B-2018-0563 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0563
1115 KENTWOOD AVE CUPERTINO,CA 95014-5807(359 31 005) BAYHILL HEAT&AIR
SAN MATED,CA
94402-1835
OWNER'S NAME:TAN YIZHI AND JUN DATE ISSUED:04/06/2018
OWNER'S PHONE: PHONE NO:(650)212-7600
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Q212 Lic.#917996 X BLDG_ELECT_PLUMB
Contractor BAYHILL HEAT&AIR Date 06/30/2018
1 hereby affirm that I am licensed render the provisions of Chapter 9(commencing X MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)M Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE FURNACE SAME LOCATION/NEW AC UNIT
I hereby affirm under penalty of perjury one of the following two declarations: (BACKYARD)
t, 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 Flom Area: Valuation:$11800.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above ane O
Number: ccn
information is correct.I agree to comply with all city and county ordinances APN p' y'I�pr:
and slate laws relating to building construction,and hereby authorize 35931 005
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 WORI{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 appliund
c nt erstands and will comply with all non-point
source regulations p Cu ngtoo-Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature_ Date 04-06-2018 Issued by:Kim Dunbar
' Date:04/06/2018
OWNER-BUI DER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two rensaus: All roofs shall be inspected prior to any roofing material being installed.If a roefis
t. I,as owner of the property,or my employees with wages as their sole ustalled without first obtaining an inspection,I agree to remove all new materials far
compensation,will do file work,and the struotme is not intended or of fed for inspection.
sale(Sec.7044,Business&Professions Code)
2. 1,as owner of the property,air exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code), Date:04-06-2018
I 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 ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by 1 have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 o£the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued, maintain compliance with tine Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I store or handle hazardous
shall not employ son in an manner so as to become subject to the material.Additionally,should I use equipment or devices which craft hazardous
p y any per y ma J air contaminants as defined by the Buy Area Air Quality Management District I
Worker's Compensation laws of California.If,after making this certificate ofwill maintain compliance with the Cnpertfno Mury'yf mI Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 2 S"6,25534.
Labor Code,1 most forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent: _
APPLICANT CERTIFICATION Date:04-06-2018
1 certify that I have read this application and state that the above Information Is CONSTRUCTION l 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 04-06-2018 professional