B-2018-0782 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-20180782
22646 SAN JUAN RD CUPERTINO,CA 95014-3933(342 18 042) CUPERTINO
PLUMBING INC
SAN JOSE,CA 95124
OWNER'S NAME: DATE ISSUED:05/09/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S D'CL RAT O BUILDING PERMIT INFO:
License Class C-36 Lie.4624905
Contractor CUPERTINO PLUMBING INC Date 04/3012020 X BLDG_ELECT X PLUMB
p p (commencing MECH X RESIDENTIAL_COMMERCIAL
I hereby affirm that I am licensed under the rovisions of Cha ter 9 in
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE TANKLESS WATER HEATER(SAME LOCATION);NEW V
1 hereby affirm under penalty of perjury one of the following two declarations: GALVANIZED GAS LINES-TANKLESS WATER HEATER(199000
r. I have and will maintain a certificate of consent to self-insure for Worker's BTU);
Compensation,as provided for by Section 3700 of the Laho Code,for the ELECTRICAL CONNECT FOR TANKLESS WATER HEATER
performance of the work for which this permit is issued.
have and wiil maintain Worker's Compensation luminance,as provided to,by
Section 3700 of the Labor Code,for the performance of the work fmwhich this
permit is issued Sq.Ft Fluor Area: Valuation:$26000.00
APPLICANT CERTTFiCATION
I certify that I have read this application and slate that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 342 18 042
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City In consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
�--•� Date 519/2018 Issued by:Abby Avende
Date:05/09/2018
O -B'TLD DE RATf
1 hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS,
fiAlowing two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. 1,as owner ofthe property,or my employees with wages as lith We inshdled without£st obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended o'offered for inspection,
sale(Sce.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed Signature ofApplicane
conhnetors to construct the project(See.7044,Business&Professions Code), Date:5/9/2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
n, 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
performance of the work for which this permit is issued HAZARDOUS MATERIALS DISCLOSURE
x I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued, maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and it,,
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Cud.,Section 25532(.)should 1 stare or handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
air contaminants as dented by the Bay Area Air Quality Management District I
Worker's Compensation laws of Califunic.If,aRm making this certificate of will maintain compliance with the Cupert. Mun 'I Code,Cla iter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cede,Sectio s�S,Oft i
Labor Code,l must forthwith comply with such provisions or this permit shall
be deemed revoked, Owner or authorized agent:
APPLICANT CERTIFICATION Date:5/9/2018
I certify that I have read this application and state that the above information isLENDf CY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that th is a construction lending agefor the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,C )
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit.Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Data 519!2018 Professional