B-2017-1517 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:.B-2017-1517
19711 DRAKE DR CUPERTINO,CA 95014-2435(316 32 035) AFFORDABLE WATER
HEATERS AND
PLUMBING INC
28358
CONSTELLATION RD
VALENCIA,CA 91355
OWNER'S NAME: CHEN DEREKAAND KAREN ANN TRUSTEE DATE ISSUED:09/08/2017
OWNER'S PHONE:408-504-9467 PHONE NO:(855)345-9087
_.. _0 .. lit: 1 p 9. BUILDING PERMIT INFO:
License Class C36 Lin.#627368
Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Date X BLDG _ELECT X PLUMB
09/30/2018 _MECH X RESIDENTIAL_COMMERCIAL
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 JOB DESCRIPTION:
license is in full force and effect. ' REPLACE WATER HEATER(40 GAL)SAME LOCATION
I hereby affirm under penalty of perjury one of the following two declarations:
1. 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 Sq.Ft Floor Area: Valuation:$1500.00.
permit is issued.
'' APPLICANT CERTIFICATION APN Number: Occupancy Type:
I certify that I have read this application and state that the.above 316 32 035
information is correct.I agree to comply with all city and county ordinances
and state laws relating to building construction,and hereby authorize
representatives of this cityto enter upon the above mentioned property for
inspection purposes.I(Vlle);agree to save indemnify and keep harmless the PERMIT EXPIRES IF WORK IS NOT STARTED
City of Cuperti o against liabilities,judgments,costs, ramex penses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue aginst s.'• City in consequence of the granting of this permit.
Additionally,th--.1-.- pt understands and will comply,with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source regulati.,s•- Cupertino Municipal Code,Section 9.18.
Issued by:Kim Dunbar
Signatu, Date 09-8-2017 Date:09/08/2017
AI ,
RE-ROOFS:
I hereby affir lei that am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofmg material being installed..If a roof is
following two r•ason:
/ CONSTRUCTION PERMIT APPLICATION
\elk/ COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
t,, 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
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CUPERTINO REV# DEF#
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❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. 'EP ❑RE-ROOF ['SWIMMING POOL/SPA
PROJECT ADDRESS i /°� ( ( �r c f �?! b ri�� APN k 3/(0 -
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CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME (/ VOLICENSE NUMBER LICENSE TYPE
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DECRIPTON \ ' `V/ vI VC
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ItaINGCE-FAMILY/DUPLEX ^0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I
E (STING USE EXISTING SF NEW'FLOOR SF PORCH SF DECK SF DEMO SF STORIES I TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
EXISING 0 YES EICHLER ❑YES SECOND STORY ADDITION 0 YES
FIRE SPRINKLERS 0 NO . . '❑ NO 0 NO
DWELLING SECONDDWELLING'I❑'YES ❑ATTACHED❑DETACHED OTHER
UNITS tt • UNIT ADDITON: ' ❑NO S F
•
POOLSL ❑FIBERGLASS; ❑VINYL-LINED ❑GUNITE '❑PREFABRICATED
• POOL-SF_ - SPA-5F , I S•PA ATTACHED AYES 0 NO I TOTAL-SF ,
REC �J TO,Tg VA ATION:
Commercial or Multi-Familu Buildings with Public Swimming Pools requires Department of Environmental Heath approval /
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RE-RO OFI EXISTING ROOF TYPE:.❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES Q WOOD SHINGLES ElTILE OTHER(SPECIFY)
REMOVE/REPLACED NO: IF NO PLYWOOD ❑1/2" El 3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
❑YES A OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER •12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER
*Provide a signed copy!ofthe Cupertino's Tear-Off Policy SF aof SQUARES
By my signature below:I,certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I
have read this application and the information I .ave provided is correct. I have read the Description of Work and verify it is accurate. I agree
to comply with all applicable local ordi •.nces.dtate laws relating to building construction. I authorize repr sentatives of Cupertino to
enter the above-identified property for ' .pectio . � poses. I acknowledge and authorize all informati9 c nt ii ed this application form
to;be made available'for public record. dik
Signature of Applicant/Agent: A Date:
SUPPLEMENTAL INFORMATIO` RE A UI r ED
*New SFD/Second Dwelling Units/Mul famil, Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a co 1.lete. Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
' *Copy of Planning Approval Letter or ,eeti'g with Planning prior to submittal of Building Permit application.
*HOA-Provide a letter of approval from the Home Owner's Association
•
BldgApp_20/7.doc revised 08/01/17
AFFORDABLE
•
WATER
AND PLUMBING INC .
March 2017
LETTER OF AUTHORIZATION
"I,undersigned, give permission to accept any of the signatures that appear below, on a
permit being issued, in lieu of my signature at the counter. I hereby certify under penalty
of perjury,that I will comply with all declarations and agreements on the permit, which
bears my signature or my representative signature, and as required by the city."
The following authorized representatives have my permission to sign and take receipt of
construction permits in the name of my company:
Jorge Becerra
Leonce Roux ear,-
Contractor Name Contractor Signature Date
Contractor Information:
Affordable Water.Heaters &Plumbing,Inc. Phone: 855-345-9048.
28358 Constellation Road#698
Valencia, CA 91355
Contractors State License Number: 627368- Class C 36
Workers Comp Insurance:
Insurance Company of the West WSA503249701 Exp. 1.1.18
See Attached Calif .....
Acknowledgment
nee Attdhed.California
Acknowledgment
28358 Constellation Road, Suite 698 • Valencia, CA 91355
(855) 345-9048 • FAX: (661) 259-9556 www.waterheatersandplumbing.com
CA State Lic#627368