B-2019-0030 CITY OF CUPERTINO BUILDING PERMIT '
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2019-0030
21483 SHANNON CT CUPERTINO, CA 95014-4970 (362 01 008) AFFORDABLE WATER
HEATERS AND
PLUMBING INC
28358
CONSTELLATION RD
VALENCIA, CA 91355
OWNER'S NAME: LIANIDES CHRIS W TRUSTEE DATE ISSUED: 01/07/2019
OWNER'S PHONE: 408-370-9106 PHONE NO: (855) 345-9087
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-36 Lic. #627368
Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Date X BLDG — ELECT X PLUMB
09/30/2020 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 WATER HEATER (50 GAL) SAME LOCATION (GARAGE)
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
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: $2837.00
permit is issued.
APPLICANT CERTIFICATION
-1 certifythat I have read this application and state that the above 362 Number: Occupancy Type:
p 362 O1 008
information is correct. I agree to comply with all city and county ordinances
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 ®F 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 regulatio s perffiZNupertino Municipal Code, Section 9.18.
Issued by: Haley McKee
Signature Date 1/7/19 Date: 01/07/20.19
OWNER-B LDER ECLARATION
RE-ROOFS:
I hereby affirm4jat amexempt 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 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 of Applicant:
2. I, as owner of the property, am exclusively contracting with licensed Date: 1/7/19
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
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
3. 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
air contaminants as defined by the Bay Area Air Quality Management District I
shall not employ any person in any manner so as to become subject to the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of the Health & Safety Cod Se to s 25505, 25533, and 25534.
exemption, I 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: 1/7/19 f
APPLICANT CERTIFICATION CO ST UCTI N LENDING AGENCY
certify that I have read this application and state that the above information is I hereby affirm that there is a %o-'nstr 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 iii su 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
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.
.. CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION13
r 10300 TORRE AVENUE CUPERTINO, CA 95014-3255
(40877 - _ * ,73228 �u�.ldln �@�u ert�nO,ar PEMIT #B 00-So
CU ER INOREV # DEF #
Q,.
9
❑ NEW CONSTRUCTION FIADDITION r ALTERATION El T.I. ❑ MEP ❑ RE-ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS 6APN#
7, S4 cr ,
OWNER NAME PHONE E-MAIL
0, I tde_,� �
S
STREET ADDRESS ChY, STATE, ZIP
,".`7 "1
® CONTRACTOR NAME ❑ OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
JORGE EECERRA AWHAP 627368 C-36
STREET ADDRESS CITY, STATE, ZIP
28358 CONSTELLATION RD. VALENCIA, CA 91355
E-MAIL PHONE BUS. LIC
jorge@awhap.com (855)345-9048 400652
❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT ❑ CONTRACTOR AGENT❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NAME EMAIL
STREET ADDRESS CITY, STATE, ZIP PHONE
DESCRIPTON
R & R V GALLON WATER HEATER
SAME LOCATION=
, I,NGLE-FAMILY/DUPLEX []MULTI FAMILY ❑ INDUSTRIAL ❑ COMWERCIAL
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES # TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION ( )
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ® ATTACHED
BATHROOM SF SF SF SF ❑ DETACHED
EXISING I,:.1 YES EICHLER ❑ YES SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS ❑ NO ❑ NO ❑ NO
DWELLING I SECOND DWELLING ❑YES ❑ATTACHED❑DETACHED OTHER
UNITS# UNIT ADDITON: ❑ NO S F
POOLS1 FIBERGLASS ❑ VINYL-LINED ❑ GUNITE ❑ PREFABRICATED
POOL-SF SPA-SF SPA ATTACHED ❑YES ❑ NO TOTAL-SF
RE 7 DB : I TOTA VALUATION:
Ca mercial or Multi-Family Buildings with Public Swimmi tg Pools re wires D artment of Environmental Heath qpffoval
RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF []ASPHALT SHINGLES 0 WOOD SHAKES❑ WOOD SHINGLES TILE OTHER(SPECIFY)
REMOVE/REPLACE ❑ NO IF NO PLYWOOD ❑ le ❑ 3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
YES I #OF LAYERS THICKNESS ❑ 5/8" OTHER ❑OSB ❑ CDX OTHER :12 A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑ WOOD SHAKES ❑WOOD SHINGLES ❑OTHER
'Provide a signed copy of the Cupertino's Tear-Off Policy SF #of SQUARES
By my signature below I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I
have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree
to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to
enter the above-identified property for ' sp ' n purposes. I acknowledge and authorize all information contained on this application form
to be made available for public record.
Signature of Applicant/Agent: Date:.1-7-2019
SUPPLEMENTAL INFORMATION R Q RED
'New SFD/Second Dwelling Units/Mul 'fam ly Dwellings: A Demolition permit is required prior to issuance of a building permit for all new construction.
'Commercial Buildings: Provide a comp d Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
'WHOA-Provide a letter of approval from. the Home Owner's Association
BldgApp 2017.doc revised 08101117