B-2016-1394 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1394
10411 CASTINE AVE CUPERTINO,CA 95014-1308(326 41 038) (F W H ACQUISITION
CO LLC)
BOTHELL,WA 98011
OWNER'S NAME: HO KUM FEI AND NEO CHIEW MOOI TRUSTEE DATE ISSUED:02/23/2016
OWNER'S PHONE:408-203-5899 PHONE NO:425-636-7054
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#987398
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 RESIDENTIAL_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-GAS
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.
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:$1333.00
APPLICANT CERTIFICATION
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 APN Number: Occupancy Type:
ordinances and state laws relating to building construction,and hereby 32641 038
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
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(See.7044,Business&Professions Code) Signature of Applicant:
2. I,as owner of the property,am exclusively contracting with licensed Date:
contractors to construct the project(Sec.7044,Business&Professions Code).
Thereby 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(a)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 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 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
92./17/Z91b wk;u 07 VV 1"aA r"aaL water meaner qu—,
73
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
CUPERTINO 1 (408)7773228-FAX(408)777-3333-bulld(n c .or �_ )� f�
cmc l6 - 13
NEW CONSTRUCTION ❑ ADDITIONTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
rrtal>rcT noDRr.SS � l ApN N
OWNERNAM6 (I1 C t�H ✓ (� E'-MAIL
STREET ADDRESSop& i r CITY. STATE,ZIP Luy\Q'4-(-1V1`w (1(�•�,I I PAX
CONTACT NAME V P U 8 v 202-t
STRP.CTADDRESS CITY STATE, Z P
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10 OWNDR ❑OWNER-BUILDER (3 OWNERAGCN1• ONTRALTOn ❑CONTRACI-OR AOENT ❑ ARCHITECT ❑ENOINFeR 1' DEVELOPER ❑TBNANT
CON I'IiACTOR NAME LICENSE NUMBER RQ(1 q Q LICLZ P Y E BUS:LIC N Del
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COMPANY NAME � l„1 , n �„�t E-MAIL l l u FAX 6
STREET AT)DRESSr CITY,STATE,ZIP PHO
ARCHITEC'VENOINEERNAM17 LICENSE NUMBER BUS.LIC N
COMPANY NAME E-MAIL FAX
STREET ADDRESS CrI'Y,STATE,ZIP PHONE
DESCRIPTION OF WORK
EXISTING USE PROPOSED USE CONSTRI TYPE N STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
ARFA AREA AREA Nel'ARL•A
BATHROOM KITCHP,N OTHER
REMODRLARPA REMODF.LARP.A RLMOUFLARFA
PORCH AKfiA DGCK AREA TOTAL DECK/PORCH AREA - QARAGF,AREAL DETACII
ATTACH
4 DWELLING UNITS: IS A WOND UNIT Ljyr..s SRCONn S'ronY- clyns
BEING ADDED? Cl NO ADDITION? ❑NO
PRE-APPLICATION YES IP YES,PROVIDP COPY OF IS TIIE BLDG AN ❑Yes } t ; ' e'. TO'A V4kU ION;
PLANNINOAPPLII 8NO PLANNINOAPPROVALLETHR EICHIARHOME? []NO
N ,.3
By my signature below,I certify to each of the following: I am the proporty owner or authorized agent to act on the property owner's behalf. 1 havo read this
application and the infoernation I have Pmvidcd 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 lawn relating to baildt construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes-
Signature of Applicant/Agent: 'leDate_ v�
SUPPLEMENTAL INFORMATION REQUIRED.
_New SFD or Multifamily dwellings: Apply for demolition permit for t: � l' t 1p
existing building(s). Demolition permit is required prior to issuance o[building e („. t I h> ,/ ;v,y � n�, ;19th,' ; ,?,,( k •
I• S' ai I
permit for new building. I,( }p ''^ "y° I
tib? tsd•.r A,a„ I .yJt� g (t '1acl� C t
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure �t
_ �;I,s`jr<tJo
-.(Ay,j;?l` 4lj'ta�y{;,!�}�pr��r(��1w(p;lgS��i(W�yr�4.'s.')S}I`ie jiI K`•It,,`-r�11lg�,i rl_�:{{ n EJt
It4!?t1,i?yIn�y,,�i U'1'',,Q:'4's'•�t�wrl,��n�I,i�It1j�,tjl�t�:rRi�I,r'xIh=F'1l'{ye�vlny,l�lHu'��9l?
nforh if any Hazardous Materials are bcing used as of this project.
anningpriortoCoPY of Planning Approval Lcttcr or Meeting with Pl
..
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S.ubinittal of Building Perini t app lication. 4i ,'rl ++N,JC�Y y y„I n;pi��E?i q r`�;i) 1,' 1. �I;•aal,`�Y�'`•i�4ii iif'�tlf{'X,r, lr.�r�aJ•^1,1<
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BldgApp 1p11.doc revised 06121111
'SVOKE I CARBON MONOXIDE SLAFILE
12 OWNER CERTIFICATE E COMPLIANCE ���,� _
COMMUNITY DEVELOPMENT DEPARTMENT.BUILDING DIVISION
CUPE,RTINO 10300 TORRE AVENUE e CUPERTINO,CA 95014-3255
(408)777-3228- FAX(408)777-3333 building(a1cupertino.org
Uhf I4 �l��rly -
�) 0rb.����`Iat�o�.de:
PFRTHIT CAltirNOT RE TIN,kLV D AND CoMPLFTRn UNTIL THIS C>CItTIFICA I I±,
. :L:►Y:.C� Sis.a A6'\iPJ'RI.c �� A.O %. yV"WG))1VW"
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions,alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section 8314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA SMOKE ALARM CO.ALARM
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)
On every level of a dwelling unit including basements X X
Within each sleeping room X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined
with smoke alarms'shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply:In dwelling units with no comm- ercial power supply, alarm(s)may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl
space.Refer to CRC Section 8314 and CBC Sections 907.2.11.4 and 420.6.2.An electrical permit is required for
alarms which must be connected to the building,wiring.
As owner of the above-referenced property,I hereby certify that the alarms)referenced above has/have been
installed m accordance wi�1 the manufacturers instructions and>n compliance with the California Buildi7ng
and Califonniat Residential Codes.The alarms have,been tested and are operational, as•of the date signed
below.
t have read and a Feer to comp!,cqTpk with trhe terms andt candahons of this statement
W1
nafil�e:.
Cor�iraofdr�Nam e: ......... ......... ......
.. ;Sa nature_ ........ ......Lic# f....... Date',.
Sn:ioke and Coform.dbe relised:03/1%8/141
i
WATER-CONSERVING PLUMBING FIXTURES ■®
OWNER CERTIFICATE E F COMPLIANCE ■L
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION -
CUPERTINO 10300 TO.RRE AVENUE CUPERTINO,CA 95014-3255
y
(408)'777-3228•FAX(408)777=3333 a buildiggg( cuaertino.org
Owner Name L<4A1 f` C� Permit Noll
Address t' d (�S r lyi-:
1. Is your real properly a registered historical site?
Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
N�'No Go to Question 2.
2. Does your real property have a licensed plumber certifying that,due.to the age or configuration of the property or its
plumbing,installation of water-conserving plumbing fixtures is not technically feasible?'
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
'❑ The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
t ❑ No Go to Question 3.
3. Is water service permanently disconnected for your building?
Q Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
y%El No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
0 No My real property is built and available for use or occupancy after January 1, 1994,
Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
❑ Yes My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
5. Please check ONE of the following:
❑ My property is a single-family residential real property. See Civil Code Section 1101.4.
On and after January 1,2014,building alterations or improvements shall require all non-compliant plumbing fixtures
to be replaced with water-conserving plumbing fixtures-throughout the building.On or before January 1,2017,all non-
compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
❑ My property is a.multifamily residential 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 with water-conserving plumbing fixtures.
On or before January 1,2019,all non-compliant plumbing fixtures shall be replaced with water-
conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or
improvements).
My property is a commercial 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 with water-conserving plumbing fixtures.
On or before: January 1, 2019, all non-compliant plumbing fixtures shall be, replaced with water- conserving
plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements).
I,as the owner or owner's agent of this property,certify under penalty of perjury that non-compliant plumbing fixtures will be
replaced prior to date specified above with water-conserving plumbing fixtures in accordance with-Civil Code Sections 1101.1
through 1101.8,the current.California Plumbing Code and California Green Building Standards Code,and manufacturer's
installation requirements,and that the water-conserving plumbing fixtures comply with the requirements as indicated in the
table on the,following,page.
Owner or Owner Agent's Signature: _1 Dates a �A-K 3,,
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building penni.t.
SB407 2015.doc revised 08126115