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B-2018-0790 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0790 10741 WUNDERLICH DR CUPERTINO,CA 95014-3848(375 29 003) AFFORDABLE WATER HEATERS AND PLUMBING INC 28358 CONSTELLATION RD VALENCIA,CA 91355 OWNER'SNAME:LEE LAWRENCE LAND JENNIFER Y DATE ISSUED:05/08/2018 OWNER'S PHONE: PHONE NO:( LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-36 Lie.#627368 Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Date X BLDG ELECT X PLUMB 09/30/2018 MECH X RESIDENTIAL_COMMERCIAL 1 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 full farce and effect. (N)40 GAL WATER HEATER-OUTSIDE CLOSET I hereby affirm under penalty of perjury one of the following two declarations: r. 1 have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of tl7c Labor Code,for the erformanec of the work for which this permit is issued, have and will he Worker's Compensation Insurance,as provided for by -- action 3700 of the Labor Code,for file performance of the woiic far which this Sq.Ft Floor Area: Valuation:$1701.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read thin,, and state that the above APN Number: Occupaney'I'ype: information is correct.I agree to comply with all city and county ordinances 375 29 003 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 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:Jasmine Archbold Sigmdure___< Data 05/08/2018 Date:05/08/2018 OWNER-BUILDER DECLARXI ION RE-ROOFS: 1 hereby oMo.that 1 am exempt from the Contrrmt is License Lore I'or one of the All roofs shall be inspected prior to any roofing material being installed.Ifs roof is following bvu reasons: installed without First obtaining an inspection,I agree to renmve all new matm ials for t. I,as owner of the properly,or my employee with wages as their sole inspection. compensation,will do die work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) Signature of Applicant x. I,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 r. I have and will maintain a Certifieate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 ofthe 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 have and will maintain Worker's Compensation boaraoce,as provided for by California Health&Safety Cade,Sections 25505,25533,and 25534.1 will Section 3700 of the Labor Code,for the performance of the work for which[Itism aintain comptiance with the Cupertfno Municipal Code,Chapter 9.12 and the rm peft is issued Health&Safety Cade,Section 25532(n)should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued,l materinl.Additionally,should I use equipment or devices which craft ha-rclous shall not employ any person in any manner so as to become subject t0 the air conmuinants as dollar,]by the Bay Area Air Quality Mmagentent 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 Code,Sections 25505533,and 25534. exemption,[become subject to the Worker's Compensation provisions of the Labor Cade,I mast forthwith comply with such provisions or this permit shall Owner or authorized agent: , be deemed revoked. Date:05/08/2018 APPLICANT CE RTIFICATION CONS1IiUCTI04 ENDING AGENCY 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 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.