B-2018-1245 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1245
10355 STERN AVE CUPERTINO,CA 95014-3643(375 10 053) - AFFORDABLE WATER
HEATERS AND
PLUMBING INC
28358
CONSTELLATION RD
VALENCIA,CA 91355
OWNER'S NAME;KURTICH MIRO DATE ISSUED:07/25/2018
OWNER'S PHONE: PHONE NO:(855)345-9087
LICE BUILDING PERMIT INFO:
License Class C36 Lic.#627368
Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Date X BLDG_ELECT XPLUMB
09/30/2018 MECH X RESIDENTIAL_COMMERCIAL
I hereby affirm that I am licensed wider 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 40 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£or Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
r performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation insurance,as provided for by
61
Section 3700 of the Labor Code,for the performance of the wa k far which this Sq.Ft Floor Area: Valuation:$1550.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and slate that the above APN Number: Creuponcy Type:
information is correct.I agree to comply with all city and county ordinances 375 10 053
and state laws relating to building construction,and hereby authorize
representatives of this city to enter upon the above mentioned properly 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.
=nderstandsnt understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
Municipal Code,Section 9.18,
Issued by:Kim DunbaDate 7-25-2018 Date:07/25/2018
CCLARATION R&ROOFS:
1 hereby affirm that I am exempt from the Contractor's License Law.l'ar one at tile All roofs shall be inspected prior to any roofing material being installed.If a roof is
following two reasons: installed without first obtaining an nspection,I agree to remove all new materials for
1. I,as owner of the property,ca my employees with wages as their sole inspection.
compensation,will do the work,and the.structure is not intended or offered for
sale(Sce.7044,Business&Professions Code) Signature of Applicant
1. I,as owner of the property,am exclusively contracting with licensed Dote:7-25-2018
contractors to construct the project(Sce.7044,Business&Professions Code). -
I hereby affirm under penalty ofperjury one of the following timet declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
L 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. 1 lervererid the hazardous aatm ids requirements under Chapter 6.95 of the
I. l 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 Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Section 25532(x)should I state or handle hazardous -
a, 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 camzd
cast lwmas
shall net employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District l
will maintain compliance with
Labor Code,I must forthwith comply with such provisions or this permit shall Owner or authorized agen��
be deemed revoked. Date:7-25-2018
APPLICANT CEIITIFICATION CONST UCTI N LE NCA E CY
I certify that I have read this application and state that the above Information Is I hereby affirm that there is a onst ction 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 I iss ed(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.