B-2018-1154 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1154
10285 PARKWOOD DR APT 7 CUPERTINO,CA(32627036) THERMAL
MECHANICAL
SANTA CLARA,CA
95054
OWNER'S NAME:Avery Gleabrook Lp DATE ISSUED:07/13/2018
OWNER'S PHONE: PHONE NO:(408)988.8744
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO;
License Class C4,C10,C20.C36..&C38 LIC.#256057
Contractor THERMAL MECHANICAL Date o1/31/2020 X BLDG X ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in fill force and effect. JOB DESCRIPTION;
BLDG 9 UNIT#7-(N)AC UNIT;REPLACE FURNACE(SAME
I hereby offirm under penalty of perjury one of the Following two declarations: LOCATION);(N)WASHER/DRYER HOOK-UPS;REPLACE
i. I have and will maintain a certificate of consent to self-insure for Worker's ELECTRICAL PANEL(70 AMP)(SAME LOCATION);(N)GAS LINE
Compensation,as provided for by Section 3700 of the Labor Code,for the FOR STOVE;REPLACE OUTLETS(10);REPLACE LIGHT
performance of the work for which this permit is issued. (BATHROOM);(N)EXHAUST FAN(BATHROOM)
z. 1 have and will maintain Worker's Compensation Insurance,as provided for by
action 3700 of the Labor Code,for the performance of the work for which this
permit is issued Sq.Ft Floor Area: Valuation:$20000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occup ri cy Type:
and state laws relating to building construction,and hereby authorize 326 27 036
representatives of this city to enter upon the above mentioned property for
inspection purposes.(We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will wyth all non-point
source regulations er the Cupertino Munici ddon 9.16. 180 DAYS FROM LAST CALLED INSPECTION.
Signature ate 7-13-2018 Issued by:Kim Dunbar
Date:07/13/2018
O�YNF,I;-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law far one of theRE-ROOFS•
fallowing two reasons: All roofs shall be inspected prior to city roofing material being installed.If a roof is
r. 1,as owner of the property,or my employeds with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the sit ucur a is not intended or offered for inspection.
side(Sec,7044,Business&Professions Code)
z I,as owner of the property,am exclusively contracting with licensed Signature ofAppllcutt;
contractors to construct the project(Sec.7044,Business&Professions Cade). Date;7-13-2018
I hereby affirm under penalty of perjury one of the following three declarations; ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,Far the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. 1 have and will maintain Worker's Compensation Insurance,as provided forby I have rend fine hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Cade,Section 25532(x)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should I use equipment o•devices which emit hazardous
Worker's Compensation laws of California.If,after making this certificate of contaminants as defined by the Bay AreaAh'Quality Mamagemen istriet 1
will maintain comptinnce with the Cupertino Municipal Cade, and
exemption,f become subject to the Worker's Compensation provisions of the the Health&Safety Cod Sections 25505,25533 nd 2 4.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked, Owner or authorized agent:
APPLICANT CERTIFICATION Date;7-13-2018
I certify that I have read this application and State that the above information Is CONSTRUCTION LENDING AGENCY
correct.I agree to complywith all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is Issued(Sec.3097,Civ C,)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,casts,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit.Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Data 7-13-2018 Professional