B-2017-1916 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: - PERMIT NO:B-2017-1916 '
20642 GARDENSIDE CIR CUPERTINO,CA 95014:5081(362 32 036) AFFORDABLE WATER
HEATERS AND
' PLUMBING INC
. 28358
CONSTELLATION RD
VALENCIA,CA 91355
OWNER'S NAME: DOSHI NILESH AND DESAI BHAMINI TRUSTEE DATE ISSUED: 11/07/2017
OWNER'S PHONE:408-410-3031 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 _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 50 GAL WATER HEATER-GARAGE
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.
f '.ve 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:$1500.00
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 362 32 036
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 aga' stsaid City in consequence of the granting of this permit.
Additionally,th='app'cant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source regulations oe he Cupertino'Wlunicipal Code,Section 9.18.
Issued by:AbbyAyende
AO re A' Date 11/7/2017 Date: 11/07/2017
0 L►E'-Bi1rE' CL�:_ O RE-ROOFS:r
I hereby aftirthat 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,an exclusively contracting with licensed Date:11/7/2017 -
contractors to construct the project(Sec.7044,Business&Professions Code).
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three declarations:
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
permit is issued. air offal. Additionally,as defined should I the Bay Area orI ev store or handleich emit hazardousads
should
b
3. I certify that in the performance of the work for which this permit is issued,I material.contaminants
I use equipment ea devices which
shall not employ any person in any manner so as to become subject to the Air Quality Management District I
1 ' will maintain compliance with the Cup•r� unicipal Code,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,S i .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 shaptcallwiffr or authorized agent: , 1l
• be deemed revoke1.
d. Date:11/7/2017
1,
,APPLICANT CERTIFICATION C t S_ :U a1 0 y _Olt G c_G C
I•certify that I have read this application and state that the above information is I hereby affirm that there is a ar ruction 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 ssued(Sec.13097,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
greeto 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
- COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
r>i 10300 TORRE AVENUE • CUPERTINO CA 95014-3255 - .
's-*'.. (408) 777-3228 • build.ing@)cupe.rtino.org PEMIT#B-7.l 11- _ 167//0
CUPERTINO REV# DEF4
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATIONC ❑T.1.'9EP ❑RE-ROOF` ❑SWIMMING POOL/SPA
PROTECT ADD V`V C I Q��V"`diS I Ok ° 1 • I APN A 3(21.... `l2. _0�
OWNER i It S1 �OSelc
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STREET ADDRESS J
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CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME j LICENSE NUMBER LICENSE TYPE
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❑AR ITECT 0 OWNER.❑OWNER AGENT 0 CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT
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❑SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL ❑COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED
BATHROOM SF SF SF SF ❑DETACHED J
EXISING ❑YES EICHLER ❑ YES SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS❑NO 0 NO ❑NO
DWELLING SECOND DWELLING' ❑YES 0 ATTACHED❑DETACHED OTHER
UNITS a UNIT ADDITON:. ' ❑NO S F
POOLS 0 FIBERGLASS 0 VINYL-LINED 0 GUNITE ❑PREFABRICATED
POOL-SF SPA-SF :�'I SPA ATTACHED❑YES 0 NO I TOTAL-SF ,
RE 'I t L ITO AL tOUAT10\:
Cnnmtrrcinl or Multi=Famiht BnilditiPs with.Puhlir Sn!immine Pnnls requires Ocvnrtment o(Envirntvueulnl Healh unPrnt�n! 5
�iIL/ • f
RE-ROOF) EXISTING ROOF TYPE:''❑BUILT-UP ROOF Q ASPHALT SHINGLESO WOOD SHAKES Q WOOD SHINGLES E TILE OTHER i. (SPECIFY)
REMOVE/REPLACE I:NO IF NO PLYWOOD ❑'h"" ❑3/8" ' PLYWOOD TYPE: PITCH: ROOF CLASS
❑YES F OF LAYERS THICKNESS 0 5/8" OTHER ❑OSB ❑CDX OTHER •12 A
PROPOSED ROOF TYPE:❑BLSLT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER
*Provide a signed copy of th'e 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 have provided is.correct. I have read the Description of Work and verify it is accurate. I agree
to comply with all applicable local ordin,l: ce - d state laws relating to building construction. I authoriz representatives of Cupertino to
enter the above-identified properfy for i 1 i... .urposes. I acknowledge and authorize all information ntai ed on this application form
to be made available for public record. •
p y
Signature of Applicant/Agent; Date: !/ r x -
SUPPLEMENTAL INFORMATION,R:. REP
*New SFD/Second Dwelling Units/M iI ly Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a comp= r. 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 08/01/17