B-2017-0226 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0226
10313 E ESTATES DR CUPERTINO,CA 95014-3376(369 08 015) AFFORDABLE WATER
HEATERS AND
PLUMBING INC
28358
CONSTELLATION RD
VALENCIA,CA 91355
OWNER'S NAME: O'HAGAN MICHAELAAND PATRICIA S DATE ISSUED:02/07/2017
OWNER'S PHONE:408-257-5029 PHONE NO:(855)345-9087
LICENSED CONTRACTOR'S DECLARATION 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 _11ECH 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. (N)40 GAL WATER HEATER(SAME LOCATION)
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.
I have and will maintain Worker's Compensation Insurance,as provided for by
q. Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$1500.00
P _ 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 08 015
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 pplicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source regulatio s e Cupertino Municipal Code,Section 9.18.
Issued by:Abby Ayende
Signature /� 1 i Date 2/7/2017 Date:02/07/2017'
OWNER-BUIL ER DII\CLARATION
V RE-ROOFS:
I hereby affir hat 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
I 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:2/7/2017
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
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 air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cu.- n'H o Municipal Code,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code, e-tions r 5505,25533,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:2/7/2017 /t!Milk
APPLICANT CERTIFICATION f TR 1 �`� �t I ° , Y
I certify that I have read this application and state that the above information is I hereby affirm that there is a cons,trbctio 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 i s ed(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 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.
• O22
* GENERAL PERMIT APPLICATION MEP
•
COMMUNITY DEVELOPMENT DEPARTMENT. BUILDING DIVISION
•
10300 TORRE AVENUE.CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333• buildina(a cuperltino,orqMISC
CUPERTINO
®PLUMBING ['MECHANICAL ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESSr /0 2 C E-c Jes APN# 3teqf ®J O is
' OWNER NAME `y li k?, ViQ 4(6/143
,141+ - PHoe.40 'I LS 502 E-MAIL
STREET ADDRESS
CJj�i e DY"g f �� CITY, S � er(ND D IP q� ki FAX
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CONTACT NAME 3o� � 6 PHONE C /_/)51,-3_4,6/ EMAILrC� /� a- 4,p
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STREET ADDRESS r _ ,.^ E/ LQ IC p CITY, IP 14 Ci
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El OWNER 0 OWNER-BUFLDDERR0 OWNER AGENT. ' ARCHITECT 0 CONTRACTOR AGENT 0 ARC HTE_ CT ❑ENGINEER 0 DEVELOPER 0 TENANT
r6rok.aCTIDR6;\'4ME�� 2r Legl-4.r_s _`V1'rbt LICENSENUMBER P 2 ,�i LICE1\�51w.T T BUS.LIC r 2(08 So
COMPANY NAME , E-MAIL 1p J
(in 2Si s6
S ADO SSVnsi174740 el
747 ®el F v CITY,
ST „ /,z
ARCHITECT/ENGINEER.NAME I LICENSE NUMBER BUS.LIC
COMPANY NAME IL E-MAri FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX 0 MULTI-FAMILY I PROJECT IN WI1.DLAND 0 YES PROTECT LN 0 YES IS THE BLDG AN 0 YES
BUILDING: ❑COMTMERCLLAL UJRBpppANINTERFACEAREA O. NO FLOOD ZONE 0 NO .. EICHLER HOME? 0 NO
DESCRIPTION OF WOP-K. pe,416.:12/
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4-0 ge11/
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TOTAL VALUATION:
c'
By my signature below,I 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 read the Description of Work and verify it is accurat.. I agree to comply with all applicable local
ordinances and state laws relating toJl.,�,'Iding construction. I authorize representatives of Cupertino to enter the ab ove�identrifii,•operty for inspection purposes. •
Signature of Applicant/Agent: l//�! Date: L I I
IPPLEMENTAL INFORMATION REQUIRED
.ice- -'� EXPRESS
11 IEPMiscApp_2011.doc revised 06/21/11