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B-2017-0325CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0325 18855 NEWSOM AVE CUPERTINO, CA 95014-3856 (375 31 028) F W H ACQUISITION CO LLC BOTHELL, WA 98011 OWNER'S NAME: GADEPALLI GANGADHAR AND ROMM OWNER'S PHONE: 408-307-0203 LICENSED CONTRACTOR'S 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: 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 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. Date 17 hereby affirm that I am exempt from the Contractor's License Law for one of the allowing two reasons: i. 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 (Scc.7044, Business & Professions Code) 2, I, 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. s. 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 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 2/28/2011 ISSUED: 02/28/2017 PHONE NO: (425) 636-7078 BUILDING PERNUT INFO: BLDG —ELECT X PLUMB MECH X RESIDENTIAL _ COMMERCIAL DESCRIPTION: ,ACE 40 GAL WATER HEATER (CLOSET) Sq. Ft Floor Area: Valuation: $1320.00 "N Number: Occupancy Type: 375 31 028 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Ayende Date: 02/28/2017 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature ofApplicant: Date: 2/28/2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sec ' " s 25505, 25533, and 25534. �Owner or authorized agent: Date: 2/28/2017 CCONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional Vz/1j/zV1( MWN n:jy FAX FaSt water Heater '�' 1 006/008 COMMUNITY U IVE OPMiiNT DEPARTMENT MENT , BUILDING DMV ON 50Q�b' 10300 TORRE AVENUE - CUPERTINO, CA 96014-3266 777-3228 - FAX (408) 777-3333 ► buildin Wne—r#ina.amr, C PROJECT ADDRIMS J OWM NAS-- ' -HONA .�/i sTxsJIraDDr,nas SOP, crrtr. ST T CONTACT NAME i 1 PHON9 8 tItBST ADDRESS V .oQi n 1wnJ,l .e,, CITY. &tAT$, ZIP © OWNER L7 OWNHIC-at j.Dliii [i OWNBRAGGIINt- CONIAAL = NAME � t COMPAiVY APNa .j A ?---� -31-0 iA _n t,, I) a-MAM R -MAIL PAX FAX TRACTOR ❑COITMACTORAGENT 17 ARCIMCT ❑ BN01 Mg ❑ DSVBLQPM is WNANT 1.0aMe NUIABE L� Q ["Kamm 8VS• LIC N � M D E•MAII. '' �,,.�,WJi't�J �QCS�'J.0 Ax ��'111�V�-4LJJJ STAMT ADDRESS 10 ` 4 YJ �C�F- —Y-.WI&I ARCIATEMENCindEER NAME MCENSE NUMBER Cob PANY NAME H�AII STMHT ADDA1388 CITY, STATE.21P USE of 8VDof IDPLEX ❑ rvltJLruFA14IV.Y FROMCTR W[LDLAND q YSI ®Un.VIN47. L3r.OMMRCIAL UPMAN INTBRFACH AREA ria DESCRIMTIONOFWORX nr1 . 1^ f _77 _ TOTAL. VALUATION: r - Sy my signature below, I certify to each of the Fallowing: I am the property owner of auttlare ed APtit to eat Ott the ptop4rly owner's behalf. I have read this application and the Information I have provided b correct. 1 hove read the DtOerlption of Work and verify it 18 accurate. I agree to comply with all applicable local ordinances and state laws relating to building cons Inn. I authorize repreaen thea of Cupertino to anter the above-IdWifted�raperty for inspection purposes. Signature of Appllcant[Apnt: hate; _ - - " - „— SUPPLEMENTAL INFORMATION RZEQUIRM) MEPAf1ac4pp_.?01 hdoc revised 06121111 BUS. LIC A FAX ❑ we PROM ISTIi8IAUGAN i3 yo8 ==P-2T;1M 0 No/f SICUMHOn+Ist ❑ NO /� TOTAL. VALUATION: r - Sy my signature below, I certify to each of the Fallowing: I am the property owner of auttlare ed APtit to eat Ott the ptop4rly owner's behalf. I have read this application and the Information I have provided b correct. 1 hove read the DtOerlption of Work and verify it 18 accurate. I agree to comply with all applicable local ordinances and state laws relating to building cons Inn. I authorize repreaen thea of Cupertino to anter the above-IdWifted�raperty for inspection purposes. Signature of Appllcant[Apnt: hate; _ - - " - „— SUPPLEMENTAL INFORMATION RZEQUIRM) MEPAf1ac4pp_.?01 hdoc revised 06121111 CUPERTINO 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 • building(a_)eupertino.ora PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with. 2016 CRC Section R314, R315, 2016 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 -,vith 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 Carbon Monoxide Alarms be installed.in the following locations: AREA Outside of each separate sleeping area in the inunediate vicinity of the SMOKE ALARll2 . X CO ALARM X bedrooms) •- (Smoke alarms shall not be located within 3 feet of bathroom door) �Name: ontractor On every level of a dwelling unit including basements and habitable attics _ X X LWithin each sleeping room _ X I _� Carbon Monoxide alarms are not required in dwellings which do not contain fuel -bunting appliances az,d that do not have an attached garage. Carbon monoxide alarms combined with. smoke alarms shall comply withh 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, alarm(s) may be solely battery operated. 1n existing divelliig 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 8314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms ivliich must be connected to the building wiring. As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/Inave been installed in accordance with the manufacturer's instructions and i1 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. 955 Address: w Permit No. Specify Number of Alarms: # Smoke Alamis: 4 Carbon Monoxide Detectors: I have read and agree to comply with the terms and conditions of this statement Owner or Owner Agent's) Name: Si nature- ............................ .......--...................................... ... �Name: ontractor Signature.................................................................. Uc.0...................................... Date:.................. Smoke and COfO7777.doc revised 0111012017 CUPERTINb Owner Name WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION f 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildin cue ' o.or L,-, Permit No o Address z b1 � /V �L? ��-� �-� A 3- 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 forin. INo 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 phunbing, 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. _ 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 form. �SNo 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.. 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 pluinbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑ My property is a inultifaniily 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 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 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 pane. fit// _ Owner or Owner Agent's Signature: A/ahZ-�� fir-✓' Date: Upon completing and si2nina this Certificate, please return it to the Building Division in order to final vour buildinu pennit. SB407 2015.doc revised 08126/15