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B-2016-2909CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2909 1092 MILKY WAY CUPERTINO, CA 95014-5009 (362 20 009) F W H ACQUISITION CO LLC BOTHELL, WA 98011 OWNER'S NAME: ZHANG YIN TRUSTEE OWNER'S PRONE: 408-406-3931 LICENSED CONTRACTOR'S DECLARATION License Class -QaQ Lic. #987398 Contractor F W H ACQUISITION CO LLC Date 10/31/2017 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.. I hereby affirm under penalty of perjury one of the following two declarations: 1. 1 have and will maintain a certificate of consent to self -insure for Worker's 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 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 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 City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature/. t' �) Date 10/13/2016 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). hereby affirm under penalty of perjury one of the following three 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. 3. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of 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 be deemed revoked. PLICANT 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 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 City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 10/13/2016 DATE ISSUED: 10/13/2016 PHONE NO: (425) 636-7078 BUILDING PERMIT INFO: X BLDG —ELECT X PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: REPLACE 50 GAL WATER HEATER, SAME LOCATION Sq. Ft Floor Area: I Valuation: $1280.00 "N Number: Occupancy Type: 362 20 009 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED-RTSPECTION. Issued by: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 10/13/2016 COVERINGS TO BE CLASS "A"' HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous 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 the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: 1� Date: 10/13/2016 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION understand my plans shall be used as public records. Licensed 10/12/2016 WED 7.36 FAX Fast Waiter Heater�� d�2�8 VV G�►GIiNL. I-CTCIYII I ArrL 11-rlk II 1UN COMMUNITY DEVELOPMENT DEPARTMENT ■ BUILDING DIV18ION 10300 TORRE AVENUE 6 CUPERTINO, CA 95014-3255 r ,(406) 777-3228 * FAK (4DB) 77, 7'-3333 • tai'pu a M I GJIPIrtT}N0 `` PROJECT ADDRB93 OWNER NAME S'IUBT ADDRESS 4� CONTACT NAIMI3 UA STREET ADDRESS 11 OWNER El OWNER-D=DBR 11 OWNER AGENT CONTRACTOR NAME to ^ COMPANY NAME IP A r- 4 V lr �/_ A� 1 ARCtuTECTIENOENEER NAME COMPANYNAME STREET ADDRESS USE OF oroUPLEX BUILDINt3: I� OMMRRCIAL DESCRIPTtON OF WORIC 0 : APN # PHOtrB CYrf, STAVE, ZIP t L I RA11 FAX "96TOR U CONTRACTOR AGRNT 17 ARCMUCT El 13NUIM12R ❑ DEVELOPE1t ,O TFNAM- LICBNSff NCMn LICENS T E BUS, W tm (] �rrw GAS (�If .fri-It lJr�llm.r�tn�-, FAc�.rc,. LtCENgn NUMBER R -MAIL. CIT'% STATE. ZIP 69ULTE FAMILY PltOMCTEs WILDLANO ❑ YES PROJECT IN [� YES URBAN INMRFACE ARBA [3 NO IN ZONE I] NO w BUS, LIG a FAX PHONE IS I= BLOO AN I YES RICHLeit Ho"" NO � ■ � �� ......; �-,n :;r�-�.F. d r r.',y'''r� •nisi.' n:.-i��: �t4:r:,;: '+ +✓� Ic��.+;T:l�':Ilid.t:�.i��''.rfr:�r�,eiid!IGI�:;�?.:s��G' :,4+�e,;.�:�:ruJ:�u'.�' By my signature below, f certify to each of the following; t am the property owner or authorized agent to act on the property owns shelf. I have read this application and the information I have provided is correct. I have rend the Description of Work and verify it is accurate, 1 agree to comply with all applicable local ordinetliceu sn4 state laws gelating to buil g constn otion. i authorize representatives of Cupertino to enter the above-identifted/pproperty for inspection purposes. Signature of ApplicEint/Agetrt Date; J _ �t% RD SUPPLEMENTAL INFORMATION REOUMED NIEAMfsc 4�1�_a111 l.doc revised 06121/11 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION CUPERTIN-0 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 -PAY renal 779_anav _ �..:r:- _ ,• PURPO 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 multifamily 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 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 Outside of each separate sleeping area in the immediate vicinity of SMOKE ALARM X CO ALARM the bedroom(s) X On 6very level of a dwelling unit including basements X X Within each slee in 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, a]arm(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 ineans 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 alarin(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: (t9g2 Moo (Kq VA, Com. .1^- 9 NA' CA 4v' Permit No. jj� Specify Number of Alarms: # Smoke Alarms: # Carbon Monoxide Detectors: -lt 1 have read and a ree to com 1 with the terms and conditions of this statement Owner (ar OwnarAgenrs) Name: Signature..... ----- G"""""'(T"...... _ .... • .....................................................Date: rfZ4�f"J Signature.................................................................. Lie.# ...................................... Data: Smoke Gyri COfnrer•doc revised 09127115