BLD-2020-1411BUILDING PERMIT
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10680 MINETTE DR Cupertino APN: 375 31 045 PERMIT NO: BLD-2020-1411
OWNER'S NAME: OWNER'S PHONE: Not Provided
CONTRACTOR: PACIFIC COAST ELECTRIC - HEATING & AIR, 2372 QUME DR STE A San Jose CONTRACTOR PHONE:
DATE ISSUED 9/21/2020 7:23:46 AM ISSUED BY: PhuongD VALUATION: $10000
JOB DESCRIPTION
NEW CONDENSER UNIT; (5) NEW MINI-SPLIT HEAD UNITS (BEDROOMS/LIVING/DINING/KITCHEN); UPGRADE EXISTING ELECTRICAL PANEL TO 100 AMP; INSTALL AFCI
BREAKERS
LICENSED CONTRACTOR DECLARATION
CONTRACTOR: PACIFIC COAST ELECTRIC -
HEATING & AIR
LICENSED CLASS:
B GENERAL BUILDING CONTRACTOR, C10
ELECTRICAL, C27 LANDSCAPING, C20 WARM-
AIR HEATING%2C VENTILATING AND AIR-
CONDITIONING
LICENSED NO: 863274 EXP DATE:
03/31/2021
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
I hereby affirm under penatly of perjury one of the following three declarations:
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, for the performance
of the 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 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 not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, l must
forthwith comply with such provisions or this permit shall be deemed revoked.
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534.
EPA LEAD-SAFE DISCLOSURE
An EPA Lead-Safe Certified Renovator will be responsible for this project.
Certified Firm Name: Firm Certification No:
No EPA Lead-Safe Certified Firm is required for this project.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work which this permit is issued (Section 3097, Civil
Code).
Yes No
Lender's Name: Lender's Address:
APPLICATION 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 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 City of Cupertino against liabilities, judgements, costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature:
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.
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