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B-2016-1899
CITY OF CUPERTINO BUILDING PERMIT ' BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1899 10134 IMPERIAL AVE CUPERTINO,CA 95014-5955(357 22 043) AFFORDABLE WATER HEATERS AND PLUMBING INC 28358 CONSTELLATION RD VALENCIA,CA 91355 OWNER'S NAME: VENUGOPAL AND UDAYAVANI KAMBHAMPADI DATE ISSUED:05/06/2016 OWNER'S PHONE:(408)218-9688 PHONE NO:(855)345-9087 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class PLUMBING Lic.#627368 Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Date X BLDG —ELECT —PLUMB 09/30/2016 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 50 GALLON WATER HEATER SAME LOCATION IN I hereby affirm underpenalty of perjury one of the following two declarations: GARAGE 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 Sq.Ft Floor Area• Valuation:$1989.00 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 357 22 043 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 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 per the Cupertino Municipal Code,Section 9.18. Issued by:Susan Winslow Signature Date Date:05/06/2016 Z"�� OWNER-BUILDER 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(See.7044,Business&Professions Code) Signature of Applicant: 2. i,as owner of the property,am exclusively contracting with licensed Date: contractors to construct the project(See.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 shall not employ any person in any manner so as to become subject to the 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 Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Sections 25505,25533,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 agent: be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(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 ARCHITECT'S DECLARATION consequence of the granting of this permit. Additionally,the applicant understands 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. uatwtcu to 13.UO 4rAA) r.uu I GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CU PE RTI (408)777-3228•FAX(408)777-3333•buildincl(�cunertino.org MISC NC? dPLUMBING ❑MECI•TANICAL []ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS. APN 9 3 Y a A-\[ O ERN.ME. P T E-MAIL V ria a M6 VA am aCut ?1g- STItEL'T AllD SS M1 \ z � `00 L CITY,STAT)"" g `f� I FAX CONTACT NAME �t 'PHONE 'G E`,.MAI . I2 oUX� S 2 Ym I+ a-) w Co rn STREET ADDRESS • . CITY,STATE,zip - FAX s3sa- co e.r d . # 8` q�3ss basq - gssh ❑OWNER ❑ OWNE•R•BUTLDER ❑OWNER AGENT ❑CONTRACTOR *ONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑. DEVELOPER ❑TENANT CONTRACTOR�ltrdable Water Heaters&Pl ©g�tyIJMC. 6�,Z,1\p g LICENSETYPE\_ BUS.LIC S Z � C O COMPANY NAME' 26358 onste anon Road Ste 69 E-MIIIIAIL `St - FAXVakneiaJ e CA 9135-51 STREET ADDRESS CrI•Y,STATE,-LIP PHONE ARC}QTFCT/ENGINEERNAME - LICENSENUMBER EUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF 'Q AFD or DUPLEX MULTI-FAMILY PROIECT IN WILDLAND ❑ YES PROIECTIN 11 YES ISTHEBLDGA14 ❑YES BUILDING: UCOMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE I]NO EICIILERIIOMF? ❑NO DESCRIPTION OF WORT: cm e, oio n w a tP_j In e r Sam e Ic a 16n.= a TOTAL VALUATION: 1tEt=L•t_iFE6;H1:�::-rc=..:::=ii=iid'== i^i5i i'=ii:i:ia3:ii;.:i?i` _.. -- _._. 0191 11 ip, By my signature below,I c rtify to each of the following: I am the property owner or authorized agent to act on the property owners behalf. l 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 buildingns etion. I authorize representatives Of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent Date: t1 Q SUPPLEM NTAL iNFORMATIO REQUIRED `- k 4(#I1N C.,l,li �.� i- _ z::=��:•_�_�r:�1�=�s��_Awa: iWEPA,iscApp_2011.doc revised 06/21/11 PERMIT FEE RECEIPT Case # B-2016-1899 ,Pe�,Iwo Date Printed: 05/06/2016 C1 CITY OF CUPERTINO - FEES RECEIPT Permit Summary Case Number: B-2016-1899 Permit No: Project Valuation: 1989.00 Date Submitted: 05/06/2016 Permit Type: Building Address/APN: 10134 IMPERIAL AVE CUPERTINO,CA Receipt#: 204090 95014-5955(357 22 043) Scope of Work: REPLACE 50 GALLON WATER HEATER SAME LOCATION IN GARAGE Contacts Contact Type: Applicant - - — - .➢ Company Name: AFFORDABLE WATER HEATERS AND PLUMB Primary Phone: (855)345-9087 Full Name: Address: 28358 CONSTELLATION RD VALE'!, Email: PERMITS@AWHAP.COM Contact Type: Contractor CITY DF'CUPERTINO-BLD Company Name.- AFFORDABLE WATER HEATERS/ r" V, ,. 10300'TDRRE.AVE 345-9087 Full Name: CUPERTINO,CA 95014 Address: 28358 CONSTELLATION RD VALET"".0 r 05J06%2016 ( ' ,06 Email: PERMITS AWHAP.COM 06;09 , ,CREDIT CARD :09 Contact Type: Property Owner Full Name: VENUGOPAL AND UDAYAVANI KP :r Sad E� , 218-9688 Address: 10134 IMPERIAL AVE CUPERTIND, ",U&# >„ =0=9389 Email: B --SER#, 2 Bath#; 172 -INVOICE 2 od Approval Code Enty-Method:: -Manual Administrative Fee Mode: Online $45.00 " ``Tai Amount. Bldg Stds Commission Fee $1.00 Plumbing Water Heater Fee SALE AMOUNT(NT �(�} $29.00 PME Permit Fee uV $48.00 Strong Motion Category 1 CUSTOMER COPY _ $0.50 Travel and Documentation Fee $48.00 Ifo maR� X Plumbing Water Heater Fee 05/06/2016 KATIE VOELTZ Credit Card $29.00 Strong Motion Category 1 05/06/2016 KATIE VOELTZ Credit Card $0.50 Bldg Stds Commission Fee 05/06/2016 KATIE VOELTZ Credit Card $1.00 Travel and Documentation Fee 05/06/2016 KATIE VOELTZ Credit Card $48,00 Administrative Fee 05/06/2016 KATIE VOELTZ Credit Card $45.00 PME Permit Fee 05/06/2016 KATIE VOELTZ Credit Card $48.00 FEE TOTAL $171.50 AMOUNT PAID $171.50 BALANCE DUE $0.00 05/06/2016-8:17:41 AM-Generated by:suew 1/1