B-2018-1322 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PEIiMIT'NO:B-2018-1322
19866 PEAR TREE LN CUPERTINO,CA 95014-2360(316 31 010) AFFORDABLE WATER
HEATERS AND
PLUMBING INC
28358
CONSTELLATION RD
VALENCIA,CA 91355
OWNER'S NAME: DATE ISSUED:08/06/2018
OWNER'S PHONE: PHONE No:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC36 Lle.#627366
Contractor AFFORDABLE WATER HEATERS AND PLUMBING ING Dale X BLDG—ELECT X PLUMB
09/30/2018 MECH X RESIDENTIAL_COMMERCIAL
I hereby affirm that I am licensed under the provisions of Clmpter 9(commencing
with Section 7000)of'Divisfon 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:
m. I have and will maintain a certificate of consent to self-insure far 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.
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.Rt Floor Area: Voiced-$1426.00
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 316 31 010
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 WORT{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,t e applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source regal ions er a Cupertino Municipal Code,Section 9.16.
Issued by:Kim Dunbar
Signature Date 08-06-2018 Date:08/06/201A
OWNER-B 71 D DC LARATION RE-ROOFS:
1 hereby affirm that I am exempt from the Contractor's License Law for one of the Ail more shall be inspected prior to any roofing material being installed,if e roof is
following two rrinmo: installed without First obtaining an inspection,I agree to remove all new materials for
1. I,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 orApplicanb
z I,as owner of die property,am exclusively contracting with licensed Date:08-06-2018
contractors to construct the project(See.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations: ALI,ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. I have and will nmintain a Certificate of Conawn to self-insure for Workers
Compensation,as provided for by Section 3700 of the Labor Code,Fc the HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous mate tats 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 25534.1 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(0 should I stare or handle hazardous
s. I certify that in the performance of the work for which this permit is Issued,I material.Additionally,should I use equipment o•devices which emit hazardous
air contaminants as defined by the tiny Area Air Quality Management District I
shall not employ any person in any nionner so as to become subject to the will maintain umnplinu=1 .12aa'' nl Code,Clmp[e•9.12 and
Worker's Compensation laws ofCalifornia.If,after making this certitcee of the Heald,&
I certify that I have read this application and state that the above Information is I hereby affirm that there is a con ruction 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 is lied(S c.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 9.16.