B-2017-1888 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1888
10590 STERLING BLVD CUPERTINO,CA 95014-3834(375 23 026) AFFORDABLE WATER
HEATERS AND
PLUMBING INC
28358
CONSTELLATION RD
VALENCIA,CA 91355
OWNER'S NAME: NIU CHENG Y AND KUO Y DATE ISSUED: 11/02/2017
OWNER'S PHONE:408-463-6250 PHONE NO:(855)345-9087
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC=36 Lic.#627368
Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Date X BLDG _ELECT X PLUMB
09/30/2018 _MECH XX 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. (N)40 GAL WATER HEATER-(OUTSIDE CLOSET)
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
63?
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$2700.00
permit is issued.
APPLICANT CERTIFICATION Occupancy APN Number: Type:
I certify that I have read this application and state that the above p y
information is correct.I agree to comply with all city and county ordinances 375 23 026
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 appli a derstands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source regulations pip
pertino Municipal Code,Section 9.18.
Issued by:Jasmine Archbold
Signature \ Date h/ , Date: 11/02/2017
1
RE-ROOFS:
I hereby affirm that' 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
1. I,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:
2, 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
2. I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 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 Code,Section 25532(a)should I store or handle hazardous
3. I certify that in the performance of the 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 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 Cupe •o Municipal Code,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code, a•r,s 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: j.r
be deemed revoked. Date: ��
APPLICANT CERTIFICATION a TR ulI►1►!_1!,►I
I certify that I have read this application and state that the above information is I hereby affirm that there is a c. uction 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 i- .ued(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.
CONSTRUCTION PERMIT APPLICATION
\r COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO CA 95014-3255 •
4,41-.1p,,
(408) 777-3228 • building@cupertino.org PEMIT#B-2..on - raeb
CUPERTINO REVS DEFF
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
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CONTACT NAME S:71. '� c� C Q E-MAIL I S ET DDRESS t `��J CITY,STAer-clu,Lo,fsc.,)),Y1
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❑SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES A TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED.
BATHROOM SF SF SF SF 0 DETACHED
EXISING ❑YES EICHLER ❑ YES SECOND STORY ADDITION DYES
FIRE SPRINKLERS❑NO 0 NO 0 NO
DWELLING SECOND DWELLING ❑yEs 0 ATTACHED DETACHED OTHER
UNITS A UNIT ADDITON: ❑NO S F
POOLS' ❑FIBERGLASS ❑VINYL-LINED 0 GUNITE ❑PREFABRICATED
POOL-SF SPA-5F I SPA ATTACHED OYES 0 NO I TOTAL-SF 1
CEIVED BY: ha_ I. T`�' / / LUr¢TION:
Commercial or Multi-Family Buildings with Public Swinmdue Pools requires Department ofEnpironmental Heath approval r IF
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i
RE-ROOF EXISTING ROOF TYPE: E BUILT-UP ROOF❑ASPHALT SHINGLES WOOD SHAKES NOOD SHINGLES❑TILE OTHER(SPEC I )
REMOVE/REPLACE 0 NO IF NO PLYWOOD 01" ❑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 O w000 SHAKES OWOOD SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF cof 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. 1
have read this application and the informa '• I have provided is correct. I have read the Description of Work and verify it is accurate. I agree
to comply with all applicable local or.ina s and state laws relating to building construction. I authori repr entatives of Cupertino to
enter the above-identified property • ins.- 'on purposes. I acknowledge and authorize all information ontail d o his application form
to be made available for public rec`T• i n
Signature of Applicant/Agent: Date: !� -
SUPPLEMENTAL INFORMATIO ,s UI ED
*New SFD/Second Dwelling Units , •,amily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
"Commercial Buildings: Provide a c.v.leted Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
"HOA-Provide a letter of approval from the Home Owner's Association
BldgApp_2017.doc revised 08/01/17