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B-2017-1515 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1515 10385 N BLANEY AVE CUPERTINO,CA 95014-2331(316 33 003) AFFORDABLE WATER HEATERS AND PLUMBING INC 28358 CONSTELLATION RD • VALENCIA,CA 91355 OWNER'S NAME: SAUVAGE HARLEY P AND RITA R TRUSTEE DATE ISSUED:09/08/2017 OWNER'S PHONE:408-255-9657 PHONE NO:(855)345-9087 i ICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C36 Lic.#627366 Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Date X BLDG _ELECT X PLUMB 09/30/2018 _MECH Y 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 WATER HEATER(40 GAL)SAME LOCATION I hereby affirm under penalty of perjury one of the following two declarations: 1. IC have and will maintain a certificate of consent to self-insure for Worker's ompensation,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:$2500.00 permit is issued. APPLICANT CERTIFICATION p y Typ I ify that I have read this application and state that the above APN Number: Occu anc e: information is correct.I agree to comply with all city and county ordinances 316 33 003 and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection pur•oses. (We)agree to save indemnify and keep harmless the PERMIT EXPIRES IF WORK IS NOT STARTED City of Cupett\o against liabilities,judgments,costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR may accrue a'r :instsaid City in consequence of the granting of this permit. Additionally,tl.-�:. .nt understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION. source regula ,ns Cupertino Municipal•Code,Section 9.18. Issued by:Kim Dunbar Signatt /� Date 9-8-2017 Date:09/08/2017 -: Ac. ' C •i:__4:4 RE-ROOFS: I hereby affirm hat am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofmg material being installed.If a roof is following two r •: 04 installed without first obtaining an inspection,I agree to remove all new materials for 1. I,as o .-r of the property,or my employees with wages as their sole inspection. compe,.atm, ,will do the work,and the structure is not intended or offered for sale(Sec.-044,Business&Professions Code) Signature of Applicant: 2. I,as owner of the property,am exclusively contracting with licensed Date:9-8-2017 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 3. I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use eq,I pment 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 Ba rea Air Quality Management District I will maintain compliance with the Cu+• •Municipal Code,Chapter 9.12 and Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code, • ' u• 25505,25533,and 25534. exemption,I become subject.to the Worker's Compensation provisions of the r� . Labor Code,I must forthwith comply with such provisions or this permit shall Owner or authorized age ". be deemed revoked. Date:9-8-2017 V MIL 11 APPLICANT CERTIFICATION CO. S_KU; h G.:_G C_ I certify that I have read this application and state that the above information is I hereby affirm that there is a co ,tion'=nding 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 i d(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. CONSTRUCTION PERMIT APPLICATION `elk COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 • 4Sc.l,,r- (408) 777-3228 • building@cupertino.org PEMIT#B i� / CUPERTINO REVS DEF# ❑ NEW CONSTRUCTION ❑ADDI ❑ALTERATION ❑TI. MEP ❑RE-ROOF ❑SWIMy�MI�N7yG POOL/SPA PROJECTADDy .�cl�/' $/cne ' Ave I AP d3 1 Q r A 3 , f�O 3 OW NE A E l l//lJ�I ( P E II E-MAIL ,y�J� V 7_, STREETVD7lScJ .'IV .... 411e1 cRITE, i.if 1,... Vim" I St)11 OCONTRACTOR NAME 0 OWN ER-BUINIcER COMPANY NAME1 LICENSE NUMBER LICENSE TYPE a e gbeicvy q 4-(1),(4 4,tA).1.. 1,444e,5 (02"d-3(p g. C IConskYDr\ V`i 2 SATE, Z'' cA V q\ssS I E-MAIC VE tBUS.LIC a ,�,�� ' ti;s, l) ��3-(��IO �-U(�X52 0 A CHITE&❑OWNER 0 OWNER AGENT 0 CONTRACTOR AGENT!:ENGINEER 0 DEVELOPER 0 TENANT CON.J.ACT NAME `e w�q E-MAIL `, e—C I` — P TTTT�� V ((� �\\ 11,e�'V UUU\ '�11N�1[JI WCC Hip,1En /_ / S ET g I G'S"�4 U l" \)I C I/G lel ZIP /'1 An q{ J Ql1lo) 553"19cf 0 DECRIPTON /470 � �� ik � SQir4 L oc-'a- tkr-C7,-4- toINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL ❑COMMERCIAL I EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES I TOTAL NET SF USE TYPE OCC SQ.FP. VALUATION(5) REMODEL REMODEL KITCHEN REMODELOTHR GARAGE ❑ATTACHED BATHROOM SF SF SF SF 0 DETACHED • EX1S TS SPRINKLERS❑ NO ❑ N EICHLER ❑YES ❑ SECOND STORY ADDITION YES FIRE 0 NO DWELLING SECOND DWELLING ❑YES ❑ATTACHED DETACHED OTHER UNITS a UNIT ADDITON: ❑NO S F POOLSI '.❑FIBERGLASS 0 VINYL-LINED ❑GUNITE 0 PREFABRICATED POOL-SF SPA-SF I SPA ATTACHED❑YES ❑ NO l TOTAL-SF - RECE BY 0 TOTAL VALUATION: Commercial or Multi-Familu Buildings with Public Swimming Pools renuires Department of Environmental Heath approval (JV RE-RO OFI:EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY) REMOVE/REPLACED NO IF NO PLYWOOD I:11/2" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS ❑YES #OF LAYERS THICKNESS Q 5/8" OTHER ❑OSB ❑CDX OTHER •12 A PROPOSED ROOF TYPE:❑BUILT-UP ROOF DASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER *Provide a'signed copy of the Cupertino's Tear-Off Policy SF Oaf SQUARES 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 lave provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordi .nces - d state laws relating to building construction. I authorize repr sentatives of Cupertino to enter:the above-identified property for ' .pectio p . poses. I acknowledge and authorize all informatig c ntaii ed o this application form to be made available for public record. /I/ Signature'of Applicant/Agent: _ Date: SUPPLEMENTAL INFORMATIO' RE UI r ED . *New SFD/Second Dwelling Units/Mul famil, Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction. *Commercial Buildings: Provide a corrTlete. Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. *Copyof Planning Approval Letter or ,eeti'g with Planning prior to submittal of Building Permit application. *HOA-Provide.a letter of approval from the Home Owner's Association BldgApp_2017.doc revised 08/01/17 AF F OR DABLE f - 06er- r 4r-= AND PLUMBING INC . March 2017 LETTER OF AUTHORIZATION "I,undersigned, give permission to accept any of the signatures that appear below, on a permit being issued, in lieu of my signature at the counter. I hereby certify under penalty of perjury,that I will comply with all declarations and agreements on the permit,which bears my signature or my representative signature, and as required by the city." The following authorized representatives have my permission to sign and take receipt of construction permits in the name of my company: Jorge Becerra Leonce Roux f", lear'c-k Contractor Name Contractor Signature Date Contractor Information: Affordable Water Heaters & Plumbing,Inc. Phone: 855-345-9048 28358 Constellation Road # 698 Valencia, CA 91355 Contractors State License Number: 627368- Class C 36 Workers Comp Insurance: Insurance Company of the West WSA503249701 Exp. 1.1.18 See Attached Calix Acknowledgment See Attached California Acknowledgment 28358 Constellation Road, Suite 698 • Valencia, CA 91355 (855) 345-9048 • FAX: (661) 259-9556 • www.waterheatersandplumbing.com CA State Lic#627368