B-2017-1079CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1079
19503 STEVENS CREEK BLVD UNIT 227 CUPERTINO, CA 95014 (316 49 060)
AFFORDABLE WATER
HEATERS AND
PLUMBING INC
28358
CONSTELLATION RD
VALENCIA, CA 91355
OWNER'S NAME: LING MADELINE J
DATE ISSUED: 07/06/2017
OWNER'S PHONE: 408-421-3936
PHONE NO: (855) 345-9087
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class Q-U 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.
(N) 50 GAL WATER HEATER (OUT DOOR CLOSET) - SAME
LOCATION
I hereby affirm under penalty of perjury one of the following two declarations:
r. 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 Cade, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $2999.00
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
316 49 060
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, t e p Ica t understands and will comply with all non-point
180 DAYS FROM LAST CALLED INSPECTION.
source reg io a he Cupertino Municipal Code, Section 9.18.
Issued by: Kim Dunbar
Signature' Date 07-06-2017
Date: 07/06/2017
OWNER- IL ER DECLARATION
RE-ROOFS:
I hereby ofm at 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 sons•
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: 07-06-2017
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 vices 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 Air Qu 'ty Management District I
in
will maintain compliance with the Cup Muni al Code, Chapter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of
the Health & Safety Code, on , 25533, nd 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: 07-06-2017
APPLICANT CERTIFICATION
MNS-TRUC N NDINENCY
I certify that I have read this application and state that the above information is
I hereby affirm that there is a cons ucti n 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 issed ec. 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.
m F %J
GENERAL PERMIT APPLICATION 'a =EL
COfAMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ma Us AOM&
CU?ERi1NO
(408) 777-3228 • FAX (408) 777-3333 • buildinc0cupertino.oro
PLUMBTNO ❑MECHANTICAL [:]ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS � %J %
OW ERNAi d PHO?` �D �'2 - ��j3 E-MAIL
STREET ADDRESS ST. Z P • ( J� FAX
CONTACT N.A_?`4E 3on e � g33--6 al v b 4�-J�a? '/�1n
STREETADD S 1 4 CIT ^ CTATE, ZIP tJf
13awNER ❑Ot1NER-BurLDER ❑ ORT'ERAoE 1 CONTRACTOR Y l❑/ CONTRACTOR AGENT `1-1 IARRCHITECT ❑ ENGINEER ❑ D1 -ELOPER ❑ TENANT
CONTRA T R N LI%$ 4R D LI �S u BUS. LIC R D/
A 'NAT 4SL W 'C �!' E-MAIL FAX (�
� 4
CITY', T'C ZIP
` -'"A C" s 5 (0)3 1J-490
ARCHITECT ENGINEER NAME LICE. TSE NUMBER BUS. LIC r
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY, STATE, -LIP PHONE
USE OF ❑ SFD or DUPLEX NTULTI-FAMILY PROJECT IN, WILDLA.ND ❑ YES PROJECT IN ❑ 17FS LS THE BLDG AN ❑ 1-zs
BUILDING: ❑ CM0,1ER.CLAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO
DESCRIPTION OFW'ORK 1 X71 n O
G (� l�J
nI,npo -
I
TOTAL VALUATION: I RE D
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 accurate. I a fire to comply with all applicable local
ordinances and state laws relating to buil Q struction. I authorize representatives of Cupertino to enter the ab 'e -i entifie pro e y for inspection purposes.
Signature of Applicant%Agent: Date: S �/
S PPL MENTAL INFOR\4ATION REQUIRED
LARGE:
ALU 6R-:
AIFPATisc,4pp_2011.doc remised 05/21111