BLD-2020-1730BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10270 PARKWOOD DR APT 8 CUPERTINO
APN: 326 27 037
PERMIT NO: BLD-2020-1730
OWNER'S NAME: AVERY GLENBROOK LP
OWNER'S PHONE: 6509618330
JOB DESCRIPTION
FURNACE (SAME LOCATION); (N) WASHER/DRYER HOOK-UPS; REPLACE ELECTRICAL PANEL (70 AMP) (SAME LOCATION); (N) GAS LINE FOR
LIGHT (BATHROOM); (N) EXHAUST FAN (BATHROOM)
BLDG 6 UNIT # 8 - (N) AC UNIT; REPLACE
STOVE; REPLACE OUTLETS (10); REPLACE
LICENSED CONTRACTOR DECLARATION
C-4 BOILER%2C HOT WATER HEATING AND STEAM FITTING, C10 ELECTRICAL, C38 REFRIGERATION, C36 PLUMBING
of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LICENSED
C20
LICENSED
EXP
01/31/2022
I hereby
force
I hereby
THERMAL MECHANICAL
CLASS:
WARM -AIR HEATING%2C VENTILATING AND AIR-CONDITIONING,
NO: 256057
DATE:
affirm that I am licensed under the provisions
and effect.
affirm under penatiy of perjury one of the
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 be
following three
to self -insure
Insurance,
for which this
this certificate
deemed revoked.
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
V
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
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
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
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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
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Lender's
Name:
APPLICATION CERTIFICATION
and state
representatives
liabilities, judgements,
comply with
that the above
of this city
costs,
all non -point source
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
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 have read this application
construction, and hereby authorize
harmless the City of Cupertino against
the applicant understands and will
Signature:
fr;r.
.