B-2019-0034 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR., PERMIT NO: B-2019-0034
867 HYDE AVE CUPERTINO, CA 95014-4638 (375 41 003) AFFORDABLE WATER
HEATERS AND
PLUMBING INC `
28358
CONSTELLATION RD
VALENCIA, CA 913 5 5
OWNER'S NAME: WALKER JAMES DATE ISSUED: 01/07/2019
OWNER'S PHONE: 408-446-9192 PHONE NO: (855) 345-9087
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-36 Lic. #627368
Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Date X BLDG — ELECT X PLUMB
09/30/2020 _ 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 (50 GAL) SAME LOCATION (GARAGE)
I hereby affirm under penalty of perjury one of the following two declarations:
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: $2200,00
permit is issued.
APPLICANT CERTIFICATION APN
I certify that I have read this application and state that the above
37541 003
Number: Occupancy Type:
information is correct. I agree to comply with all city and county ordinances 375
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 WORD 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 perAiFVupertino Municipal Code, Section 9.18.
Issued by: Haley McKee
Signature �.� Date 1/7/19 Date: 01/07/2019
OWNER-Bu. DECLARATION RE-ROOFS:
I hereby affirm 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
y p installed without first obtaining an inspection, I agree to remove all new materials for
following two reasons:
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: 1/7/19
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 , f the
2. I have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. I ill
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 an , the
Health & Safe Code Section 25532(a) should I store or handle hazard0
permit is issued. Safety ' ( )
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
air contaminants as defined by the Bay Area Air Quality.Management District I
shall not employ any person in any manner so 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, after making this certificate of the Health & Safety Code ,ee ons 5505, 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 age (UCTI1
be deemed revoked. Date: 1/7/19
APPLICANT CERTIFICATION CONSTLkDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is constr ction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws of works for which this per is iss ed (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
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE * CUPERTINO, CA 95014-3255
(408) 777-3228 o builder @cu e�rt�r�0.0� PEMIT #B - 2,0
� od5l-
CU ERTINO REV # � DEF #
❑ NEW CONSTRUCTION ADDITION [:] LTERATION [:1 T.I. ❑ MEP ❑ RE-ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS ► APNU/ N
#
FJ hV
OWNER NAME PHO0
E-MATE
a
STREET ADDRESS STATE,ZIP
1 �?
21 CONTRACTOR NAME ❑ OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
JORGE BECERRA AWHAP 627368 C-36
STREET ADDRESS CITY, STATE, ZIP
28358 CONSTELLATION RD. VALENCIA, CA 91355
E-MAIL PHONE BUS. LIC #
jorgea�avuhap.com (855)345-9048 400652
❑ ARCHITECT ❑ OWNER C❑ OWNER AGENT ❑ CONTRACTOR AGENT❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NAME E-MAIL
STREET ADDRESS CITY, STATE, ZIP PHONE
DESCRIPTON
R & R 50 GALLON WATER HEATER
SAME LOCATION=
❑SINGLE-FAMGLY/DUPLEX ❑MULTI FAMILY ❑ INDUSTRIAL ❑ COMvIERCIAL
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES # TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION ($j
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ ATTACHED
BATHROOM SF SF SF SF ® DETACHED
EXISING ❑ YES ETCHLER ❑ YES SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS ❑ NO ❑ NO ❑ NO
DWELLING SECOND DWELLING ❑YES ❑ATTACHED }DETACHED OTHER
UNITS# UN1T ADDITON: ❑ NO S F
P007 ❑ FIBERGLASS 0 VINYL-LINED ❑ GUNITE ❑ PREFABRICATED
POOL-SF SPA-SF= SPA ATTACHED ❑YES ❑ NO TOTAL-SF
RWID TOTAI,VALUATION:
Commercial or Multi-Family Buildings with Public Swimmin Pools re wires Dggartment of Environmental Heath aWroval I. k
RE-.RC7OF EXISTING ROOF TYPE: ❑BUILT-UP ROOFE]ASPHALT SHINGLES❑WOOD SHAKES❑ WOOD SHI NGL ❑ OTHER(SPECIFY)
REMOVE/REPLACE [:] NO IF NO PLYWOOD ❑ 1�2„ ❑ 3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
❑YES #OF LAYERS THICKNESS ❑ 5/8" OTHER ❑OSB F1CDX OTHER �--- :12 A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑ WOOD SHAKES ❑WOOD SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF #of 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 have provided is correct. I have read the Description of Work and verify it is accurate. I agree
to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to
enter the above-identified property for insp cti urposes. I acknowledge and authorize all information contained on this application form
to be made available for public record.
Signature of Applicant/Agent: Date: 1-7 2019
SUPPLEMENTAL INFORMATION REQ RE
'New SFD/Second Dwelling Units/Multifa 'ly D ellings: A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a complet H ardous 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.
WHOA-Provide a letter of approval from the Home Owner's Association
BldgApp 2017.doe revised 08/01117