B-2016-1924 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1924
10527 MANZANITA CT CUPERTINO,CA 95014-6579(342 61 019) AFFORDABLE WATER
HEATERS AND
PLUMBING INC
28358
CONSTELLATION RD
VALENCIA,CA 91355
OWNER'S NAME: ZORKO OLEG AND SNEJANA DATE ISSUED:05/10/2016
OWNER'S PHONE:408 480 8078 PxoNE No:(855)345-9087
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class PLUMBING Lic.4627368
Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Date X BLDG —ELECT—PLUMB
09/30/2016 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 50 GALLON WATER HEATER
I hereby affirm under penalty of perjury one of the following two declarations:
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,for the.
performance of the work for which this permit is issued.
x. 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:$1750.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above APN Number: Occupancy Type:
information is correct.I agree to comply with all city and county ordinances 342 61 019
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 180 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:Patricia Garcia
Signature Date Date:05/10/2016
OWNER-BUILDER 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 roofing material being installed.If a roof is
following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
t. 1,as owner of the 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 of the property,am exclusively contracting with licensed Date:
contractors to construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
1. 1 have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I 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 Code,Section 25532(a)should I store or handle hazardous
3. I certify that in the performance of the work for which this pennit is issued,I material.Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the 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
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Sections 25505,25533,and 25534.
exemption,I become subject to the Worker's Compensation provisions of the
Labor Code,.I must forthwith comply with such provisions or this permit shall Owner or authorized agent: ,
be deemed revoked. Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application 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,Civ 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
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records.
Code,Section 9.18.
0511012016 13:30 (FAX) P.0021004
MAY/10/2016/TUE 01 :46 PM City of Cupertino FAX No. 408 777 3333 P. 003
05110/2016 11:08 (FAX) P.0011002
GENERAL PERMIT APPLICATION E
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
U:P ERTi Nd (408)777-3228-FAX(408)777-3333-Dui1QinD(a pupertino.ora M Is(;
EdLUMON0 MECHANICAL ❑ELECTRICAL ❑MISCELLANP//�1OUS —Zb _ 004
[S'MEETA13DRESS %.-
ROICCT ADDRI'SfrnbiO c n x a 11 APN u6 1 ,t'1(�
WNORNAMO J ' PNONE EMAIL llb_1
Q 7-2 k1Co. � D
CITY,STAT¢,ZIP fAX
1 ,S
CONTACT NAME PHONC EMAIL
Ie l Qo ass . - 9OP'� Pe),n-iI of A, �•
STREErADDRESS crTv STATE.ZIPS , Pax
a 1?3 S i,• co c o l 0 01 - c',
E3owwm 13owNER-BUILDER ❑OWNCRAcwr 11 cotiflLACTOR ONTRACTOR ACONT ❑ ARCHITECT 13 WOW= ❑ Prvr"FER E3 TENANT
CONTRACTOR NAMEa Q O LICENSE'NUMOOR ,�� �( LICENSHTYPE BUS.LIC0
a
CO l' NYNAME EMAIL FAX
of e e e ,P
wMETA DORESS i CITY.STATE,ZIP WINS
ARCHITCGT/ENCINPPANAIdE
LICENSENUMBER BUS.LIC N
COMPArrY NAME• E-MAIL FAX
STREET AODUSS CrIN,STATE.ZIP PHONE
USE OF SroorDUPLEX ❑ MULTI-FAMILY PR016t7WlV1LOLANOE3YES PROJECT IN ❑YEs ISTHEBLDOAN ❑YES
BUI OOS1O: 0 Ol0tURCIAL UBIIA14lWl U'ACL'ARPA [3 NO PLOOOZONE ❑No EICIILF10IOME7 ❑ ND
DESCRIPTION OF WORK
o cA j a P r e- r^
TOTAL VALUATION: `+'` zr1�.-,IF ,x LI
S I -_•—
Dy.my signature below,l cenify to each of Ilio following I am the property owner or authorized agent to net on(be properly owner's beholE i have read this '
uppliealiull and ilio information 1 have pravidod is eormct. I lwvo read the Doscriplion of Work and verify it is occurute. 1 agree to comply with all applicable locul
ordinances and state laws relating to building ImAsiruction. 1 aulhoriu representatives of Cupertino to enter ttus above-identilied mperty for inspection purposes.
SignalumofApplicant/Aaenu bate: cs o
ax
SUPPLE TALINFO AT10NREQUIRED
,1•fEPA,li rrApp_2011.doc Pevised 06/21/11