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B-2018-0959 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0959 22156 CLEARCREEK CT CUPERTINO,CA 95014-1101(326 18 020) AFFORDABLE WATER HEATERS AND PLUMBING INC 28358 CONSTELLATION RD VALENCIA,CA 91355 OWNER'S NAME: DATE ISSUED:06/05/2018 OWNER'S PHONE: PHONE NO:( LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-36 Lic.#627368 Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Date XBLDG_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. (N)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, I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Cade,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 slate that the above APN Number: Oc ,pancy'I'ype: Information is correct.I agree to comply with all city and county ordinances 326 18 020 and stale 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. AdditiotnI understands and will comply with all non-point180 DAYS FROM LAST CALLED INSPECTION. ourceheCupertino Municipal Code,Section B1B. Issued by:Jasmine ArchbolSignatDate 06/05/2018 Date:06/05/2018 ONECLAR TION RE-ROOFS: Iherebexempt from the Comb actor's License Low 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 alt inspection,I agree to remove all new materials for r. 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 ofApplierut: z. 1,as owner ofthe property,am exclusively contracting with licensed Date:06/05/2018 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 t. 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 z. I Its-and will maintain Worker's Compensation Insurance,as provided for by Calif ornis Health&Safety Code,Sections 25505,25533,and 25534.1 will Section 3700 of the Labor Cade,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(x)should 1 store or handle hazardous a. 1 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 Worker's Compensation laws of California.if,alter making this certificate of wdl maintain compliance with the t cr i Municipal Code,Chapter 9.12 end P g the Flealtlr&Safety Ca oc 25505,25533,and 25534. exemption,I become subject to the Worker's Compensation in of the Labor Code,l must forthwith comply with such provisions or this permit shall Owner or authorized agent \ be deemed revoked. Data:06/05/2018 APPLICANT CERTIFICATION CONST UCT ON LENDINGAGENCY I certify that I have read this application and state that the above information Is I hereby affirm that there is con traction lending agency for the performance correct.I agree to comply with all city and county ordinances and slate laws of work's for which this perm is sued(Sec.3097,Civ C.) relating to building construction,and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned properly 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.