The URL can be used to link to this page

B-2017-0273 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0273 11513 SEVEN SPRINGS LN CUPERTINO,CA 95014-5131(366 52 013) F W HACQUISITION CO LLC BOTHELL,WA 98011 OWNER'S NAME: HUKKOO AJAT AND PRITI DATE ISSUED:02/16/2017 OWNER'S PHONE:408-252-4849 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 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 y, performance of the work for which this permit is issued. 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 permit is issued. Sq.Ft Floor Area: Valuation:$1770.00 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 366 52 013 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 LASS 1 �► v 'ECTION. tV � Signature � .J Date 02/16/2017 Issued by:MEL ES Date:02/16/2017 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: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 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,Secti s 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:02/16/2017 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 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. I understand my plans shall be used as public records. SiSignature Date 02/16/2017 Licensed 9 Professional V4/V //4VL / '1Ur, It VV FAX Fast Water Heater UOO41/O12 ,../.„, �aCPI C,KAL r=ri.IVII 1 AVf'LI ,:A I 'UN :=y�—rti 'v' t lwj l ).J COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO CA 95014-3255 cupg ,r #• (400)777-3229••FAX{408)7:77-334.4 bulldlnty�afaupe�tJnQAarst ,fin_11..SC (3- 2at7 - 029_3 ''4 PLUMBING •MECHANICAL M ELECTRICAL .E' MISCELLANEOUS eRCI,SFCT ADURtiS� / APN 6 V - 5 7—--d 1 OWNER NAME I a AL dr PHONE /"Q � 7 , _ `A E-MAIL — STREET ADDRESS ' , Y,STATB,ZIP C� lPA e CONTACT NAME , J ) O 13,14Au. .STREET ADDRESS CITY,STATE,Zip FAX 0 OWNER © OWNER.eUtLDER 13 OWNER Merl' .1 CONTRACTOR ❑CONTRACTOR ACiENT 0 ARE.AO acT ❑ENOtNEBR In DEVELOPER El TENANT CONTRACTOR NAML' LICENSE NUMBER ,e$73 ..r LICENSE TYPE�i BUS.LfC fi ��/+l SfT fele _ ` 1 (� . (x�/ COMPANY NAMIII E-tv1An, P - .-- r 406--A�6- , 'a ccs./1c-14-1 5 t� i 04., ,d or g.n 'Crwr al',� S'IREpT ADDRESS l /9 id,/ , ' -7 sYATIs, ,,-1�74X / 1&MZLL - — ,/// PH S.. ,N„- 05 !r ARCHITECT/ENGGVEEli NAME LICENSE NUMBlitt BUS.L1C R COMPANY NAME BIS, ...... V FAX STRUT ADDRESS CITY,STATE,ZIP PHONE Use OF ...)SFD or DUrLex 0 WMUt.TFPAMI,Y PRWECT IN W ILDLAND 0 YES PROJecT IN 0 YES ES TETE ELDD AN 13 YES BUILDING: ❑COMMERCIAL URBAN IN1BRPACB AREA Li No FLOOD ZONE ❑NO EICI"E nR Row CI No Dg3CWr1ON OP WORD I , it �7�// •:Irk :,.-r,1�,�:I 4 TOTAL VALUATION: ( 6 !K ':`',;..JO.•i tr,-"�yl rtt iJll4:Te9i y+�1+,;J#t+/,A r. By my signature below,1 certify to each of the tbllowing: I am the property owner or authorized agent to act on the property owner's behalf. 1 have read this application and the information I have provided la correct. [have read the Description of Work and verify it Is accurate. [agree to comply with all applicable local ordinances and state laws relating MA lding consttction, u •rize representatives of Cupertino to enter the above-identified property for inspection purposes, Signature of Applicant/Agent ..', / _ ..,4 " Date: 1--3-1 . U'PLEMLNTAL INFORMATION REQUIRED • 4, i . ' S' ri, . 4zo r, tik NG'PN1iscApp_2OIl,dee revised 016/21/lI