B-2018-0990 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0990
7553 DUMAS DR CUPERTINO,CA 95014-4310(359 24 050) AIR&PLUMBING
SYSTEMS INC
LOS GATOS,CA 95032
OWNER'S NAME: DATE ISSUED:06/11/2018
OWNER'S PHONE: PHONE NO:(408)733-2000
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C20 Lie.#90[246
Contractor AIR&PLUMBING SYSTEMS INC Date 07/31!2019 X BLDG_ELECT_PLUMB
I hereby affirm that I am licensed am
tinder the provisions of Chapter 9(comencing X MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Cade and that my
license is to fall force and effect. JOB DESCRIPTION:
REPLACE FURNACE(SAME LOCATION);INSTALL NEW AC UNIT
I hereby affirm under penalty of perjury one of the following two dechurdlons: (BACK OF HOUSE)
2. 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:$13000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
Information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 359 24 050
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,costs,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 tmant al Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 6-11-20108 Issued by:Kim Dunbar
Data:06/I I/20 t S
OWNER-BI11fAER DECLARATION
I hereby affirm that I our exempt from the Contractor's License Law for one of the RF-ROOFS:
following two reasons: All roofs shall he inspected prior to any roofing material being installed.Ifs roof is
t. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,l agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(See.7044,Business&Professions Cade)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(See.7044,Business&Professions Cade), Date:6-11-20108
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. I have and will maintain a Certificate of Consent to self-insure£m'Worker's
Compensation,as provided for by Section 3700 of the Labor Cade,for the
Pat formance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. 1 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 offs,Labor Code,for the performance of the work for which this California Health&Safety Cade,Sections 25505,25533,and 25534.I will
permit is issued. maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and the
s. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Cade,Section 25532(x)should I score or handle hazardous
shall not employ any person in any manner so as to became subject to the material.Additionally,should I use equipment or devices which emit hazardous
Worker's Compensation laws of California.If,after making this certificate of air c maintain
nants pl ancedefftd h the Bay Area M Quality Management District I
P E will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 an ____._.
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,22 3Ya 9'4.
Labor Code,I must forthwith comply with such provisions or this permit shall �-
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Data:6-11-20108
I 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,casts,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-paint source regulations per the Cupertino Municipal ARCHITECT'S DECi.ARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Si nature Date 6-11-20108 Licensed
9 Professional