B-2017-0237CITY OF CUPERTINO BUILDING PERMIT
BUH.DINGADDRESS: CONTRACTOR: PERMIT NO: 'B-2017-0237
20586 MURANO CIR CUPERTINO, CA 95014-1755 (366 58 008) PAYLESS WATER
HEATERS &
PLUMBING INC
VALENCIA, CA 91355
OWNER'S NAME: JEONG CHEOL JOO AND SHIM HYEWON I DATE ISSUED: 02/08/2017
OWNER'S PHONE: 201-835-5612 PHONE NO: (661) 775-2979
License Class C-3¢ Lic. #836216
Contractor PAYLESS WATER HEATERS & PLUMBING INC Date 08/31/2018
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 penalty of perjury one of the following two declarations:
m. 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.
! z 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.
APPLICANT 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 inderr)nify'and keep harmless the
City of Cupertino against liabilities, judgmepts;
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION,
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildinaecupertino.or
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Byinysignature below, Icer-d,toeach ofthe following: I am the propert ommer or authorized a!gent to act on the p perm ownpeq behalf. I have read this
application and the information I have provided is correct. I have re!pbeTiescription of NVork and verify it is accurate. I agree to co -ply -ith all applicable local
Cupertino to the for inspection
ordinances and state laws relating to building-, ion. I auth ze representatives of enter above-Idelpffled ljopeMs purposes.
Signature of.Applicant%gent: Date:
SUPPLEMENTAL LNTFORMAT101\7 REQUIRED
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