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B-2016-3187
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3187 10660 STOKES AVE CUPERTINO,CA 95014-1237(326 49 008) F W H ACQUISITION CO LLC BOTHELL,WA 98011 OWNER'S NAME: KRISHNASWAMY SATHYA AND TURLAPATI SUNITHA DATE ISSUED;11/30/2016 OWNER'S PHONE:408-881-3504 PHONE NO:(425)636-7078 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C36 Lic.#987398 Contractor F W H ACQUISITION CO LLC Date 10/31/2017 X BLDG _ELECT X 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: REPLACE 40 GAL WATER HEATER(GARAGE) 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. i%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:$1480.00 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 ordinances APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 326 49 008 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 FRO D INSPECTION. Signature'` / Date 11/30/2016 Issued by:MELISSAN Date: 11/30/2016 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 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 the 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:11/30/2016 , 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. I certify that in the performance of the work for which this permit is issued,I Health 8z Safety Code,Section 25532(a)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the 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 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:A> APPLICANT CERTIFICATION Date:11/30/2016 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 th'e 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. I understand my plans shall be used as public records. Licensed Signature Date 11/30/2016 Professional 11/22/2016 TUE 9: 44 FAX Falit Water Heater U005/013 ,...,:i ' ta � t � Crcwt_ t'CI'CIViI �. wri�A I IUN IVI ' _ COMMUNITY DEVELOPMENT DEPARTMENT.BUILDING DIVISION ;' t r, ; 10300 TORRE AVENUE•Ct1PERTINO,CA 960i4426b Cr) (1-(-g 7 M I S C CUPERTINO taoe�777-3220 r-ax..i� t3 � �7� -a3�? • sa[��In c ��#ngttm .�r� PLUMSINO [vtlrCHANICAL 13 I 2o 16 3� g ELECTRICAL MISCELLANEOUS PROJECT ADDRESS OwNi3R NAME '-o C� PEONS E-MAIL ..-. ..�� ti STREET AbDREsS _to , C..+rY STATE zap t� %� CONTACT ,�� • , "�10T AT Z Lp Cpc clic t '4 FAX NAME `e ' jSc2 Tom__t� ik%i1 i 19`j `/�'.t1 STREET ADDRESS CITY,STATE,ETF FAX IJ OWNER ❑ OWNEPAHRLDER ❑ OWNER AGENT NTRACTOR ©coNt'RACTORAOENT © ARCHITECT 0 ENGINEER CI OBI/ELOPER D TENANT CONTRACTOR NAME LICENSE NUMBER I tt� �'Q' a S0 6 Vri LI XP� BUS.r.u��: 1 Zg[OO COMFANY NAME ' E-MAIL FAX I✓-r .- "*....6A`o gr",, .e waft _/ . STREET ADDRESS _ CITY STATE zip u 1_ cr J- 1L / ' LD •u l't _ ,. ARCHJTECT/ENO1NEER NAME LIC8NSE NUMBER r BUS.LIC COMPANY NAME 8-MAIL FAX — STREET ADDR83S �... CITY,BTATs,ZIP PHONE USE OF LT-PDorDUPLHx ❑ ,Ty-PAMLI.Y PRWECTINWtt.DI.AND p YES PROHICTR4 ❑YES ISTHBBLDG AN ©YES BU1LDIND; ❑COMMERCIAL ULAN INTERFACE AREA 0 NO FLOOD ZONE ❑NO EICHLER no= ❑NO DRSCRIPTION OP WORK — ,^^..,� iftillaike l p ./I4 r ...j4i . ,.. f A , r a .. TOTAL VALUATION: + ,`, u , dfc , „-ha '' `I{ l �_;.,! f #,11W'q {t�trSFyMa41j 1YyL, I D4(�i` i, le, i: 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. I have read this application and the information I have provided Is correct, I have read the Description of Work and verify it is accurate. (agree to comply with ail applicable local ordinances and state laws relating to building construction.+authorize represet[talyes of Cupertino to enter the above-identified property for inspection purposes. Signature of AppiicandAgent, ��""� Date:: ' ` " t�k to SUPPLEMENTAL INFORMATION REQUIRED 1i.. l , . i ,. :IIS I '!..1'�Y.)I•1f� .I I i as"(;t;'! , 5 ' . :i.t;f,.fir;}%f1•4,l i. Ar , 1 ' "m Ii`'' flaFNfiscApp_2011.elnc vevlsea!06/21/11