B-2018-0789 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0789
7915 BELKNAP DR CUPERTINO,CA 95014-4973(362 08 040) AFFORDABLE WATER
HEATERS AND
PLUMBING INC
28358
CONSTELLATION RD _
VALENCIA,CA 91355
OWNER'S NAME: DATE ISSUED:05/08/2018
OWNER'S PHONE: 7 PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-36 Lic.#627368
Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Date X BLDG_ELECT X PLUMB
09/30/2018 MECHX RESIDENTIAL_COMMERCIAL
I hereby affirm that lam licensed under the provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my JOB DESCRIPTION:
licenseis in fall farce and effect. (N)50 CAL WATER HEATER-KITCHEN CLOSET
I hereby affirm under penalty of perjury one of the following live declarations:
r. I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labe,Code,for the
crformance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work far which this Sq.Ft Floor Area: Valuation:$1500.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above APN Number: Occupancy'lype:
information is correct.I agree to comply with all city and county ordinances 36208 040
and slate 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
Signature--- "I Data 05/08/2018 Date:05/09/2018
OWNER-BUILDER DECLARATION RE-ROOFS:
I hereby arfnrm that I ani exempt from the Contractor's License Law 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 Erst obtaining an inspection,I agree to remove all new materials for
n. 1,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 ofApplieran:
z. 1,as owner of the property,am exclusively contracting with licensed Dam:05/08/2018
contractors to causnecl 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 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 ofthe work for which this permit is issued. I hove read the hazardous materials requirements under Chapter 6.95 or the
x. 1 have and will maintain Worker's Compensation Insurance,as provided for by C.lifernia lle:dth&Sat'ety Cede,Sections 25505,25533,and 25534.[will
Section 3700 of the Labor Code,for the performance ofthe wank Cor which thisainmin compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Perm is issued. m Health&Safety Code,Section 25532(.)should I store or handle for-rdons
s. 1 certify that in the performance of the work for which this permit is issued,I naterial.Additionally,should I use equipment or devices which emit hazardous
•contaminants as dented by the Bay Area Air Quality Management District 1
shall not employ any person in say manner so as to become subject to the will ll maintain compliance with the Cupertino Municipal Code,Chapter 9.12.ad
Worker's Compensation laws of Californis.IC,after making this certificate of the Health&Safety Code,Sectio 25.JI5r255vv3,and 25534.
exemption,1 become subject to the Worker's Compensation provisions of the
Labor Code,I must forthwith comply with such provisions or this permit shall Owner or authorized agent:
be deemed revoked. Date:05/08/2018
APPLICANT CERTIFICATION CONSTRUCTION LENDING 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.