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B-2016-2815 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2016-2815 7475 PROSPECT RD CUPERTINO,CA 95014-5241(M6 15 054) AFFORDABLE WATER HEATERS AND PLUMBING INC 28358 CONSTELLATION RD VALENCIA,CA 91355 OWNER'S NAME: MASLI HANS AND MINDY PHAN TRUSTEE DATE ISSUED:10/05/2016 OWNER'S PHONE:408-508-9307 PHONE NO:(855)345-9087 r.TCEN .D TRACTOR'S DE RATION BUILDING PERMIT INFO: License Class C=36 Lic.#627368 Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Date X BLDG _ELECT X PLUMB 09/30/2018 _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 GAL WATER HEATER(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. z.. 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:$1500.00 permit is issued. APPLICANT CERTIFI AXON 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 36615 054 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:AbbyA ey nde Signature Y�i"� Date 10/5/2016 Date: 10/05/2016 OWNER-BUILDER R-B I D .R 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:10/5/2016 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 z. I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534.. 1 will Section 3700 of the Labor Code,for the performance of the work forwhich 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 s. 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 a 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 ° r be deemed revoked. Owner or authorized agent: Date:10/5/2016 APPLICANT CERTIFICATIONI.TRFT(-Ti'O-T4;tTENDINGAG]ENCy 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 consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATTON 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. 0912712016 14:09 (FAX) P.0031003 GENERAL PERMIT APPLICATIONMEP COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228 FAX(408)777-3333•building(a-cupertino.org �C[JPERTfMfJ MISIC MPLUMBING ❑MECHANICAL []ELECTRICAL ❑MISCELLANEOUS�� PROJECT ADDRESSe \ APN# OWNERNAMEU �^ f PHON E-MAIL /- �an STRFETADDRESS 1 C it CITY, STATE,ZIP FAX s �r �o �, eu � Y•+rho c �so�� CONTACT NAME" PHON° L'-h1A1L s Od ? 5 - O81 � t C'0 r'-) STREC•TADDRESS CITY,STATE,ZIP• FAX zF 15(X 1 R d•#q�` 1 6- c I -s s - c,z ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER_ ❑. DEVELOPER ❑TENANT O1T�ItACfOK AML• I e W r LICENSENUMUER L[CENS£'l'YPE BUS.LIC N f a e rS lP713 u g` '3 c_e 2 U T_5 'Q, COMPANY NAME E-MA'L Vrn FAX 0 (too STREET ADDRESS CIT �1AT4 ZIP PHONE 2g 5 GO S`r af- . • 4LPO VOti C} � (2S FSS)3 S- 9 iox ARCHITECT/ENGINEER NAME LICENSENUMBER BUS.LIC X COMPANY NAME F-MALI, FAX STREETADDRESS CITY,STATE,ZIP PHONE USE OF 0. ar DUPLEX ❑ MULTI-FAMILY P110leCT IN WILDLAND ❑ YES PROJECT IN ❑.YES IS THE BLDG AN ❑YES BUILDING: COMMERCIAL URBAN INTERFACE AREA �.NO FLOOD ZONE ❑NO EICFILER HOME? Q NO DESCRIPTION OF WORK < nn TOTAL VALUATION: 15 V r �•®•'"� uaya: _— Y ssa' By my signature below,l certify to each of the following: I am the property owner or authorized agent to act on the property owners behalf. I have read this application and the information I have provided is correct. I have read the Description of Vdork and verify it is accurate. I agree to comply With all applicable local ordinances and state laws relating to buildin construction. I authorize representatives of Cupertino to enter the above-id ntifiied property for inspection purposes. Signature ofApplicant/Agent: Date: �r 51 ( gip T SUPPLEMENTAL INFORMATION REQUIRED Tar>rcLINT - _ i:...:L GME _�`EiIV1�tl7il�'•_. - - � ;��: A1CP/Lfiscflpp_2011.doc revised 46/21/11