BLD-2024-1991_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: 1174 ELMSFORD DR APN: 362 09 008
PERMIT NO: BLD-2024-1991
OWNER'S NAME: MA TONY KAM-MING AND FU JENNIFER JIE TRUSTE
OWNER'S PHONE:408-930-7078
CONTRACTOR: FUSE HVAC REFRIGERATION ELECTRICAL & PLUMBING
CONTRACTOR PHONE:408-721-2011
DATE ISSUED: SeD 5. 2024 ISSUED BY:Abby Ayende VALUATION: 2000
JOB DESCRIPTION: MAIN PANEL UPGRADE (200A) - SAME LOCATION
LICENSED CONTRACTOR'S DECLARATION:
NO: EXP DATE: 04/30/2025
1052421
7000) of Division 3 of the Business & Professions
CONTRACTOR:
I hereby affirm
Code and
FUSE HVAC
that I am
that my license
under penalty
REFRIGERATION ELECTRICAL & PLUMBING LICENSED CLASS: HEATINGC IR LICENSED
VENTILATING AND
AIR-CONDITIONING,
licensed under the provisions of Chapter 9 (commencing with Section
is in full force and effect.
of perjury one of the following three declarations:
and will maintain a certificate of consent to self -insure for Worker's Compensation,
Code, for the performance of the work for which this permit is issued.
as provided for by Section 3700 of the
I hereby affirm
❑ I have
Labor
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
of the work for which this permit is issued.
that in the performance of the work for which this permit is issued, I shall
subject to the Worker's Compensation laws of California. If, after making
Worker's Compensation provisions of the Labor Code, I must forthwith comply
revoked.
performance
❑ I certify
become
the
deemed
HAZARDOUS MATERIALS DISCLOSURE
& Safety Code, Sections 25505, 25533, and 25534. I
read the hazardous
compliance
hazardous
Management
25505, 25533,
materials requirements under Chapter 6.95 of the California Health
M I have
will maintain
handle
Air Quality
Sections
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,
material. Additionally, should I use equipment or devices which emit hazardous
District I will maintain compliance with the Cupertino Municipal Code,
and 25534.
EPA LEAD -SAFE DISCLOSURE
No:
Lead -Safe
Firm Name:
Lead -Safe
Certified Renovator will be responsible for this project.
Firm Certification
❑ An EPA
Certified
✓ No EPA
Certified Firm is required for this project.
CONSTRUCTION LENDING AGENCY
of the work which this permit is issued
I hereby affirm under penalty
(Section AV7, Civil Code).
of perjury that there is a construction lending agency for the performance
No
Yes El
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
laws relating
purposes.
accrue against
source regulations
Signature
I have read
to building
(We) agree to
said City
per the
this application and state that the above information is correct. I agree to comply
construction, and hereby authorize representatives of this city to enter upon
save indemnify and keep harmless the City of Cupertino against liabilities,
in consequence of the granting of this permit. Additionally, the applicant
Cupertino Municipal Code, Section 9.18.
Date Sep 5, 2024
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.