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B-2017-0274CUPERTINO SMOKE / 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 • buildingacupertino.org PURPOSE '11 -Lis affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with -2016 CRC Section R314, 8315, 2016 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single-family andmu?ti-.fainly-c-T,,Tellulgs shall be provided Nrt7 tl-i-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 J. Carbon, Monoxide Alarms be installed.in the following locations: AREA SMOKE ALARM CO ALARM I Outside of each separate sleeping area in the immediate vicinity of the _ bedroom(s) — (Smoke alarms shall not be located within 3 feet of bathroom door) X X On every level of a dwelling unit including basements arld habitable attics _ X X Within each sleeping, room X I { Carbon Monoxide alarms are not required in dw-ellings which do not contain fuel-burniing 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 Marshals Power Supply: In dwelling units with no commercial power supply, alarms) 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 funishes 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 c'oiuiected to the building wirnlg. As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been f 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: 2 2 1' e u-,Dn't, Permit No. 6 -2of7- 42? If Specify Number of Alarms: # Smoke Alanils: #Carbon Monoxide Detectors: FT -1 1 have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: t .51M AA' ................................. . i nature ..... .................................................................... Date:. (....: Contra or Name: Signature............................ ............ I ............ ,............ Lic.# ...................................... Date:................. Smok-e acid COfornr.doc rei"ised 01/10%1017 I 'pry NOwner Name WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE.AVENUE • CUPERTINO, CA 95014-3255 777-3 8 • FAX (408) 777-3333 • building(aDcupertino.org nn k_ 1 T(" a4L5L _ Permit No. 17 ., ddress 22-4-&-2.V t _ V� (s F J e P i) ✓' 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. ❑ No Go to Question 2. 2. Does your real. properly 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 oftlae "form and sign bottom of form. ❑ No Go to Question 3. 3. Is water service permanently 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 fonn. 'L ❑ 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 forin.. 5. 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 property undergoes alterations or improvements). ❑ 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 -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). ❑ 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- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). I, as the owner or owner's agent of this properly, 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 Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the table on the following page. (%Amar nr Ownar Anant's SinnnfiirP- ^s—i Date: , 7-fiI 7 Ui)on comuletina and sianina this 1�ertificate'Ulease rkum it to the Building Division in order to final your building pen -nit. SB407 2015. doc revised 08126115 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0274 22433 RIVERSIDE DR CUPERTINO, CA 95014-3960 (356 03 039) F W H ACQUISITION CO LLC BOTHELL, WA 98011 OWNER'SNAME: SIRAVARANAGENDRAAND SABITHA DATE ISSUED: 02/16/2017 OWNER'S PHONE: 408-718-9020 PHONE NO: (425) 636-7078 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class .CM Lic. #987398 Contractor F W H ACQUISITION CO LLC Date 10/31/2017 X BLDG _ ELECT X 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: REPLACE 50 GAL WATER HEATER (GARAGE) I hereby affirm under penalty of perjury one of the following two declarations: i. 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. 161-1 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 Sq. Ft Floor Area: Valuation: $2480.00 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 356 03 039 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 t ' pertino Municipal Code, Section 9.18. J� 180 DAYS FROM LAST SPECTION. �( Signature FSI Date 02/16/2017 Issued by: MELI OWNER -BUILDER DECLARATION Date: 02/16/2017 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 r. 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: 02/16/2017 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 s. I 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 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 Mun opal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 1,5 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent l APPLICANT CERTIFICATION Date: 02/16/2017 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city 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 ARCHITECT'S DECLARATION and will comply with all non -point source regulations per the Cupertino Municipal I understand my plans shall be used as: public records. Code, Section 9.18. Licensed Signature Date 02/16/2017 Professional 02/07/2017 TUE 7., 00 FAX FaLA-L water Heater M ar r th 10005/012 Wr-mr-MAL. rtZKMI I Art"LIL;A I 1UN IVI t: V COMMUNITY DEVELOPMENT DEPARTMENT & BUILDING 10300 TORRE AVENUE oo CUPERTINO, CA 96014-3256 77-32AS -FAX f4.pq) 777-333.13 # buj1dlngQcumyj[Ig.gLg, misc nmn MK=P.UAWJ1rAt Mm verUTPAT rl r.4T.q?-,,t.j.AWP_n1 IS FROMM ADDRESSAM DP, -0 3 - WAIL OWNER NAME 51&&day STUBTADDRESS, CITY, WA-M,Z��./ CONTACT NAME E-MAIL CONTACT'MIKE Ge LJ T 01 P $T" E ADDRESS STOXAT ADDRESS CrrV, STATE, ZIP FAic L LORI 0 OVIMR C3 OWNSBAMWER El OWNHRAOEN-r CONTRACTOR E3 CONTUCTOR, AOBNT AACMTWr GMUMR DOVOLOFUR n UNANT o FPHONE CONTRACTOR NAME 7 LICENSENUMBER LICENSE TYPE1,11 JURAN BUS. LIC a N ta Y A COMPANY 6-MAM L4Axe ST#=T ,CtrY, STATE, UP V- - - _. - � "'P No' BERI NAM CT_zrnFC A LICANI SSNUMER AhA C,I,4PANV NAW &mAIL FAX STRSSTAD'FUSS to, V C", STATE. Z& PRONS tmg 0? EWSM.Dupum 0 ;Mrlmmv PROMCMWO.DLAHO u YES PR=CT IN E3 YES O'niBBLDGAN y INS eUitDJRt4 COMMERCIAL MAN RMRVACS APSA [3 NO FLOQDZOM Na BiCrlLHrttiOl�? ©NO DESCYIPTION OF WORK 6 e—f— TQTAj, VALUATION: ay my aignature below, I certify to each of the following-. I am the property omer or autharIzed agent to act ot, the property owner's behalf, 1 have read this Ig I have the Oescription ofWvtk and vorlty It Is accurate, I agree to comply wIdL all applicable local application and the tnf I I I heCV9.WVided correct. read 101:Z110a", r Inspection PutPO*00. ordinances and state law relating I Ku lye representatives or Cupertino to enter the above-Identiflold I =11- 7'-V Datbg_ � 6, Signature of Applicunr/Agent- 27-- &JEPAtfhcApp_201 I Aod Pvvised 06(21/11