BLD-2020-1152BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10732 ALDERBROOK LN Cupertino
APN: 369 20 046
PERMIT NO: BLD-2020-1 152
CONTRACTOR: RELIABLE AIR MECHANICAL, 3680 CHARTER PARK DRIVE STE E SAN JOSE
CONTRACTOR PHONE:
DATE ISSUED 9/4/2020 4:07:39 PM
ISSUED BY: haleym
VALUATION: $12400
JOB DESCRIPTION
DUCTS
REPLACE FURNACE, A/C, AND
LICENSED CONTRACTOR DECLARATION
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
RELIABLE AIR MECHANICAL
CLASS: C20 WARM -AIR HEATING%2C
NO: 954400
DATE: 1 1 /30/2020
affirm that I am licensed
and effect.
affirm under penatly
I have and will maintain a
for which this permit is issued.
I have and will maintain
I certify that in the performance
laws of California.
with such provisions or
VENTILATING AND AIR-CONDITIONING
under the provisions of Chapter
of perjury one of the following three
certificate of consent to self -insure
Worker's Compensation Insurance,
of the work for which this permit
If, after making this certificate
this permit shall 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
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
6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements under Chapter
the Cupertino Municipal Code, Chapter 9.12 and the Health
le
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
25505, 25533, and 25534.
or devices which emit hazardous air contaminants as
Code, Chapter 9.12 and the Health & Safety Code, Sections
EPA LEAD -SAFE DISCLOSURE
Renovator will be responsible for this project.
Firm Certification No:
Firm is required for this project.
An EPA Lead -Safe Certified
Firm Name:
No EPA Lead -Safe Certified
Certified
v
CONSTRUCTION LENDING AGENCY
lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Lender's Address:
I hereby
affirm
under penalty of perjury that there is a construction
No
�YesV
Lender's
Name:
APPLICATION CERTIFICATION
and state that the above
representatives of this city to
against liabilities, judgements, costs,
will comply with all non -point source
information is correct. I agree to comply with all city and county ordinances and state laws relating to building
enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
regulations per the Cupertino Municipal Code, Section 9.18.
I certify that I
construction,
harmless the
the applicant
Signature:
.