B-2019-0032 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2019-0032
22350 REGNART RD CUPERTINO, CA 95014-4825 (366 41 002) AFFORDABLE WATER
HEATERS AND
PLUMBING INC
28358
CONSTELLATION RD
VALENCIA, CA 91355
OWNER'S NAME: ISHII SEITARO AND TOSHIMI DATE ISSUED: 01/0.7/2019
OWNER'S PHONE: 408-517-1423 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 (75 GAL) SAME LOCATION
(BASEMENT)
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: $3800.00
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 366 41 002
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,Kept understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION,
source reguCupertino Municipal Code, Section 9.18.
Issued by: Haley McKee
Signaturew Date 1/7/19 Date: 01/07/2019
OWNER-BU DE DECLARATION RE-ROOFS:
All roofs shall be inspected prior to an roofing material being installed. If a roof is
I hereby affirm tti I am exempt from the Contractor's. License Law for one of the p p y g g
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 & Profeskons 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 2.5505, 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, aftermaking this certificate of the Health & Safety Code, ect' 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
APPLICANT CERTIFICATION CONSTRJCTIO LENDINGAGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a constru tion 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 'ssu 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 DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 7773228 • building@cupertino.or PEMIT #B -
CUPERTINO REV # DEF #
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION ❑ T.I. ❑ MEP ❑ RE-ROOF ® SWIMMING POOL/SPA
PROJECT ADDRESS APN #
zz� 1 r 1
OWNER NA PHO _ �— ,,, E-MAILJAq-
STREET ADDRESS CITY, STAR,ZII'
j,�,-40 0
Lev J A,
0 CONTRACTOR NAME ❑ OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
JORGE BECERRA AWHAP 627388 C-36
STREET ADDRESS CITY, STATE, MP
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 E-MAIL
STREET ADDRESS CITY, STATE, ZIP PHONE
DESCRIPTON
R & R GALLON WATER HEATER
SAME LOCATION= 19AJeWell
❑SINGLE FAMILY/DUPLEX ❑MULTI FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL
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 ❑ YES EICHLER ❑ YES SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS ❑ NO [I NO ❑ NO
DWELLING I SECOND DWELLING ❑YES ❑ATTACHED 0 DETACHED OTHER
UNITS# UNIT ADDITON: ❑ NO S F
POOLS ❑ FIBERGLASS ❑ VINYL-LINED ❑ GUNITE ❑ PREFABRICATED
POOL-SF SPA-SF SPA ATTACHED YES ❑ NO TOTAL-SF
RE C BY• TOTAL VALUATION:
Commercial or Multi-Family Buildh s with Public Swimming Pools re uires Pe artment of Environmental Heath a oval LOD
IRE-R00F EXISTING ROOF TYPE: ❑BUILT-UIQ ROOF ❑ASPHALT SHINGLES❑WOOD SHAKES❑ WOOD SHINGLES ❑ULL OTHER(SPECIFY)
Enim
REMOVE/REPLACE ❑ NO IF NO PLYWOOD ❑ 1�., ❑ 3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
[]YES # 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 Cupertin.o'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 insp'e7fion purposes. I acknowledge and authorize all information contained on this application form
to be made available for public rec7)or
Signature of Applicant/Agent: Date: 1-7-2019
SUPPLEMENTAL INFORMATIU REPtMHazardous
ED
'New SFD/Second Dwelling Units ltiDwellings: A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a ca 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.doe revised 08/01117