BLD-2020-1390BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 6670 CLIFFORD CT Cupertino
APN: 369 24 052
PERMIT NO: BLD-2020-1390
CONTRACTOR: RANDO AAA HVAC INC, 1712 STONE AVE #1 SAN JOSE
CONTRACTOR PHONE:
DATE ISSUED 9/3/2020 8:32:22 AM
ISSUED BY: JASMINE ARCHBOLD
VALUATION: $10600
JOB DESCRIPTION
AND AC - SAME LOCATION
REPLACE FURNACE
LICENSED CONTRACTOR DECLARATION
VENTILATING AND AIR-CONDITIONING
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LICENSED
LICENSED
EXP
I hereby
force
I hereby
RANDO AAA HVAC INC
CLASS: C20 WARM -AIR HEATING%2C
NO: 768871
DATE: 09/30/2021
affirm that I am licensed under the
and effect.
affirm under penatiy of perjury one
I have and will maintain a certificate
for which this permit is issued.
I have and will maintain Worker's Compensation
I certify that in the performance of the
laws of California. If, after
with such provisions or this permit
of the following
of consent to self
Insurance,
work for which this
making this certificate
shall be deemed
three declarations:
-insure 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
revoked.
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
requirements under
9.12 and the
Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials
the Cupertino Municipal Code, Chapter
V
with
equipment
Municipal
Health & 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
will be responsible for this project.
Firm Certification No:
is required for this project.
An EPA Lead -Safe Certified Renovator
Firm Name:
No EPA Lead -Safe Certified Firm
Certified
v
CONSTRUCTION LENDING AGENCY
that there 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
No
V
Lender's
Name:
APPLICATION CERTIFICATION
and
representatives
liabilities,
comply
state that the
of this city
judgements,
with all non -point
above 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 I have read
construction, and hereby
harmless the City of
the applicant understands
Signature:
.