B-2016-1375 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1375
7668 NORMANDY WAY CUPERTINO,CA 95014-5253(366 17 054) (F W H ACQUISITION
CO LLC)
BOTHELL,WA 98011
OWNER'S NAME: CRUM WILLARD L TRUSTEE&ET AL DATE ISSUED:02/16/2016
OWNER'S PHONE: PHONE NO:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#
Contractor(F W H ACQUISITION CO LLC)Date X BLDG —ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTiAI,_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REMOVE&REPLACE WATER HEATER IN EXISTING LOCATION-48
I hereby affirm under penalty of perjury one of the following two declarations: GALLONS
1. 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.
2. 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 permit is issued. Sq.Ft Floor Area: Valuation:$1210.00
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
information is correct.I agree to comply with all city and county APN Number: Occupancy Type:
ordinances and state laws relating to building construction,and hereby 366 17 054
authorize representatives of this city to enter upon the above mentioned
property for inspection purposes. (We)agree to save indemnify and keep
harmless the City of Cupertino against liabilities,judgments,costs,and PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will
comply with all non-point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION.
Code,Section 9.18.
Issued by: 1444
Signature Date Date:
OWNER-BUILDER DECLARATION RE-ROOFS:
I hereby affirm 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 first obtaining an inspection,I agree to remove all new materials for
i. 1,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. 1,as owner of the property,am exclusively contracting with licensed Date:
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 California Health&Safety Code,Sections 25505,25533,and 25534. I will
by Section 3700 of the Labor Code,for the performance of the work for which maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
this permit is issued. Health&Safety Code,Section 25532(#)should I store or handle hazardous
3. 1 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 to the air contaminants as defined by the Bay Area Air Quality Management District I
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 Code,Sections 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:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction 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 issued(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 ARCHITECT'S DECLARATION
consequence of the granting of this permit. Additionally,the applicant I understand my plans shall be used as public records.
understands and will comply with all non-point source regulations per the
Cupertino Municipal Code,Section 9.18.
Licensed
Professional
Signature Date
vet let 4vlv 1vr; o: %'A rxs r4RL water nOeLerS 3 �Vz/VVI
J
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(4.08)777-3333 building(cOCupeltlno.org d/ 5
❑NEW CONSTRUCTION ADDITION LTERATION/TI REVISION I DEFERRED ORIGINAL PERMIT 0 /
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ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC 0
COMPANY NAME E-MAIL I+AX
STREET ADDRESS CITY,STATE,ZIP L'HONG
DESCRIPTION OF WORK n ��Q__ Uj_ -. �� t `n VL
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P$ISTINOUSS - PROPOS13DUSE CONSTR.'rym BSTORIBS _
USE TYPE OCC- SQ,F'r, VALUATION(5)
ARGA AREA
PIxyOR DEMO TOTAL_ O
ARBA nnen NF,'1'AREA
BATHROOM KITCHEN -- OTARR
REMODELARF.A RBMOOPLARP.A RE•MODP,LAREA
PORCH ARF,A DECK AREA TOTAL DBCKMORCH ARRA I GARAGE.AXEA1 DETAChI. --
ATTACH
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ABINGADDBD7 NO ADDITION? C3NO
PRE-APPLICATION ❑VHA. IPYES,PROVIDECOPY OF ISTHEBLDGAN ffYkfSN L "t" J'p4� �,' w TO VALTION:
PLANNIN(,'AI'PLR C3 NO PLANNINO APPROVAL LRTTP.R RIC)tI,RR HOMET ❑NO
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: [have rend this
application and the information I have provided is correct. I huvc read the Description of Work and verify it is aecaratc. I agree to comply with all appltcablo local
ordinances and state laws relating to buil ing cons ruction, I authorize representatives of Cupertino to enter the above-identified pro e y fur inspection purposes,
Signature of Applicant/Agent: ( � Y��'� Date: ���yo
SUPPLEMENTAL INFORMATION REQUIRED 7iY `r/ tb:i a �t; s' A�il';g
,k i
$1k !" I r y' l:o• 1
New SFD or Multifamily dwellings: Apply for demolition permit tot' fi ' u &� ENO �Y,�?
existing building(s), Demolition pctTnit is required prior to issuance of building i �4ryAl�i"•v ►; cin t(, � '''+ �
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permit for new building. '�+,: V � "�
p ardour Materiels Discloswe
Commercial Bldgs: Provide a completed I az {
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4,;n � 1♦. i l,11�„u.y,. ddN %a�:'I..k.tt,( C:
Torm,if any Hazardous Materials are being used as part of this p►vject. , '�(Y(Q�•'.1°,�>c�7 r,a',v�,4�'QIi�q.'jy%��;t
_
Copy of Planning Approval Tetter or Meeting with Planning prior to
submittal of Building Permit application.
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BrdgApp_2011.docrevfsed 06121111
PERMIT FEE RECEIPT
Case # B-2016-1375
u�l=leT,t�o
Date Printed: 02/16/2016
CITY OF CUPERTINO - FEES RECEIPT
Permit Summary
Case Number: B-2016-1375 Permit No:
Project Valuation: 1210.00 Date Submitted: 02/16/2016
Permit Type: Building
Address/APN: 7668 NORMANDY WAY CUPERTINO,CA
95014-5253(366 17 054) - Receipt#: 201281
Scope of Work: REMOVE&REPLACE WATER HEATER IN EXISTING LOCATION-48 GALLONS
• Contact Type: Applicant
Full Name: CRUM WILLARD L TRUSTEE&ET AL
Address: 3890 AYRES HOLMES LN AUBURN CA 95602
Contact Type: Property Owner
Full Name: CRUM WILLARD L TRUSTEE&ET AL
Address: 3890 AYRES HOLMES LN AUBURN CA 95602
Strong Motion Category 1 $0.50
Plumbing Water Heater Fee $29.00
PME Permit Fee $48.00
Administrative Fee $45.00
Bldg Stds Commission Fee $1.00
Travel and Documentation Fee $48.00
Am
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Plumbing Water Heater Fee 02/16/2016 JASON HANLEYBROWN•FASTWATER HEATER Credit Card $29.00
Strong Motion Category 1 02/16/2016 JASON HANLEYBROWN-FAST WATER HEATER Credit Card $0.50
Bldg Stds Commission Fee 02/16/2016 JASON HANLEYBROWNTAST WATER HEATER Credit Card $1.00
Travel and Documentation Fee 02/16/2016 JASON HANLEYBROWN•FASTWATER HEATER Credit Card $48.00
Administrative Fee 02/16/2016 JASON HANLEYBROWNTAST WATER HEATER Credit Card $45.00
PME Permit Fee 02/16/2016 JASON HANLEYBROWNfASTWATER HEATER Credit Card $48.00
FEE TOTAL $171.50
AMOUNT PAID $171.50
BALANCE DUE $0.00
02/16/2016-12:45:06 PM-Generated by:suew
1/1
SMOKE F1
I CARBON MONOXIDE ALARMS LI
OWNER CERTIFICATE OF COMPLIANCE
OOWUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
Eo100 TOPRE AVENUE CUPER T ENO,CA§5Q14-3263
(4018)777-3228•FAX t406,1777-3333.Eildin�Cc�cupertEna ori
Address TV1 0 Permit Nt> �
€afAlars Stncike. E bon Monoxide.
4 �
PUTRPt3Sl
This affidavit is a self certification for rile installs im of all required Smoke and Carbon IV onoxide Alarms for
compliance with 2013 CIBC Section 1 314,2013 CIBC Sections 4201.6 and 907.2.11.2 where no interior'acc€� ss for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi-fancily dwellings shall be provided,with Stroke Marrs and Carl en
Monoxide alarms. When the valuation of additions,alterations,or repairs to existing dwelling units exceeds
$10010.00E CRC Section 8324 and CPC Sections 907.2.11,5 and 420.6 rewire that Smoke Alarms and/ Carbon
Monoxide Alarms be installed in the following locations:
AREA SMOKE ALARM AYItI
Outside of each separate sleeping area in the immediate'vicixnity of the X
bedroom s)
livery level of a dwelling tarot inchadin basements r
Within each slee aria rQorn
Carbon.Monoxide alarms are not required in dwellings which Flo not co tai feel burning appliances and that
do not hate an attached garage. Carbon monoxide alarms cornbiraed with smoke alarms shall c#tply with
CBC Section.4,20.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply:In dwelling units with no commercial power supply, alarm(s)may be solely battery operated.
In existing dwelling units, marina are permitted to be solely battery operated where repairs car a.te atiotv;do
not resu].t in the rem-oval of wall and ceiling finishes or there i o=access by means of attic,basement or crawl
space.Refer to CRC Section R314 and.CPQ Sections 907:211.4 and 420.6.2.An electrical permit is regzzixed for
alarms Which dust be cormected to the building wiring.
As owner of the above-referenced property,I hereby certify Haat the alarms)referenced above a�tlhave been
installed in accordance with the manufacturer's instructions and in compliance:with the CaliEorni4 Puilding
and.California residential Codes.The alarms have been-rested and are operational,as of the date signed
below.
r
C7wne or c7v�ner n#rs3 N. mean react and agree to cortacly v&fhe,torrrms app condmllons of this stafe�rnent
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WATER-CONSERVING PLUMBING FIXTURESOWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT-13t,11LL311 G D111OON
10300 TORRE AVENUE-C PERTINO,CA 95014-3255
1 8}777-3228•FAX 408)7g-313333btri{dingt cUr� rtint�tra
Owner blame �
Permit leo, 0
Address
1. is your teal property a registered historical site?
Yes Civil Code Sections I 10 1.1 through 1101.8.do not apply. Slip the rest of tine-Fora and,sign bottom o Fforian.
Ta GO to Question 2.
2. hoes your real property have a licensed plumber certifying that,clue to tine age or configuration of the property c r its
plumbing,installation of wat r-conserving plumbing fixtures is not technically feasible?
C Yes Civil bode sections 1101.1 through,1101.8 dna.not apply,
0 The licensed plus iber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom o'I form,
O Go to Question 3.
s is water service permanently disconnected for your buildsn `?
0 Yes Civil Code Sec-tions 1101.1 through 1 10 1.&do not apply. Skip the rest sof the form and sign bottom o ff'furan,
o Go to Question 4.
4. is your real property built and available For use or occupancy on or before January 1, 1994? i
F7 No My real property is built anal available for use or occupancy Aftet January 1 1494,
Civil Code Sections,1101.1 through 1101.8 do not apply, ship the rest of the form and sign bottom o�form.
V es TV1y real property is built and available fdr use or occupancy on or before January 1, 1994.
Civil Code Sections 11C11.t through 1 till{8 apply. check one of the three following statements and sign
bottom,of form,,
5. please check ONE of the following.
/ IVY,property is a singh?fanti�y resideiifial real property, See Civil Code Section 1 I01.4..
rn and after January 1, 2014,building alterations of %rniprovemem8 shall require all non-compliant phimb t g fixtures
to be replaced with water-conserving plumbing fixtures throughout the building,.On or before January 1,20IV,all noon
compliant plumbing fixtures shall be replaced with water�conserving plumbing fixtures (regardless of whether
property undergoes alterations or unnprovenients). x
C1y property is a intittifantily resitfe�it'ial real:property. See Civil Code Section 1101.5.
On and after January 1,111014,specified building,alterations or improvements shall require none coannpliant
plumbing fixtures to be replaced with water-conserving plum ing I Cores. -
Can or before January 1,21119,all non-compliant plumbiiig fixtures shall be replaced YA ith water-
conserving pl ntnbittg fixtures throughout the building(regardless of whether.property undergoes alterations+i
I
improvements),
iW property is a.eoin erciat real property. See Civil Code Section 1101.5,
On and after January 1,2014,specified building alterations or improvements shall require non-compliant
plumbing fixtures to be replaced withh eater-conserving plumbing fixtures,
On or before January 1, 2019, all: non-compliant plumbing fixtures shall be replaced: with wafer- Con erving
plumbing fixtures throughout the building(regardless of whether property undergoes alterations or inproverr%ents).
s
1'as the oW ner err owner's agent of this property,certify under penalty of perjury that non-cornpliant plumbing frvtures will be
replaced prion to elate specified above with water-conserving plug nbing fixtures In accordance with Civil Code Sections 1101.1
through 1101.8,the current California Plumbing bode and California Green building Standards Code,and niamifacturer's
installation requirements,and that the water-conserving plumbing fixtures comply with the requirements as indicated in the
table on thefollowing a e. 5,8411720I5.doetesz,secl0.8,? ft