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B-2018-0791 - CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0791 10110 CRESCENT CT CUPERTINO,CA 95014(326 17 059) AFFORDABLE WATER HEATERSAND PLUMBING INC 28358 CONSTELLATION RD VALENCIA,CA 91355 OWNER'S NAME: DATE ISSUED:05/08/2018 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 Data X BLDG—ELECT X PLUMB 0913012018 MECH X RESIDENTIAL_COM M ERCIAL I hereby affirm that 1 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 and effect. (N)75 GAL WATER HEATER-GARAGE I hereby affirm under penalty of perjury one of the following two declarations: 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 erfonmanec of the work for which this permit is issued. have and will maintain Worker's Compensation Insurance,as provided for by ection 3700 of the Labor Code,for the performance critic work for which this Sq.Ft Flom Area: Valuation:$2850.00 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 326 17 059 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 Cupertino­Mmric'aI Code,Section 9.18. i" Issued by:Jasmine At Signature Date 05/08/2018 Date:05/08/2018 OWNER-BUILDER DECLARATION lt&-120085• I hereby affirm that I am exempt from the Contractor's License Law 1'ar one of the AI I roofs shall be impeded prior to any rooting material being installed.If.roof is following two reasons: installed without first obtaining an inspection,I agree m remove all new materials for 1. 1,as owner of the property,or my employees with wages as their sole inspection. compensation,will do the wok,and the structure is not intended or offered For said(Sec.7044,Business&Professions Cade) Signature o£Applicant: 2. 1,as owner of the property,am exclusively contracting with licensed Date;05/08/2018 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 1. I have and will maintain a Certificate of Consent to self-insure£or Worker's Compensation,as provided for by Section 3700 o£the Labor Code,for the HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. 1 have read the hazardous materials requirements under Chapter 6.95 of the 1. 1 have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534.f will Section 3700 of the Labor Code,for the performance of the work for which thismaintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Code,Section 25532(x)should I stare or handle hazardous s. 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 unit h-ardous shall not employ any person in any manner so as to become subject to the air eonrnmmnnts es defined by the Bay Aron Air Quality Management District 1 w Worker's Compensation laws of California.1C,after making this certificate of ill maintain connpliance with the Cupertino Municipal Cade,Chapter 9.12 andthe health&Safety Code,Sections 25505,25533,and 25534. exemption,l become subject to the Worker's Compensation Provisions o£llre �� ,.-"�-j Labor Code,I must forthwith comply with such provisions cr this permit shall Owner or authorized ager#.__ / bedeemed revdked' Date:05/08/2016 , APPLICANT APPLICANT CERTIFICATION I certify that I have read this application and state that the above information Is I hereby affirm that there is a construction 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 issued(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 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 DECLARAIJONNCT'S DECLARNIJONN 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.