BLD-2020-1042BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 21629 TERRACE DR Cupertino
APN: 356 20 019
PERMIT NO: BLD-2020-1042
CONTRACTOR:
ON -TIME AIR CONDITIONING & HEATING INC, 7020 COMMERCE DR PLEASANTON
CONTRACTOR PHONE:
DATE ISSUED 7/15/2020 3:07:39 PM
ISSUED BY: haleym
VALUATION: $27397
JOB DESCRIPTION
REPLACE A/C UNIT IN THE BACK YARD; DUCT REPLACEMENT
LICENSED CONTRACTOR DECLARATION
C36 PLUMBING, C-2 INSULATION AND ACOUSTICAL
of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
ON -TIME
LICENSED
C20
LICENSED
817040
EXP
09/30/2021
I hereby
force
I hereby
AIR CONDITIONING & HEATING INC
CLASS:
WARM -AIR HEATING%2C VENTILATING AND AIR-CONDITIONING,
NO:
DATE:
affirm that I am licensed under the provisions
and effect.
affirm under penatly of perjury one of
I have and will maintain a certificate of consent
for which this permit is issued.
I have and will maintain Worker's Compensation
I certify that in the performance of the work
laws of California. If, after making
with such provisions or this permit shall
the following three
to self -insure
Insurance,
for which this
this certificate
be deemed revoked.
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's
of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
under
and the
Health
Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements
the Cupertino Municipal Code, Chapter 9.12
V
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
Sections 25505, 25533, and 25534.
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety Code,
EPA LEAD -SAFE DISCLOSURE
be responsible for this project.
Firm Certification No:
for this project.
An EPA Lead -Safe Certified Renovator will
Firm Name:
No EPA Lead -Safe Certified Firm is required
Certified
v
CONSTRUCTION LENDING AGENCY
is a construction lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Lender's Address:
I hereby
Yes
affirm
under penalty of perjury that there
No
V
Lender's
Name:
APPLICATION CERTIFICATION
that the
of this
judgements,
all non -point
above
city
information is correct. I agree to comply with all city and county ordinances and state laws relating to building
to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
source regulations per the Cupertino Municipal Code, Section 9.18.
I certify that
construction,
harmless
the applicant
Signature:
I
the
have read this application and state
and hereby authorize representatives
City of Cupertino against liabilities,
understands and will comply with
days after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period
of 365 days after the time the work is commenced.