B-2018-1044 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1044
10507 MANZANITA CT CUPERTINO,CA 95014-6579(342 61 017) A B C COOLING
HEATING&
PLUMBING INC
HAYWARD,CA 94545
OWNER'S NAME:DO CALVIN T AND TRAN ALISSA T TRUSTEE DATE ISSUED:06/20/2018
OWNER'S PHONE: PHONE NO:(510)471-8181
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C20 Lie.#1017332
ContractorA B C COOLING HEATING&PLUMBING INC Date 08/31/2018 X BLDG—ELECT—PLUMB
I hereby affirm that I am licensed tinder the provisions of Chapter 9(commencing X MEsCH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect JOB DESCRIPTION:
REPLACE AC UNIT(SAME LOCATION)
I hereby affirm under penalty of perjury one of the£ollmving five declarations:
r. 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.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
.permit is issued. Sq.Ft Floor Area: Valuation:$8731.00
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above ane O
Number: Occupancy information is correct.I agree to comply with all city and county ordinances APN NumP y T'pr
and state laws relating to building construction,and hereby authorize 34261 017
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,casts,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature / ��Date 06-20-2018 Issued by:Kim Dunbar
Date:06/20/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
r. I,as ovvner ofthe property,or my employees with wages as their we installed without first obtaining an inspection,I agree to remove all new materials for
omp nation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. 1,as owner of the properly,am exclusively contracting with licensed Signature o£ApplicanC
contractors to construct the project(Sec.7044,Business&Professions Code). Date:06-20-2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 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 tris permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ an son in an to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
p y y per y manner so as J air contaminants as defined by the Bay Area Ah-Quality Management District I
Worker's Compensation laws of California,If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the health&Safety Code,Sections 25505/,25533,im 534-------
Labor Cade,I must forthwith comply with such provisions or this permit she]]
mvo
be deemed reked. Owner or authorized agent:
APPLICANT CERTIFICATION Data:06-20-2018
1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there Is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is Issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit.Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 06-20-2018 Professional