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B-2016-2082
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2082 10091 SANTA CLARA AVE CUPERTINO,CA 95014-1212(326 25 006) F W H ACQUISITION CO LLC BOTHELL,WA 98011 OWNER'S.NAME: VENGALASETTI RAMAKRISHNA AND MADHUMATHI TRU DATE ISSUED:06/07/2016 OWNER'S.PHONE:408 306 0134 PHONE NO:(425)636-7078 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class PLUMBING Lie.#987398 Contractor F W H ACQUISITION CO LLC Date 10/31/2017 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 38 GALLON WATER HEATER 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. a 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 permit is issued. Sq.Ft Floor Area: Valuation:$772.78 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 326 25 006 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 180 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:06/07/2016 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 aroof is 1. 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 die structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. I,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 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. HAZARDOUS MATERIALS DISCLOSURE 2: I 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 3. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous - shall not employ any person in any manner so as to become subject tothe material.Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of Califomia.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 A.ENCV 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 06/46/2016 MON 11! 20 FAX Ftipt Waiter HptLteY I(Q002/004 GENERAL PERMIT APPLICATION S l Mhp COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TOf2FtE AVENUE•CUPERTINO, GA 96018-32$5 MI CUPL'R71NQ (408)777-3228-FAX(408)777-3333 UI1dIng@SC Ino.o 1 UMI31NOMECHANICAL EISLECTRICAl DMISCELLANCOUS PROJECT ADDRESS O N {0 V E-MAIL STREET ADDR�SFAX CONTAC'P NAME �II .� � ,) PHD� Iy.,, �� `�' fi•MAIi" STREET ADDRESS CITY,STATE,2(PJ PA7C 13 OWNER Q OWNER-BUILDCR ❑. OWNERAOENT *CONTRACTOR ❑CONTRACTOR AUNT 13 ARCHITsu Q ENOINBER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LlC$NSE NUMBE LICENSE TY ' BUS,UC M COMPANY NAME MA - , �e� W �12 �s�`vlr�sr1 -e��e� ,�c�r► �-�36�- ass STRt= T Dl1�S 'Ct E. 71 I ► �$ b-�t GV ARCHITECTIENOINOBR NAME LICENSE NUMBER W DU9.LIC 0 COMPANY NAME. E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE orDOrt7UFLEX p MVLThPAMILY PROJOC1'INWRALAND ❑;'Y13 ECT IN ❑YES ISTIMBLDGAN ©vas OUILDINO: EI COMMERCIAL URBAN IN'113UACE AREA NO FLOOD ZONE Q N0. EICHLER HOME? QNO DESCRIPTION OF WORK wl TOTAL VALUATION; By my signature below,I certify to each of the following: I em 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 rood the Description ofWork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. t authorize representatives of Cupertino to enter the above-/identified properly for Inspection purposes. Signature oPApplieanVAgenr. Dale, SUPPLEMENTAL INFORMATION REQUIRED ' II i MGAMisc-A1.?p_201l.docr-evised 46!21/Fl SMOKE I CARBON MONOXIDE ALARM. FIL OWNER CERTIFICATE OF COMPLIANCE o COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPEfTNE3 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333-building(a)cupertino.org ermit No. "2'e)`P-7— Address POT Sandr /-Uv - #of Alarms Smoke: Carbon Mon aide: PERMIT CANNOT DE FINALED AND COMPLETED UNTIL THICERTIFICATF T, HAS B ASVD$ # ��BUILDING DIVISIC?N a,Ksr xis' rll x' 'r1z'`T..'.�.,R.W" �:r2 \ ..:....3 3p: .,,a. ;, }'y aa ..»;.,.w \u�u a,.,,., ,F e,.... .,,,... ,:a,,;.x�., 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 v There 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 uni s exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Sinoke Alarms and or Carbon Monoxide Alarms be installed in the following locations: .AREA SMOKEALARM COALARM 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 applian es and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall co ply 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)ma be solely batter3,operated. In existing dwelling units, alarms are permitted to be solely battery operated whe e repairs or altei ations 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 R314 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 w th the California Building and California Residential Codes.The alarms have been tested and are operation 1,as of the date signed below. 1 have read and a ree to comply with the terms and conditions of this statement Owner(or Owner Agent's)Name: knom_`_' V6'AffALA-- f l' Signature............. ......:.........�--�"......... .................................. ate: ........ ......., Contractor Name: Signature......................................................_............Lic.#..................................... ate: .............,..... Sioke and Wfonn.doe revised 03/18/14 WATER-CONSERVING PLUMBING FIXTURESir I L 2 i OWNER CERTIFICATE OF COMPLIANCE =-�....,. COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION , CUPERT1NO 10300 TORRE AVENUE CUPERTINO,CA 95014-3255 (408)777-3228• FAX(408)777-3333 f building.(aDcupertino.org �—() �er_-Name- m t s r� Permit No.` �� ® � � 'I�delress 1. Is your real property 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 o form. .(K,No Go to Question 2. 2. Does your real property have a licensed plumber certifying that,due to the age or confrgurati n of the property o r its plumbing,installation of water-conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Code.Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Divisio . Skip the rest of the form and sign bottom of form. �,No Go to Question 3. 3. Is water sei vice permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the foil and sign bottom o I fonn. -'No Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ 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 o f form. Yes My real property is built and available for use or occupancy on or before January t, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements an sign bottom of forn.. 5. Please check ONE of the following: Y 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 plumbir g 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). El 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-conseiving 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 ergoes alterations r irnprovements). G 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- co serving 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-cc inpliant plumbing Extures will be replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code S ections 1101.1 through 1101.8,the current California Plumbing Code and California Green Building Standards Code, and imam facturer's installation requirements, and that the wat -conserving plumbing fixtures comply with the requirement s nd' at-ed in the table-on the following page. Owner or-Owner-Agent's-Signature: Date: Upon completing and signing this Certificate lease return it to the Building Division in ord r to final your building permit. P p g g g ,p SB407 2.015.d c revised 08126115