B-2018-1353 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1353
10180 BYERLY CT CUPERTINO,CA 95014-5647(342 12 086) A R S AMERICAN
RESIDENTIAL
SERVICES OF
CALIFORNIA INC
MEMPHIS,TN 38120
OWNER'S NAME: DATE ISSUED:09/10/2018
OWNER'S PHONE:408-893-0050 PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C20 Lic.#742039
Contractor 18 AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC X BLDG—ELECT_PLUMB
Date 10/3112019 X MECH X RESIDENTIAL_COMMERCIAL
I hereby affirm that I am licensed order the provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my SOB DESCRIPTION:
license is in full force and effect. REPLACE FURNACE LIKE FOR LIKE SAME LOCATION
I hereby affirm under penalty of perjury one of the following two declarations:
1. 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.
Section 3700 of the Labor Code,for the performance or the work for which this Sq.Ft Floor Area: Valuation:$7570.80
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above APN Number: Occupancy Type:
Information is correct.I agree to comply with all city and county ordinances 342 12 086
and state laws relating to building construction,and hereby authorize
representatives of(his city to enter upon the above mentioned property for A
inspection purposes. (We)agree to save indemnify and keep harmless the PERMIT EXPIRES IF WORT{IS NOT STARTED
City of Cupertino against liabilities,judgments,costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue against said City In consequence of the granting of this permit.
Additionally,the applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source regulations per the Cupertino Municipal Code,Section 9.18.
/ Issued by:Kim Dunbm'
Signature " � Date 9-10-2018 Date:08/10/2018
OWNER-BUILDER DECLARATION RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law far one of'the All root's shall be inspected prior to any roofing material being installed,Its roof is
following two reasons: installed without first obtaining an nspection,1 agree to remove all now materials for
t. I,as owner of the property,or my employees with wages as their sole inspection.
compensation,will do the work,and the stncmre is not intended or offered for
sale(Sec.7044,Business&Professions Code) Signature ofApplicanh
Z I,as owner of the property,am exclusively contracting with licensed Date: -19 0-2018
contractors to construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the fallowing three declarations: AL1,ROOF COVERINGS TO 13E CLASS"A"OR BETTER
a I have and will maintain a Certificate of Consent to self-insane for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the HAZARDOUS MATERIALS DISCLOSURE
performance ofdre work for which this permit is issued I Imve read the hazardous materials regWre cuts order Chapter 6.95 of the
z. I have and will maintain Worker's Compensation Insurance,as provided for by Calif.,-,,[.Health&Safety Code,Sections 25505,25533,and 25534.I will
Section 3700 ofthe Labor Code,for the performance of the work for which thism aintain compliance with Om Cupertino Municipal Code,Chapter 9.12 and the
Perrot is issued, Health&Safety Code,Section 25532(a)should I store m•handle hazmdous
s. 1 certify that in the performance of the work for which this permit is issued,I material.Additionally,should I use equipment or devices which emir hazardous
shall not employ in ner to become subject to the air contanunants as defined by the Bay Area Air Quality Management District I
p y any person any°1a° so as will momfivi,compliance with the Cupertino Municipal Code,Chapter 9.12 and
Worker's Compensation laws of California.If,after making this certificate of the Health&Safety Code,Sections 25505,25533,and 25534.
exemption,I become subject to the Worker's Compensation provisions of the
Labor Code,I must forthwith comply witli such provisions or this permit shall Owner or authorized agent:
be deemed revoked. Date:9-10-2018
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information Is I hereby affirm that there Is a construction lending agency for the performance
correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit Is issued(Sec.3097,Clv C.)
relating to building construction,and hereby authorize representatives of this city Lender's Name
to enter upon the above mentioned properly for inspection purposes. (We)agree
to save Indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address
judgments,costs,and expenses which may accrue against said City In
consequence of the granting of this permit.Additionally,the applicant understands ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records.
Code,Section 9.18.
Licensed