B-2016-1228CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
20800 VALLEY GREEN DR CUPERTINO, CA 95014-1735 (326 09 040)
CONTRACTOR:
( AMERICAN WATER
HEATER SERVICE INC )
NEWARK, CA 94560
PERMIT NO: B-2016-1228
OWNER'S NAME: 20800 VALLEY GREEN DRIVE DATE ISSUED: 01/20/2016
OWNER'S PHONE: PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
Contractor ( AMERICAN WATER HEATER SERVICE INC ) 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:
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
performance of the work for which this permit is issued.
2.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.
Signature___________________________________ Date
OWNER - BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor’s License Law for one of the
following two reasons:
1.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)
2.I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
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
performance of the work for which this permit is issued.
2.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.
3.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 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.
Signature___________________________________ Date
BUILDING PERMIT INFO:
X BLDG ELECT PLUMB
MECH X RESIDENTIAL COMMERCIAL
JOB DESCRIPTION:
ONLINE PERMIT TO REPLACE WATER HEATER WITH SAME SIZE
100 GALLON IN SAME LOCATION. (FOR ENTIRE BLDG)
Sq. Ft Floor Area: Valuation: $6345.00
APN Number:
326 09 040
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: 1444
Date:
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
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
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent: ________________________________
Date:
CONSTRUCTION LENDING AGENCY
I hereby 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
Lender's Address
ARCHITECT’S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional________________________________________________
CITY OF CUPERTINO BUILDING PERMIT INSPECTION CARD
BUILDING ADDRESS
20800 VALLEY GREEN DR
CUPERTINO, CA 95014-1735
CONTRACTOR
AMERICAN WATER HEATER SERVICE INC
PERMIT NO
B-2016-1228
OWNER'S NAME:
20800 VALLEY GREEN DRIVE PO BOX 1368 CARLSBAD CA 92018 PERMIT ISSUED:
01/20/2016
OWNER'S PHONE:PHONE NO:
JOB DESCRIPTION:
ONLINE PERMIT TO REPLACE WATER HEATER WITH SAME SIZE 100 GALLON IN SAME LOCATION.
(FOR ENTIRE BLDG)
TYPE INSPECTOR DATE
PLUMBING
UNDERGROUND GAS PIPING
UNDERGROUND WATER
UNDERGROUND SEWER
UNDERFLOOR
ROUGH PLUMBING
SHOWER PAN
WATER HEATER
WATER SERVICE
GAS PRESSURE TEST
GAS METER RELEASE
PROPERTY LINE CLEANOUT
PLUMBING FINAL
ELECTRICAL
UFER
UNDERGROUND
UNDERFLOOR
ROUGH ELECTRICAL
TEMPORARY POWER POLE
SERVICE UPGRADE
ELECTRIC METER RELEASE
ELECTRIC FINAL
MECHANICAL
UNDERFLOOR
ROUGH MECHANICAL
FURNANCE
AIR CONDITIONER
HOODS
MECHANICAL FINAL
T-BAR
PLUMBING
ELECTICAL
MECHANICAL
BUILDING
FIRE
SWIMMING POOL
REINFORCEMENT
P/M/E
ELECTRICAL BONDING
ROOFING
PRE INSPECTION
TEAR OFF
NAILING
BATTENS
TO ARRANGE INSPECTION
Call 777-3228 between 7:30 am and 3:30 pm Monday through Friday, at leas t 24 hours before required
ins pection. Job address and Permit Numbers are needed when reques ting an ins pection.
CUPERTINO SANITARY DISTRICT
Clos ed circuit video ins pection of property line cleanout, point of connection
and street lateral required prior to pas s ing FINAL CITY PLUMBING
INSPECTION. Call the Dis trict (408-253-7071) for an appointment.
NO BUILDING FINALS INSPECTIONS UNTIL ALL REQUIRED
BUSINESS LICENSES ARE OBTAINED
PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT
IS SUANCE OR 180 DAYS FROM LAST CALLED INSPECTION.
IMPORTANT When a permit has expired, a charge totaling one-half the fees to obtain a new permit
mus t be paid in order to reactivate the permit. If a permit has been expired for more
than one year, a charge totaling the full fees to obtain a new permit must be paid
to reactivate the permit.
NOTES:
TYPE INSPECTOR DATE
FOUNDATION
FOOTINGS
UFER
PIERS
GRADE BEAMS
GARAGE SLAB
GROUND/SITE WORK
UNDERGROUND ELECTRICAL
UNDERGROUND GAS PIPING
UNDERGROUND WATER
UNDERGROUND SEWER
SITE WALLS
FOOTING
MASONRY REBAR
DRAINAGE
CMU WALLS
UNDERFLOOR
UNDERFLOOR PLUMBING
UNDERFLOOR MECHANICAL
UNDERFLOOR ELECTRICAL
UNDERFLOOR FRAMING
UNDERFLOOR INSULATION
FRAMING
FLOOR NAIL/SHEATHING
ROUGH PLUMBING
ROUGH MECHANICAL
ROUGH ELECTRICAL
ROUGH FRAMING
INTERIOR SHEAR
EXT ERIOR SHEAR
WALL INSULATION
CEILING INSULATION
ROOF NAILING
INTERIOR FINISHES
SHEETROCK
TILE BACKER UNDERLAYMENT
TILE BACKER
INTERIOR LATH
EXTERIOR FINISHES
EXT ERIOR LATH
SCRATCH COAT
SIDING
TYPE INSPECTOR DATE
PLUMBING
SHOWER PAN
WATER HEATER
WATER SERVICE
GAS TEST
GAS METER RELEASE
ELECTRICAL
TEMP POWER POLE
SERVICE UPGRADE
PV SYSTEM
EV SYSTEM
MECHANICAL
FURNANCE
BOILER
AIR CONDITIONER
HOODS
DUCT WRAP
T-BAR
PLUMBING
ELECTICAL
MECHANICAL
BUILDING
FIRE
SWIMMING POOL
REINFORCEMENT
P/M/E
ELECTRICAL BONDING
DEMOLITION
BACKFILL
ROOFING
PRE INSPECTION
TEAR OFF
NAILING
BATT ENS
TYPE INSPECTOR DATE
SANITARY INSPECTIONS
UNDERGROUND
HYDROFLUSH
PUBLIC WORKS
RIGHT OF WAY
GRADING
RETAINING WALL
FIRE DEPARTMENT
SITE COMPLIANCE
FIRE MAIN SYSTEMS
FIRE SPRINKLERS - ROUGH
FIRE SPRINKLER - FINAL
FIRE ALARM FINAL
STANDPIPE SYSTEMS
ENGINEERED FIRE PROTECTION SYSTEM
FIRE LIFE SAFETY
DOCUMENTATION
PAD/SETBACK CERTIFICATION
TRUSSES
SPECIAL INSPECTION REPORTS
SMOKE/CARBON MONOXIDE CERT OF
COMPLIANCE
WATER FIXT URE CERT OF COMPLIANCE
ENERGY COMPLIANCE FORMS
CALGREEN MANDATORY ITEMS CHECKLIST
DEPARTMENT FINALS
PLANNING- CALL 777-3308
PUBLIC WORKS - CALL 777-3354
FIRE - CALL 378-4010
HEALTH - CALL 408-918-3400
SANITARY - CALL 253-7071
BUILDING FINALS
PLUMBING
ELECTRICAL
MECHANICAL
TEMPORARY OCCUPANCY
BUILDING