B-2018-1420 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1420
10605 JOHANSEN DR CUPERTINO,CA 95014-3508(375 37 055) AFFORDABLE WATER
HEATERS AND
PLUMBING INC
28358
CONSTELLATION RD
VALENCIA,CA 91355
OWNER'S NAME: DATE ISSUED:08/23/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Cif.Llc.#827388
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. (N)40 GAL WATER HEATER-(SAME LOCATION)
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain Wor'ker'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:$1275.00
permit is issued.
APPLICANT CERTIFICATION AIN Number: Occupancy Type;
I certify that I have read this application and state that the above
Information Is correct.I agree to comply with all city and county ordinances 375 37 055
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 S'TART'ED
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 reg our thhCupertino Municipal Code,Section 9.18.
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Signatu Date 08/23/18 Date: 8 233/201) Issued by: 8MeKee
OWNER- UILD DECLARATION RE-ROOFS:
I hereby af8rr 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 roof is
following two reasons: installed without fust obtaining an inspection,I agree to remove all new materials for
r. 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(See.7044,Business&Professions Code) Signature of Applicant:
2. I,as owner of the property,am exclusively contracting with licensed Date:08/23/18
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
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 of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
2. 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 Code,Chapter 9.12 and the
permit is issued, Health&Safety Code,Section 25532(a)should I store 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 or devices which emit hazardous
shall not employ any person in any manner so as to become subject[o
the air contaminants as deitned by the ay Area Air Quality Management District I
will maintain compliance with the p o-A4 iclpal Code,Chapter 9.12 and
Worker's Compensation laws of California.If,after making this certificate of the Health&Safely*,C.od, e t o 225 5,25533,and 25534.
exemption,I become subject to the Worker's Compensation provisions of the ,�",✓
Labor Code,l must Forthwith comply with such provisions or this permit shall Owner or authorized a
be deemed revoked, Date:08(23148
APPLICANT CERTIFICATION CO STRUCTI0 LEND AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that
the Is a constru tion in, agency for the performance
correct.I agree to comply with all city and county ordinances and state laws of work's for which this ermit is Issu d(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 Lender's Address
to save Indemnify and keep harmless the City of Cupertino against liabilities,
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.