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B-2016-3317CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10661 HALE PL CUPERTINO, CA 95014-1627 (326 40 011) OWNER'S NAME: RAHNEMOON MORTEZA AND AMINA SHAHR ZAD S TRUS OWNER'S PHONE: 408-306-3864 LICENSED ONT A TOR' DECLARATION License Class C-36 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: 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 r f� performance of the work for which this permit is issued. z: 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 CERtTIFICATION 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 CE pl with all non -point source regulations per the Cupertino Mun, ipahC Section 9.18. o ®` :Signature 1r � Date 12/22/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. 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) z. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Sec.7044, Business & Professions Code). CONTRACTOR: PERMIT NO: B-2016-3317 F W H ACQUISITION CO LLC BOTHELL, WA 98011 DATE ISSUED: 12/22/2016 PHONE NO: (425) 636-7078 BUILDING PERMIT INFO: X BLDG —ELECT X PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: (I) 50 GAL WATER'HEATER (SAME LOCATION) Sq. Ft Floor Area: IValuation:$1390.00 APN Number: Occupancy Type: 326 40 011 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180, DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: AbbyAvende Date: 12/22/2016 RF -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: 12/22/2016 I hereby affirm under penalty of perjury one of the following three declarations:I ALL 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. APPLICANT CERTIFICATION 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 12/22/2016 "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous material's requirements under Chapter 6.95 of the California Health c:: 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, Ch ter 9.12 and the Health $c Safety Code, Sections 25505,x, 3 ndV5 34. Owner or authorized agent:tv �\�,// �\ Date: 12/22/2016 l t)NSTRUCTIO I LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which thjs permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed 12/14/2016 WED 6125 FAX FaLSt Wafter Heater � � ei [4007/010 "=1'1r -MAL r=K1V11 1 'VI = F COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION r ` 90300 TOP -RE AVENUE= CUPERTINO, CA 9&0943255 (408) 777-3228 * FAX {4081777-333 • Wil din guytartlr►o A misc LUMBINO NfECIiAN]CAL BLECTAICAL iii iSyCELLANEOUS MO=T ADDRESS { AM It 3 -40 10 m-('�, 1 OWNSR NAME Wt '9�y I ` y con 1 ` c Er i7 "MML S'rR.itST ADARBSS o u k \— t L CrfY, aT rH, V� g) ILL VAX 1 �J CONTACT NAME PZ�dNA 6 MAIL STREET ADDRHSS � Y, STATE, ZIP FrAX gWNHTL dWNlt•sULtt Ou40fApHSf CTGwR CONTRACTOR AgIHWT iT&GPi �ENGINEER DE TENANTQNATON C OCRO LCHNBN48HR LICAERNC BUS.Uc# cploorCC0)WANYNA"ffl � �W10 , tV4&;kwA hk b Pe s C VSHLt ,10& � STRUTADDUSSB ' t S { / cl Y,S TE• + , NEER NAMB LIC043NUMBER BUS, LLC aNO (WAIL � PAX FARCMTOCUOUGMEERG ESS CLTY, biATFF, zIPSFDorDLjPLBB (� MiJLTFPAMiLY PXWHCTINW%*tAND ❑ YHs PR)MCTTN7 13 YHS taTHEBLDDAN GI yes No O GdiYIlVtHttCtAL irR aN SNrHaPACE AiitsA No t2txtDZON$ Q Nca EtGEitBlSiidMHt WOnLt Yr uV V i i fA fA t�A1%li� _ llWil Ult��.f " TOTAL VALUATION: fWEI 131r my signature, below, i certify to each of the following: f am the property owner or authorized agent to aat on the property owner's behalf. t have read this application and the inthrmation i have provided is correct. l have read the Description of Work and verify it Is accurate. l agree to comply with all applicable local ordinances and atatp laws relating to building cons action• l authorize representativee of Cupertino to entar the above4dentified pro rty jfor inspection purposes. Signature of AppllcanVAgent: _ Datei, 5UPPLEMENTAI- INFORMATION REQUIRED N,(EPtI'ltsc dtlp 2011.dac revised 06121111 N Owner Name Address WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org G: 2 A 10 A is J!:' MSS n w% Permit No. 8-2016--33►-7 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 of form. M 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? ❑ 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. J� No Go to Question 3. 3. Is water service pernanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. A 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 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.. 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 roperty undergoes alterations or improvements). My property is a nnultifarnily 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 unprovements). ❑ My property is a COnzrrrercial 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 Plui ng o e a is Green Building Standards Code, and manufacturer's installation requirements, and that the water -c riseiving plummg fixtures with the requirements as indicated in the table on the followins Dace. _--Al 4---/. / Owner or Owner Agent's Sign Upon completing and signing this Certificate, p Date: return it to the Building Divisio rder to final your building SB407 2015. doe revised 08/26115 - l � CUPERTINO SMOKE 1 CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building a.cupertino.org PURPOSE n -Lis 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 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 _ SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of X X the bedroom(s) Signature.................................................................. Lic.# ......................................Date: On every level of a dwelling unit including basements 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 commercialpower supply, alarm(s) may be solely battery. operated, ha 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 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 with the California Building and California Residential Codes. The alarms specified below have been tested and are operational, as of the date signed below. p,, ,Q Address: I V 6"6 ) N ""V` W. C Permit No. B — 2-n 16 -3 3 17 Specify Number of Alarms: — 3 # Smoke Alanns: r-2)7 k # Carbon Monoxide Detectors: / have read and agree to cQmply with the terms and conditions of this statement Ovvner (or Ovmer Agent's) Name: .. .... ................ ................................Date:) 7) .............. ......................... Contractor Name: Signature.................................................................. Lic.# ......................................Date: Smoke and CO fonn.doc revised 09/27/16