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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