HomeMy WebLinkAboutBLD-2021-0517 PermitBUILDING PERMIT
CUPEttT INO
CITY HALL
10300 Torre Avenue • C soerrra. CA9$0I4-3255
PHONE 408.777-3718
4Vi W W. Ct:�ER"::O.O7G
IUILDING ADDRESS 7x18 SWWORD PL CIJPE3TTw0 APN:35932026
OWNERS NAME Anond Dos
CONTRACTOR: iCe $HOT BAY k Y A C SERVICE 603 WEAT)El GW IN LANE SAN iEAtO O
DATE ISSUED ,/27/2Q218:21 :01 AM �� ISSUED IT: hakym
JOB DESCRIPTION
To opc' r -e?:w •race end odd o ewAirCondt,orting
Lt_CENSED CON IRACTTOR
PERMIT NO: ILD•2021-0517 OWNS PHONE: Flat Pwsvded
CONIRACIOR PHONE
CONTRACTOR: ZiL. PAY H V A C SERVICE UCENSED CLASS: U U4ED No- T?7" EXP DAIS _
C20 WARM -AIR HEATING= 07/31/2021 '_____
1 hereby affirm that I am ricerned under the provisions of Chop (cammencMa with Secton 7000) of Division 3 d the Rusirtess L holessfans Code and that rrsy Rcerrse Ii In Iv1
lorce and efecl.
I hereby affirm under penally of perjury one of the following three declarations:
I have and wit manta:+ a ce•r''Cate of ccrsent to $elf-uM a for Workers Compensation. as provided for by Section 3706 of the Lobar Case. for the oerformatce of the work
fc• h,ch 11th pemtit a rued.
2I have and will maintain Workers Compensation Insurance, as pro ded for by Section 3706 of the Labor Code, for the performance of fie work for which Hilt permd[Ila issued
1 certfy that in the performance of the work for w4tich this aen t a owed. I shah not employ any person in any mariner so as to became subject to the Workw s Cer. mensotion
lows of Coftomia_ U. after ntaiang the certificate of euempfion. I become subject to the Workers Carnpensalien Provivara of the Labor Code. I mrgl foil -with comply vrth such
pre7itions or the penal that be deemed revoked
HAZARDOUS MATERIALS 615CL05URE---A -
havereact the hazcrdou3materiaYregy'remenhunder Chapter 6.95ofttie Cafform5a IeoOl, 1. Softy Code, Section,Iwillmoetancort�farce
v the �aemrino MunicippI Code. Chaorer 9. E2 and the HeoRh E. Safety Code. Section 255321o1 should I sore or handle hazardous moferiaL Add ,anatly. shosdd I use
equipment or devices which emit harcrdcus of contour non`s at defined by the Say Area Air Ouafty Mcrwgement Dehvct i wig Mart U compFance with the Cupertino hk uicipd
Coae. Chapter P12 cad the Hea'h b 5crely Code. Sections 25505.25533. and 255.ia-
SPA LEAD; SAFE DISCLOSURE
An EPA Lecd•Safe C Fed Renovator -3i be responswble fix lhs project.
Certified Fvas Name'
Per., is reamed For
Firm Cert:5cafion No.
I hereby oWe,. under penally of perjury tho! there, a corwIr cfior. lending agency far lire Derfonrtance o₹ the woric which fhc pemit it issued f5ecfiot 3097. CM') Code)
Yes. lid Na
Lenders Name'
Lenders Address: ; C
I certify that I have read Ike appfeation and state that the above nforrrofion is correct. I agree to comply with aR city and county ordinances and state tow relating to buidng
construction. and hereby authorize representatives of this city to enter upon the above mentioned property for nsoecSon pvposet, {Wet agree to save indemnify and keep
harmtets the City of Cuaerlim against fabitoes. ludgernents costs and eaperses which rm'a'y aacnre against said Ciy n consequence of the granting of this to nrit. Addfior ty,
the opptcanf understands and wit comply with on non -point sowce regulations per the ytraerfwt0 Myrnicioal Code. 5brfian 9.18.
Signofure
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