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B-2016-1869CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1869 10465 MADRONE CT CUPERTINO, CA 95014-6577 (342 60 025) F W H ACQUISITION CO LLC BOTHELL, WA 98011 OWNER'S NAME: SANKAR HARI AND MEERA DATE ISSUED: 05/02/2016 OWNER'S PHONE: PHONE NO: (425) 636-7078 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class PLUMBING Lic. #987398 Contractor F W H ACQUISITION CO LLC Date 10/31/2017 X BLDG —ELECT —PLUMB 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 license is in full force and effect. JOB DESCRIPTION: REMOVE/REPLACE 75 GALLON WATER HEATER I hereby affirm under penalty of perjury one of the following two declarations: t. 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. 1 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: $2138.00 permit is issued. 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 ordinances APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 342 60 025 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 expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 1�0 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date Issued by: Patricia Garcia Date: 05/02/2016 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. if a roof is t. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. 1, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER t. 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. HAZARDOUS MATERIALS DISCLOSURE 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the s. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(x) should I store or handle hazardous 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 Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date Professional 05/MON 9110 FAX Faet water treater (_ QUO Z/009 ilm GENERAL PERMIT APPLICATIONJ' COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION MEP 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 CUPERYIN� (40r3) 777-3228 •FAX (409),777-3333 • bui in Ino,o 2 1� -MISC l� _9;4UMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCBLLA RODS PROTECT ADDRESS � APN N OWNER NAMEI^ w � I SiF-'�/ 1 PHONE &MAIL fnl� �a lr STREET ADDRESS ` © �^ , CI ST , 7,1 Q�CSI I .FAX CONTACT NAME P T Is STREET ADDRESS CITY, sPAT} , ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNHR AGENT 461f1RACTOK ❑ CON•RtACTOR AGENT D ARCHITECT ❑ fN01NEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMES -NiqCtee L&M'411 LICENSE NU e 3q LICEN BUS. L1C OL9, (N) COMPANY NAME �^ J I 1Ca.VII'i&a ,Go pAxq, L'�--Co a6"/OS- STREET ADDRL'SS I. 1 Creak � l• 8 n `06 CIT S�ArF ZIP bu ' 1 n `,`JET Q c ,� 1 �/j)(J l PHONPa / �c; I � t f)� b - I ARCHITECTIENGINEERI NAME tACENSE NUMBER BUB. LIC UOrJ'�J COMPANY NAME. B�MAIL PAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OP PD or DUPLEX ❑ NIULTI•PAMILY PROJECT INWILDLANO ❑ YES PmucTIN ❑ YES (ST(AVOLDOAN YES RUILO NO: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONP ❑ NO EICHLERROME4 ❑ NO DESCRIPTION OP WORK TOTAL VALUATION,IR , i ,. ^ ! • r 1 ��'!,a 1,�•C; I �i,S1j� ��y, d �� �� �P�i4n �: �'+ J�� By my signature below, I certify to each of the following: t aln the property owner or authorized agent to act on the property owner's behalf. 1 have read this application and the information I have provided Is correct. 1 have read the Description of Work and Verify it is accurate, l agree to comply with all applicable local ordinances and state laws relating to buildin onstruction, I authorize representatives of Cupertino to enter the above- identl fled property for inspection purposes. ofApplicant/Agent: `J ✓�Signature pate: SUPPLEMENTAL INFORMATION REQUIRED !, a 1• •� 9 op CIT/ �0 NlEPMlsc;lpp z011.46c rcPised 06121/1 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 e building@IgUpertino.org PERMIT CANNO T.BE FINALED UNTIL TMS CERTIFICATE HAS BEEN CQMPLF,T KD, �'t�;'��a���. %eEUBM TU TRE-I3uIDIN I�IVI&I(}N PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section R314, R315, 2016 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 R314, R315, 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) — (Smoke alarms shall not be located within 3 feet of bathroom door) On every level of a dwelling unit including basements and habitable attics 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 commercial 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 alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms specified below have been tested and are operational, as of the date signed below Address. ���Q� D Permit No. (rJ� I, l Specify Number of Alarms Carbon Monoxide 1 have read and a ree to compl with the terms and condi'­F44,;_ t t Owner (or Owner Agent's) Name: AzP a q i cons �s a � ature. .�.. ..... ..... ............. ..... ... .. Date: f Contractor Name: .... Si nature Licl Date: .. Smoke and CO form.doc revised 01/10/2017