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B-2016-3067 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3067 10239 RICHWOOD DR CUPERTINO,CA 95014-3360(369 08 044) AFFORDABLE WATER HEATERS AND PLUMBING INC 28358 CONSTELLATION RD VALENCIA,CA 91355 OWNER'S NAME:KARAJGIKAR RAJEEV AND MANJU DATE ISSUED:11/08/2016 OWNER'S PHONE:408-913-6231 PHONE NO:(855)345-9087 I J.ICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-36 Lie.#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 GALLON WATER HEATER-GARAGE I hereby affirm under penalty of perjuryone 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. 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:$2562.00 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 369 08 044 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 may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR 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:Abby Ayende Signature----"/1 Date 11/8/2016 Date:11/08/2016 AA 1-:i ILDER 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(Sec.7044,Business&Professions Code) Signature of Applicant: 2. I,as owner of the property,am exclusively contracting with licensed Date:11/8/2016 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 i. 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 Health&Safety Code,Section 25532(a)should I store or handle hazardous permit is issued. a. 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. C"Date:11/8/2016 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. `D(D GENERAL PERMIT APPLICATION MEP vCOMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION r=rRs� 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•building(a cupertino.orq CUPERTINO M ISC ❑PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS r PROJECT 'DRESS APN# / „Ci OC8 o4 °T<ETil 1 P ONE E-MAIL STREET ADD ' C�ITY,STATE,ZIP, FAX coa°i1' IA/i CONTACT NAME , PHONE E-MAIL i H STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑.OWNER AGENT 0 CONTRACTOR ❑CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER. 0 TENANT CONTRACIOR tE LICE YSE BER LICENS _ BUS.LIC# r .r COMP NAME`` E-MAIL FAX [��j 1A-42ND ,/� e AJIV STREET ADDRESS /� CITY,STATE,ZIP f' PP},O_ ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF IVSFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND 0 YES PROJECT IN 0 YES IS THE BLDG AN 0 YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA 0 NO FLOOD ZONE 0 NO EICHLER HOME? 0 NO DESCRIPTION OF WORK 1.aw (Al via �.! TOTAL VALUATION: "" RECEIVED By:;F By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owns is beha. I 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 building co truction. I authorize representatives of Cupertino to enter the above-identified property/fo°r inspection purposes. Signature;of Applicant/Agent: �` — ' Date: ( ( c (- SUPPLEMENT NFORMATION REQUIREDE E -,O) CUSE ONLY ssI D O ER=THE COilNTER l F 0 EXPRESS STA NDARD x LARGE fl".MAJOR . MEPMiscApp_2011.doc revised 06/21/11 I '