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B-2018-1246 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMITNO:B-2018-1246 20230 JOHN DR CUPERTINO,CA 95014-4417(369 35 004) AFFORDABLE WATER HEATERSAND PLUMBING INC 28358 CONSTELLATION RD VALENCIA,CA 91355 OWNER'S NAME:GRUBBS WAYNE H AND CUNNINGHAM LINDSAYTRUST DATE ISSUED:07/25/2018 OWNER'S PHONE: PHONE NO:(855)345.9097 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C36 Lie.#627368 Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Date X BLDG_ELECT X PLUMB 09/30/2018 MECH X 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: r. 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 performance of the work for which this permit is issued. I have 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 Area: Valuation:$3133.00 permit is issued. APPLICANT CERTIFICATION cdrily that I have read this application and state that the above APN Number: Occuponey'fype: information is correct.I agree to comply with all city and county ordinances 36935 004 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 app_'cant ntands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION. source regulations er th Cu lino Municipal Code,Section 9.18. Date 7-25-2018 Date:07/25/2018 OWNER-BUILDE DE LARATION RE-ROOFS: I hereby affirm that I am exempt train the Contractor's License Law for one of the All roofs shall be inspected prior to any roefing material being installed.Its roof is following two reasons: installed without first obtaining an inspection,f agree to remove all new materials for t. I,ar 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 o£Applicaot z. I,as owner ofdte property,am exclusively contracting with licensed Date 7-25-2018 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 t. 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 have read the hazardous materials requirements under Chapter 6.95 of the z. f have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534,1 will Section 3700 of the Labor Code,for the performance of the work for which thism aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued, Health&Safety Cdde,Section 25532(x)should I store or handle hazardous a. I certify that in the performance of the work for which this permit 6s Issued,l material.Additionally,should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants ns defined by the Bs Area Air Quality Management District I will mninhdn complhmce with t��iudd de,Chapter 9.12 and Worker's Compensation laws of California.If,after making this certificate of the Health&Safety C 25534, exemption,l 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:7-25-2018 APPI.IGAN'f GER"I'IFICA'I'ION O TRUC ION L' DIN A ENCY I certify that I have read this application and state that the above information Is I hereby affirm that there is a con ucfon lending gency 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 iss c.3097,Civ C.) relating to building construction,and hereby authorize representatives of this city Lender's Name toenter 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.Additlonally,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.