10060166CITY OF CUPERTINO E,UILDING PERMIT
BUILDING ADDRESS: 7409 STANFORD PL
r"VNER'S NAME: HO MU L ET AL
",,'NER'S PHONE: 4086216495
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic.#
Contractor
Date
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:
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
perfonnance of the work for whichthis 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
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
nature
Date
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
CONTRACTOR: AFFORDABLE
PERMIT NO: 10060166
WA TER HEATERS &
24663 RAILROAD AVE
DATE ISSUED: 06/27/2010
SA JTA CLARITA, CA 91321
PHONE NO: (661)259-7131
BUI LDING PERMIT INFO: BLDG
ELECT PLUMB
MECH RESIDENTIAL COMMERCIAL
JOI ; DESCRIPTION: REPLACE 50 GALLON GAS WATER HEATER - SAME
LOCATION
= G. kRAGE
Sq. Ft Floor Area: 0
Valuation: $1300
AP; J Number: 35932030.00
Occupancy Type:
I hereby affirm under penalty of perjury one of the following three
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 fine performance of the work for which this
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of 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 be deemed revoked.
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
the above mentioned property for inspection purposes. (We) agree to save
,mnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Iss jed by:
Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
ins ailed without first obtaining an inspection, I agree to remove all new materials for
ins >ection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
Cs lifornia Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Hi alth & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
aii contaminants as defined by the Bay Area Air Quality Management District I
wi 3 maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
th - Health & Safety Code, Sections 25505, 25533, and 25534.
O,vner or authorized agent: Date:
CONSTRUCTION LENDING AGENCY
I I ereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
L, !nder's
ARCHITECT'S DECLARATION
I inderstand my plans shall be used as public records.
L censed Professional