B-2017-2120 . CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2120
7647 SQUIREWOOD WAY CUPERTINO,CA 95014-5054(362 27 011) AFFORDABLE WATER
HEATERS AND
PLUMBING INC •
28358
CONSTELLATION RD'
VALENCIA,CA 91355
OWNER'S NAME: POOLE JOHN E AND MARGARET J DATE ISSUED: 12/11/2017 '
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OWNER'S PHONE: 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
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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 -
performance of the work for which this permit is issued.
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 27 011
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,the applicant understands and will comply with all non-point • 180 DAYS FROM LAST CALLED INSPECTION.
source regulations per the Cupertino Municipal Code,Section 9.18.
Issued by:Kim Dunbar
Signature ,,... , Date 12-11-2017 Date: 12/11/2017
OWNER-BUIL e • E LARATION ; RE-ROOFS:
hereby affirm that m 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
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sale(Sec.7044,Business&Professions Code) Signature of Applicant:
2. I,as owner of the property,ani'exclusively contracting with licensed Date: 12-11-2017
contractors to construct the project(Sec.7044,Business&Professions Code).
I herebyaffirm under penaltyof perjury'one ROOF COVERINGS TO BE CLASS"A"OR BETTER
p J ry'one of the following three 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 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 f 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 Cupertino Municipal Code,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Cod• Se 'ons 25505,25533,and 25534.
exemption,)become subject tb 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:12-11-2017
APPLICANT CERTIFICATION CONSTRU CI ENDI G AGEN Y
I certify that I have read this application and.state that the above information is I hereby affirm that there is a c.nstr,ction 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 c ed(Sec.3097,Civ C.)
relating to building construction,andhereby 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 theJ'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. '