B-2018-0958 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0958
876 S BLANEY AVE CUPERTINO,CA 95014-4551(369 27 003) AFFORDABLE WATER
HEATERS AND
PLUMBING INC
28358
CONSTELLATION RD
VALENCIA,CA 91355
OWNER'S NAME: DATE ISSUED:06/05/2018
OWNER'S PHONE:408-427-1104 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 Dale X BLDG ELECT X PLUMB
0913012018 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 fall force end effect. (N)40 GAL WATER HEATER-GARAGE
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of eonsent to self-insure For Worker's
Compensation,as provided for by Section 3700 of the Labor Code,far the
"^performance of the work for which this permit is issued.
/1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 ofthe Labor Code,for the performunce of the work for which this Sq.Ft Floor Ares: Valuation:$1600.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and slate that the above APN Number: Occuponcy Type:
information is correct.I agree to comply with all city and county ordinances 369 27 003
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 againit said ity in consequence of the granting of this permit.
Additionally,the a plica and its and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source regulalio Municipal Code,Section 9.18.
Issued by:Jasmine Archbold
Signature Date 06/05/2018 Date:06/05/2018
OWNER-BUILDS D CLARATION RE-ROOFS:
I hereby affirm that Al exempt from the Contractor's License Law for one of the Ail roofs shall be inspected prior to any roofing material being installed.If a roof is
following hvo reasons: installed without first obtaining an inspection,I agree to remove all new materials far
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 at offered for
sale(See.7044,Business&Professions Code) Signature ofApplicann
2. 1,as owner of the property,am exclusively contracting with licensed Date:06/05/2018
contractors to construct the project(Sec.7044,Business&Professions Cade).
I hereby affirm under penalty ot'parjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 1 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 £the work for which this permit is issued. I have read the hazardous materials requirements tinder Chapter 6.95 of the
z. I have and will maintain Worker's Compensation henterce,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 Cade,Chapter 9.12 and the
permit is issued. Health&Safety Code,Section 25532(x)should I stn a or handle hazardous
a. 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"
y the Bo,,,,,,YYYYYYqAre Iity Management District 1
Worker's Compensation laws of California.If,after making this certificate of wall maintain compliance Pith the Cylp- unic at Code,Chapter 9.12 and
P 8 the health&Safety C de' Oran 2,0 5533,and 25534,
exemption,I become subject to the Worker's Compensation provisions of the
Labor Code,I must forthwith comply with such provisions at this permit shall Owner or authorized agent:
be deemed revoked. Date:06/0512018
APPLICANT CERTIFICATION CO TR 'fIONL;NDING AGENCY
I certify that I have read this application and state that the above Information is I hereby affirm that there is a c nstmctio 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 stained( c.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.