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B-2018-0602 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0602 11601 ORCHARD SPRING CT CUPERTINO,CA 95014-5122(366 54 027) AFFORDABLE WATER HEATERS AND PLUMBING INC 28358 CONSTELLATION RD VALENCIA,CA 91355 OWNER'S NAME: DATE ISSUED:04/11/2018 OWNER'S PHONE: PHONE NO:( LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CC=36 Lic.#627368 Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Date X BLDG ELECT X PLUMB 09/30/2018 MECH$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. REPLACE 50 GAL WATER HEATER-SAME LOCATION 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 Za1a7ance of the work for which this permit is issued. grave and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Arca: Valuation:$1850.00 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 366 54 027 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-M c!pal Code,Section 9.18. _ Issued by:Abby Avende Signature.— - Date 4(11t2018 Date:04/11/2018 OWNE LARATIONI—- RE-ROOFS: I hereby affirm that I am 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 real is following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1. I,as owner of the properly,or my employees with wages as their sole inspection compensation,will do the work,and the structure is not intended or offered for sale(Sm.7044,Business&Professions Code) Signorine of Applicant: z. 1,as owner of the property,am exclusively contracting with licensed Data:4/11/2018 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 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 have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534.I will Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and the permit is issued. Health&Safety Code,Section 25532(x)should I store or handle hazardous 3. 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 shah not employ any person ur any manner sur as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and Worker's Compensation laws of California,If,ager making this certificate of the Health&Safety exemption,I become subject to the Worker's Compensation provisions of the / Labor Code,I most forthwith comply with such provisions or this permit shall Owner or authorized agent: be deemed revoked. Date:4/1112 0 1 8 APPLICANT CERTIFICATION C TIO _XEND vCY I certify that I have read this application and state that the above Information Is I hereby affirm that there Is a cons ructlon 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.