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B-2017-1893 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1893 10704 MARTINWOOD WAY CUPERTINO,CA 95014-4422(369 35 033) WATER HEATERS ONLY INC GRASS VALLEY,CA 95945 OWNER'S NAME: YIN MARK T AND WONG CECI SHU-WAH ET AL DATE ISSUED: 11/02/2017 OWNER'S PHONE:415-910-8317 PHONE NO:(800)835-8345 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class PLUMBING Lic.#374573 Contractor WATER HEATERS ONLY INC Date 05/31/2019 X BLDG _ELECT X PLUMB 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 license is in full force and effect. JOB DESCRIPTION: REPLACE WATER HEATER(40 GAL)SAME LOCATION I hereby affirm un•er penalty of perjury one of the following two declarations: 1. I have•nd will maintain a certificate of consent to self-insure for Worker's Co •.ensation,as provided for by Section 3700 of the Labor Code,for the � p formance of the work for which this permit is issued. „III 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 permit is issued. Sq.Ft Floor Area: Valuation:$2054.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 369 35 033 representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments,c. ts,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequ:• - of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understand .nd will comply with all non-point source regulations per the Cuperti•. Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature '% /,406,. Date 11-01-2017 Issued by: Kim Dunbar Date: 11/02/2017 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS; following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date: 11-01-2017 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 performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE z. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 a.. the 3. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle ha rdous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which e.• hazardous air contaminants as defined by the Bay Area Air Quality Man ..ment District I Worker's Compensation'laws of Califomia. If,after making this certificate of will maintain compliance with the Cupertino Municipal Co' ,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sect 5505,255 ,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked, Owner or authorized agent: MI APPLICANT CERTIFICATION Date: 11-01-2017 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. I understand my plans shall be used as public records. SiSignature Date 11-01-2017 Licensed 9 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION r 10300 TORRE AVENUE • CUPERTINO CA 95014-3255 .61_4, (408) 777-3228 • buildin @ cu ertino.or PEMIT#B-20l . /7,...3 CUPERTINO REVS DEFE ❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. EP ❑RE-ROOF ❑SWIMMING POOL/SPA PROTECT, nia-itii;r7[1V©6cY W� APN t 3 9 — �7�Cr? / 33 OWNER NAME / / 1 1 ' PHONE �/ E-MAIL //// frek t� /`7r/, O '9'. STREET ADDRE STATE,ZIP r�/tzt G / C/,L CQNTRACT R NAME OWNER- UILDER COMPANY NAME LICENSE`NUUMBER (e� LICENSE TYPE SMDRr iie- g.31,TATE, ZIP „4„.14 e.,.... . ,,s_.5,,,,,r, LA ,,,,,,:, /1v IWC/Lv1 r ,,,9 PHONE v3"' 2, O I BUS.LIC t 0 ARCHITECT 0 OWNER 0 OWNER AGENT�� 0 CONTRACTOR AGENT ENGINEER 0 DEVELOPER 0 TENANT ,I� /, ,� CONTACT NAMEA��"d E-MAILket,),,,6 i,Aed,ac,f.' eser eILS t C�OyL STREET A� y, 64 S al it&3 ZIP L CX4 �8/29 ✓4708 / j'' �.'J Js DECRIPTON 'qa2.-5 (` / - GLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES t TOTAL NET SF USE. TYPE OCC SQ.FT. VALUATION(5) REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED BATHROOM SF SF SF SF 0 DETACHED • EXISING ❑YES EICHLER ❑ YES SECOND STORY ADDITION 0 YES FIRE SPRINKLERS❑NO ❑ NO 0 NO DWELLING SECOND DWELLING ❑yEs 0 ATTACHED DETACHED OTHER UNITS if UNIT ADDITON: ❑NO 5 F POOLS, 0 FIBERGLASS ❑VINYL-LINED 0 GUNITE 0 PREFABRICATED POOL-SF SPA-SF I SPA ATTACHED ❑YES 0 NO I TOTAL-SF / " E� R • / r•i-• X ON^ Commerrial orMulti-Family Buildings with Public Swinm:inc Pools renuires Department of Environmental Heath approval RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY) REMOVE/REPLACE 0 NO IF NO PLYWOOD ❑1" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS ❑YES t OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑COX OTHER .12 A PROPOSED ROOF TYPE:❑BLILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES D WOOD SHINGLES 0 OTHER *Provide a signed copy of the Cupertino's Tear-Off Policy SF ;of SQUARES By my signature below I certify to each of the following: I am the property owner ora otized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have r the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b ' ing construction. I authorize representatives of Cupertino to enter the above-identified property for inspection pu poses. I acknowl e and authorize all information contained,on this pplication form tog a madeaavailable for public record. 7/ /_ Signature of Applicant/Agent: Date: / � - SUPPLEMENTAL INFORMATION REQUIRED *New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction. *Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. *Copy of Planning Approval Letter or Meeting 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/I 7