiRC I Al. URDAI INTERFA('E ARF A $ n0 FLOOD ZONE. 'O EIC I ILL'R I AIME" NO DESCRIPTION Of AA'ORR TUI AI.\'AL(LYIION: �,1IT1/L-.- uO RECEIVED BY: N 13N my signature below,I ecei l.'to each of the following: I am the property owner or authorized agent to act on the properly owner's hcIn,l f. I limc read Ibis application and the in I'onnalion I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply it If all applicable Ioca1 ordinances and slate law.refuting ID bu in$Lconstruc/tiion. I nut ori'zc rcpresenlalives ofCuperlino to cntcr the:ItRlvc.identified propene for inspection purposes. Signature ol'AppGr:anl/Agent: ,� Ualc: — z_ /2 SUPPLEMENTAL INFORMA'T'ION REQUIRED OFFICE rseoNt.v ❑ OVER-THE-COUNTER 6 r^ ❑ EXPRESS L U ❑ STANDARD V ❑ L\RGr: 6 ❑ MAJOR ,I/EPAIiecapp_201 Ldoc revised 000 2111/