B-2018-0574 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0574
19826 BEEKMAN PL CUPERTINO,CA 95014-2451(316.30 125) AIR QUALITY
HEATING&AIR
CONDITIONING
INCORPORATED
SAN JOSE,CA 95126
OWNER'S NAME: DATE ISSUED:04/09/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C_20 Lic.#7677 9446
Contractor AIR QUALITY HEATING&AIR CONDITIONING INCORPORATED XBLDG_ELECT_PLUMB
Date 06/30/2019 X MECH X RESIDENTIAL_COMMERCIAL
I hereby affirm that 1 am licensed under the provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my JOB DESCRIPTION:
license Is in fall force and effect. REPLACE FURNACE AND AC UNIT-SAME LOCATION
1 hereby affirm under penalty of perJury one ofthe following two declarations:
1. 1 have and will maintains certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 ofthe Labor Code,for the
performance ofthe work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance ofthe work for which this Sq.Ft Floor Area: Valuation:$8180.00
permit is issued.
APPLICANT CERTIFICATION O
Number: ccunavy
I certify that I have read this application and state that the above ppN NumP Type'
information is correct.I agree to comply with all city and county ordinances 316 30 125
and state laws relating to building construction,and hereby authorize
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the PERMIT EXPIRES IF WORK IS NOT STARTED
City of Cupertino against liabilities,judgments,costs,and expenses which WITHIN 1S0 DAYS OF PERMIT ISSUANCE OR
may accrue against said City in consequence of the granting of this permit,
Additionally,the applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source regulations per the Cupertino Municipal Code,Section 9.18.
Issued by:Jasmine Archbald
Signature Date 04/09/2018 Date:04/09/2018
OWN EI UILUEIt DECLARATION RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any rooting material being installed.He roof is
following two reasons: installed without first obtaining an inspection,I agave to remove all new materials for
r. I,as owner ofthe property,or my employees with wages as their sole inspection.
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code) Signature of Applicant:
z. I,as owner ofthe property,am exclusively contracting with licensed Date:04/09/2018
contractors to construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty oiperjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 1 have and will maintain a Ccrtiticale of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 ofthe Labm Cade,for the HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requh counts under Chapter 6.95 of the
z. I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,-1255X 1 will
Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued, Health&Safety Cod,,Section 25532(.)should 1 stm-e or lumdle hozardons
3. 1 certify that in the performance ofthe work for which this permit is issued,I material.Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any moaner so as to become subject to the air contaminants as defined by the Bay Area Alr Quality Management District I
Worker's Compensation pe laws of California.If,after become
this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
P g the Health&Safety Cade,Sections 2550 25533,and 25534.
exemption,Ibecome subject to the Worker's Compensation provisions ofthe
Labor Code,I must forthwith comply with such provisions or this permit shall Owner or authorized agent:
be deemed revoked. Date:04109/111111
APLICANTCERTIFICATION CONSTR C IO END
ING his a� AGENCY
I certify that I have read Iplication and state that the above Information is I hereby affirm that there is a construction lending agency for the performance
correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(Sec,3097,Clv C.)
relating to building construction,and hereby authorize representatives of this city Lender's Name
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Address
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit.Additionally,the applicant understands ARCHITECT'S BE
CLARA'PION
and will complywith all non-point source regulations per the Cupertino Municipal I understand myplans shall be used as public records.
Code,Section 9.18.
Licensed