B-2019-0106 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2019-0106
21837 OAKVIEW IN CUPERTINO, CA 95014-1145 (326 19 099) AFFORDABLE WATER
HEATERS AND
PLUMBING INC
28358
CONSTELLATION RD
VALENCIA, CA 91355
OWNER'S NAME: DATE ISSUED: 01/16/2019
OWNER'S PHONE: 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 (75 GAL) SAME LOCATION, GARAGE
I hereby affirm under penalty of perjury one of the following two declarations:
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: $2000.00
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 19 099
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 IS OR
may accrue against said Cit in consequence of the granting of this permit.
Additionally, the applicant derstands an vtr,J comply with all non-point
180 DAYS FROM LAST CALLED INSPECTION.
source Section 9.18.
Issued by: Haley McKee
Signature Date 1/16/19 Date: 01/16/2019
OWNER-BU(L R 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
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 contracling with.licensed Date: 1/16/19
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 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. 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 permit is issued I material. Additionally, should I use equipment or devices which emit hazardous
' air contaminants as defined by the Bay Area Air ality Management District I
shall not employ any person in any manner so as to become subject to the fiance with the Cupertino M � "ici al Code Cha .12 and
p p p , ter 9 p
Worker's Compensation laws of California. If, after making this certificate of will maintain compliance
Health & Safety Code, Seotions 5059 25533 and 34.
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: 1116/19
APPLICANT CERTIFICATION CON TRUC IO ENDAGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a co str 4 tion lending agency for the performance
correct. I agree to comply with all cit and count ordinances an state of work's for which this permit is is �ed (Sec. 3097, Civ C.
g p y y y d a laws Lender's Name )
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 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.
MON
SMOKE / CARBON MONOXIDE ALARMS aam
OWNER CERTIFICATE OF COMPLIANCE r`rQ o 7
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
aal
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • build ingQcupertino. ong
PERMIT CANNOT.BE FINALED UNTIL THIS CERTIFICATE HAS BEEN
COMPLETED, SIGNED, AND RETURNED TO THE BUILDING DIVISION
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2016 CRC Section R314, R315, 2016 CBC Sections 420.6 and 907.2.11.2 where no interior access
for inspections are required.
GENERAL INFORMATION
Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314, R315, and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or
Carbon Monoxide Alarms be installed in the following locations:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s) — (Smoke alarms shall not be located within 3 feet of bathroom door)
X
X
On every level of a dwelling unit including basements and habitable attics
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms specified below have been tested and are operational, as of the
date signed below.
Address: 2 1 i�_ 3 Permit No.
Specify Number of Alarms: # Smoke Alarms: = # Carbon Monoxide Detectors: I G
I have read and agree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
i,
Signature ........................... .......-...................................................................... Date:..:.........
Contractor Name:
Signature...................................................................... Lic.#........................................ Date:...................
I
Smoke and COfornn.doc revised 0111012017