B-2018-0787 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0787
10041 PHAR LAP DR CUPERTINO,CA 95014-1111(326 18 027) AFFORDABLE WATER
HEATERS AND
PLUMBING INC
28358
CONSTELLATION RD
VALENCIA,CA 91355
OWNER'S NAME: DATE ISSUED:05/08/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C_36 Lip.#627368
Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Dale X BLDG_ELECT X PLUMB
09130/2018 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 1.rill force and effect. (N)50 GAL WATER HEATER- GARAGE
I hereby affirm under penalty of perjury one of the following two declarations:
r. 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.
,
Section 3700 of the Labor Code,for the performance of the work fur which this Sq.Ft Flom Area: Valuation:$1500.00
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 326 18 027
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 WORT{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.Cupertin2 uriicipal Code,Section 9.18.
��'"' -�, Issued by:Jasmine Archbold
Signaturef- Data 05/812018 Date:05/08/2018
OWNER-BUIL RE-ROOFS,
I hereby affirm let I am exempt from the Contractor Is License Low fmone of the All roofs shall be inspected prior to any roofing material being installed.Ifs roof is
following five reasons; installed without first obtaining au inspection,I agree to remove all new materials for
r. 1,as owner of the property,or my employees with wages as their sole inspection,
ompcnsation,will do the work,and the structure is not intended ce offered For
sale(Sec.7044,Business&Professions Code) Signature ofApplicanC
i. I,as owner of Ore property,am exclusively contracting with Licensed Date:05/8/2018
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
r. I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as in for by Section 3700 of the Labor Code,for the HAZARDOUS MATERIALS DISCLOSURE
performance ol'the work for which this permit is issued I have read the hazardous materials requirements under Chapter 6.95 of the -
z. 1 have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,aad 25534.f will
Section 3700 of the Labor Code,for the performance of the work for which thism aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Cuda,Section 25532(x)should I store or handle hazardous
a. I certify that in the performance of the work I'or which this permit is issued,I material.Addiflonally,should I use equipment or devices whlch emit hazardous
;'contanrinnnts as defined by the Bay At en Air Quality Fta ingt ment District 1
shall not employ any person in any manner se as to become subject to the
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Worker's Compensation laws of California.If,aner making this certificate of the Health&Safety Code,Sections 5505;f�553��d 25534.
exemption,I become subject to the Worker's Compensation provisions of4he �`
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked Owner authorized agent: -
Date:D51518l2018 ---'-
APPLICANT CERTIFICATION CONSTRUCTION LENDIN AT.ENCY
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 ARCHI'TECT'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.