B-2017-1917 •
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1917 •
10221 STERN AVE CUPERTINO,CA 95014-3666(375 11 069) AFFORDABLE WATER
HEATERS AND
PLUMBING INC
28358
CONSTELLATION RD
VALENCIA,CA 91355
OWNER'S NAME: LEE MENG-KUN AND LIU SHIH-YU TRUSTEE DATE ISSUED: 11/07/2017
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OWNER'S PHONE:408-313-6355 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 XPLUMB
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 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 .
1 >-rformance of the work for which this permit is issued.
i ,-' I have and will maintain Worker's Compensation Insurance,as provided for by
ti
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$1953.00
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 375 11 069
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,th app'c. t understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source regulati1s•er - upertino Municipal Code,Section 9.18.
/ Issued by:Abby Ayende
d +gil ature a�®S Date 11/7/2017 Date: 11/07/2017
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O ► '-: IED C L4_ 0 BE-ROOFS:
I hereby affirm NI 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. 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:11/7/2017
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
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. 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 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 •.pe . unicipal Code,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code�.ecti.. .505,25533,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 shallgir
5"`miner or authorized agent: i� 1
be deemed revoked. _
Date:11/7/2017
,APPLICANT CERTIFICATION CO S Y'U t IO LE r G AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a c•nstru,tion 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'ssu: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'ke`ep 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 :-. 4 B
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 •
'_,:} '*_ (408) 777-3228 • huild.ing@cupertino.org PEMIT#B- Oo 14 _
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION ALTERATION ❑T.I. E MEP ❑RE-ROOF ❑SWflv2vIING POOL/SPA
PROJECT ADDRESS 1t) 22 �J+04 /�C j,�` APN A `l C - I )-0 _�
O R nun E I J �( PT'H/ONEst ✓ E-MAILv ` �.fl
STREET�ADDRESS ` STMT ZIP
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KCONTRACTOR NAME D OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
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ZIP
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E-I4AIL rEJ34c
BUS:'LIw4P� �m - 5'0�� 4 606x2
0 AR ITECT 0 OWNER'.❑OWNER AGENT 0 CONTRACTOR ENGINEER 0 DEVELOPER 0 TENANT
CONTACT'f�NAME p�� E-MAIL n I Q
, 5 TADDRE 1 S ZIP PHONE
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[(AP) )Sq?——10
DECRIPTON +
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SINGLE-FAMILY/DUPLEX, 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL
ING 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 DYES EICHLER ❑ YES SECOND STORY ADDITION O
FIRE SPRINKLERS❑NO 0 NO NO
DWELLING SECOND DWELLING, ❑yes ❑ATTACHED 0 DETACHED OTHER
UNITS4, UNITADDITON: , ❑NO SF
POOLS 0 FTBERGLASS 0 VINYL-LINED 0 GUNITE ❑PREFABRICATED
POOL-SF SPA',SF I SPA ATTACHED❑YES 0 NO I TOTAL-SF
RECEI 0.14.4\
"'`U� TOT V TION:
Commercial or Mulli-Fanilu Buildin s'wit i Public SwinlniMP Pools requires Department of Environmental Heath anm.OTIal J ��
RE-RO,OF EXISTING ROOF TOE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑'WOOD SHINGLES❑TILE OTHER(SPECIFY) •
REMOVE/REPLACE NO IF'NO PLYWOOD 0 W' E)3/8" PLYWOOD TYPE: • PITCH: ROOF CLASS
I ❑YES FOFLAYERS THICKNESS OTHER ❑OSB ❑CDX OTHER . ' :12 A
PROPOSED ROOF TYPE:❑BUILT=UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER .
I *Provide a signed copy of the Cupertino's Tear-Off Policy SF rot SQUARES
E 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 witli'all applicable local ordinit ce - d state laws relating to building construction. I authoriz repre's'entatives of Cupertino to
enter the above identified property for i f l.i... .urposes. I acknowledge and authorize all information ntai ed on this application form
to be made available for public record./ y f
Signature of Applicant/Agent: Date: I` J
SUPPLEMENTAL N :• r
N AL I FORMATION R RE
*New SFD/Second Dwelling Units/Mul ly Dwellings:A Demolition permit is required prior to issuance of a buildingpetmit for all new construction.
*Commercial Buildings: Provide a comp 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