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BLD-2023-1839_SignedPermit.pdf ITY OF BUILDING PERMIT CITY HALL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 PHONE 408-777-3228 CUPERTINO WWW.CUPERTINO.ORG BUILDING ADDRESS: 10640 E ESTATES DR APN: 369 25 019 PERMIT NO: BLD-2023-1839 OWNER'S NAME: IDLE GRAYSON B TRUSTEE OWNER'S PHONE:408-409-5055 CONTRACTOR: FUSE HVAC REFRIGERATION ELECTRICAL & PLUMBING CONTRACTOR PHONE: DATE ISSUED: Aug 24. 2023 ISSUED BY:Abby Ayende VALUATION: 25000 JOB DESCRIPTION: INSTALL NEMA 15-60R EV CHARGER OUTLET (60 AMP); NEW SUB PANEL (125A) IN GARAGE LICENSED CONTRACTOR'S DECLARATION: NO: EXP DATE: 04/30/2025 1052421 7000) of Division 3 of the Business & Professions CONTRACTOR: FUSE HVAC REFRIGERATION ELECTRICAL & PLUMBING LICENSED CLASS: HEATINGC IR LICENSED VENTILATING AND AIR-CONDITIONING, I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section Code and that my license is in full force and effect. as provided for by Section 3700 of the I hereby affirm under penalty of perjury one of the following three declarations: ❑ I have and will maintain a certificate of consent to self -insure for Worker's Compensation, Labor Code, for the performance of the work for which this permit is issued. Section 3700 of the Labor Code, for the not employ any person in any manner so as to this certificate of exemption, I become subject to with such provisions or this permit shall be I. I have and will maintain Worker's Compensation Insurance, as provided for by performance of the work for which this permit is issued. ❑ I certify that in the performance of the work for which this permit is issued, I shall become subject to the Worker's Compensation laws of California. If, after making the Worker's Compensation provisions of the Labor Code, I must forthwith comply deemed revoked. HAZARDOUS MATERIALS DISCLOSURE & Safety Code, Sections 25505, 25533, and 25534. I M I have read the hazardous materials requirements under Chapter 6.95 of the California Health will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or air contaminants as defined by the Bay Area Chapter 9.12 and the Health & Safety Code, handle hazardous material. Additionally, should I use equipment or devices which emit hazardous Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Sections 25505, 25533, and 25534. EPA LEAD -SAFE DISCLOSURE No: ❑ An EPA Lead -Safe Certified Renovator will be responsible for this project. Certified Firm Name: Firm Certification ✓ No EPA Lead -Safe Certified Firm is required for this project. CONSTRUCTION LENDING AGENCY of the work which this permit is issued I hereby affirm under penalty of perjury that there is a construction lending agency for the performance (Section AV7, Civil Code). Yes El No Lender's Name: Lender's Address: APPLICATION CERTIFICATION with all city and county ordinances and state the above mentioned property for inspection judgements, costs, and expenses which may understands and will comply with all non -point I certify that I have read this application and state that the above information is correct. I agree to comply laws relating to building construction, and hereby authorize representatives of this city to enter upon purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, accrue against said City in consequence of the granting of this permit. Additionally, the applicant source regulations per the Cupertino Municipal Code, Section 9.18. Signature A� ��� Date Aug 24, 2023 EVERY PERMIT ISSUED SHALL BECOME INVALID UNLESS THE WORK ON THE SITE AUTHORIZED BY SUCH PERMIT IS COMMENCED WITHIN 365 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.