B-2016-2214 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2214
10885 SWEET OAK ST CUPERTINO,CA 95014(326 51 033) AFFORDABLE WATER
HEATERS AND
PLUMBING INC
28358
CONSTELLATION RD
VALENCIA,CA 91355
OWNER'S NAME: CHUNG YON J AND FEEI Y TRUSTEE DATE ISSUED:06/27/2016
OWNER'S PHONE:408 807 8684 PHONE NO:(855)345-9087
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class PLUMBING Lic.# 26 7368
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 40 GALLON WATER HEATER-SAME
LOCATION(GARAGE)
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 Sq.Ft Floor Area: Valuation:$2279.00
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 51 033
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:Patricia Garcia
Signature Date Date:06/27/2016
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,1 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 properly,am exclusively contracting with licensed Date:
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
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=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
consequence of the granting of this permit. Additionally,thepplicant 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.
0612412016 14:32 (FAX) P.0021003
GENERAL PERMIT APPLICATION
MRAN E P
COMMUNITY DEVELOPtJIENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPER'�I
.... N.O (408)777-3228•FAX(408 777-3333•building(GDcupertino.org MISC
dpLUMBING ❑MECIIANICAL ❑ELECTRICAL []MISCELLANEOUS)i)-o e
PROJECT ADDRESS APN p
OWNER NAME PHONE EMAIL
STREET ADDRESS ,.. , �I Q. Ct�Y,STAIn eTE,ZIP I
CONTACT NAME l PH MAIT,
STREET ADDRESS CITY STATE,ZIP FAX
25?? 5 C IIOt-I ii�tS 1%01, 195S�
❑OWNER ❑ OWNER-BUILDFR ❑ OWNERAGENT ❑ CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
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COMPANY NAME E-MAII. 1- FAX
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ARCHITECTIENGINEERNAME LICENSENUMBER BUS.LIC11
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,S'rATE,ZIP PHONE
USE OfSPD or DUPLEX ❑ MULTI-FAMILY PROJECT INWILDLAND ❑ YES PROJECT IN ElYES ISTHEBLDGAN ElYES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
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TOTAL VALUATION: ;_.....-....r..._:.:....._.._._..::e::::;::: -n-� ='-•:-..:,..,._.._...:..... 'r,:
By my signature below,11 certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have real the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to=dQ- tion. I authorize representatives of Cupertino to enter the above-identified erty for inspection purposes.
Signature of Applicant/Agent: I Date: UI 2�7
SUPPLEMENTAL INFORMAT ON REQUIRED
JLIEPJ14iscApp_2011.doc J'evised 06/21/11