Loading...
B-2017-0422CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0422 6670 CLIFFORD CT CUPERTINO, CA 95014-4554 (369 24 052) F W H ACQUISITION CO LLC BOTHELL, WA 98011 OWNER'S NAME: ALTMAR DAVID F TRUSTEE DATE ISSUED: 03/14/2017 OWNER'S PHONE: 650-336-5738 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 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 38 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 y performance of the work for which this permit is issued. yJ 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 369 24 052 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 pertheCupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature ` Date 03/14/2017 Issued by: MELI OWNER -BUILDER DECLARATION Date: 03/14/2017 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 roofmg 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) z. 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: 03/14/2017 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. 1 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 & 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 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: l APPLICANT CERTIFICATION Date: 03/14/2017 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 and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S re TION Code, Section 9.18. I understand my plans shall be used as public records. p Licensed Signature Date 03/14/2017 Professional 03/06/2017 MON 12:09 FAX FaBt water Heater /C� I%j05$/093 VCJIM =If AL rr—KIVII I f1tOPOLIUA I IVN IV[COMMUNITY DLVPL.OPMI=NT DCpARTMPNT - BUILDING DIVISION 10300 TORRE AVENUC + CUPERTINO. CA 95014-3265 777-3229 FAX {408} 777-3333 • �tallcilnOQlc�.or0 M-ISC PLUM>�iNQ MEC%AWCAL ELEC'r12xCA1 MISCELLANEOUS 1-7,6 ROrECT ADbRESS Ui t l v c`• L' `� ARN s WNER NMa DI V�t g �y E-MAIL DI L OT IS / p-„ ' f -67 G REET ADDRESS 6`L' 0 �' /' /i 7- CITATu,, ZZIPJ� ? (P ,4 0 ONTACT NAME ^�) JG� PHONEYS &MAILL REET ADDRESS ) �i q ,^ - CITY STAIR, Zip ✓ l . �,1 M/ Ali %X i la i . /S A C�'�«_ , .i PAX Ou'NBR © 0WmZJ3=RA 0 OWNERAgBjgT l CONIitACTOtt CI CONTRACTORAOBNT 13 ARCHITECT C] PNOWU13R a t18vE3.oP8R ❑ TENANT C�+I'tRAC1oRNAMa-�^ LICENSIIKMWER qf, LICENSE$tlg.LICS COMPANY NAMES 1 ...._ n ! J E-MAIL T 1 _ P. ARCHiTECTIENOEVERti NgMs COMPANY NAME STURT ApDRESS USE OF ❑$FDwDUPLax BUILPM. ©COtrIMACIAL DRECRIPTION OF WORK e -n ZIP LICRNSE NUM89R E.MAU. CITY. STAMzlp MMTt-PAMILY I PRORCTINWILDLAND q URBAN INTERFACE AREA i t 9 0416v► TOTAL VALUATION: MO r M YEs RROOCTIN 0 YE$ NO FLOOD SONG 13 No sus. LIC 0 FAX - PHONE tST9RBLDGAN © YES BICHLWROmm CI NO By my signature below. I certify t'0 aaoh of the following; I am the propetty owner or authorized agent to act on the property owner's'behalt. I have reed this application and the informatlon I have provided Is correct. I have recd the Desorlgtlon of Work and varlfy It is accurate. I Agm to comply with all applicable local ordinances and state laws relating wMilding construction. eathorize represcnWives of Cupertino to enter the abbie-ickntif od property+ for Inspection purposes, Signature of ApplicatttlAgent, _ ICAi�� J-1 KEPiWhm4pp_201 kdoc revised W2 //// v r "W+ --ft r&1A r"CLOL WiLTivr rieazer 12002/002 + +� CERTIFICATE OF LIABILITY INSURANCE [7ATH(MM)GOMYYY) INUM LTR THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONF�Rg NO FIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVi; OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy083) must be endorsed. If SUBROGATION IS WAIVED, sufi*t to the terms and Renditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER N NE Kathy Howland Bel.3, Anderson Agency, Ing, O E (425) 291-5200 F f�F6)441-61G4 600 SAT 39th St, Suite 200 WE) EBS.kathyhObell-andsraon.com INSURERS AFFORDING COVERAGE NAIC6 Renton WA �BQ57 INSURERA:AM&ri0&n Statea Inauranco Company 19704 INSURED FMAcgluiaibion Co LLC,1�Bd�t Fast Water t3sak+4i' COINSURERC_ INSURER S ;Liberr't Mutual Fire In6urance 23028 �— 11715 North Creak Parkway 9 #e-106 2/17/2017 2/17/201a -INSURER v INSURER s Baathell 98C� 1 P`P76ICDd!_`Ca nr•r�-r, r•,w.w.r... _t.9 .,...... INSURER P! . __ 14CY1�14/IV IV[1tViRCli: THIS IS TO CERTIFY THAT THE POLICIES V INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED SY THE P61.I0IES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS CF SUCH POLICIES. LIMITS SHCVVN MAY HAVE BEEN REDUCED SY PAID CLAIMS, INUM LTR TYPE OF INSURANCE POLICYNUMBER P L LIMITa A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE M CCCUR _FREM1SE6fEapccuLMMgj EACH OCCURRENCE 1,004,400 Ef 8 200,000 �— O1GIB86D9t361 2/17/2017 2/17/201a MED EXP (Any one Icon) S 10,000 PERSONAL &ADV INJURY S i, 000,000 GEN1 A90RECATE LIMIT APPLIES PER: POLICY ❑ JPP& Ej LOC NPR4t?UCYd-OOMFIOgA3O GENERAL AGGREGATE S 2,000,000 $ 2,400,000 I Empl FraCOCaa Mab Ina $ 10,000 AUTOMOBILE LIABILITYE I a LIMIT$ ANY AUTO ALL OWNEDSCHEDULED ALlyce AUTOS HIRED AUTOS NUS NED EIODILYINJURY(For pemon) S BODILY INJURY(PeraMlaaet) S PROPERTY DAMADE 3 3 UMBRELLALIAe OCCUR EACH OCCURRENCE EXCESS LIAO CLAIMS -MADE AGGREGATE $ RETeNnoNs $ WORKHRS COMPENSATION PER AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIBXECUTIVE YIN OFFICEMMEMBEREXCLUDED7 (MandaloryIn NH) Ir ae d1P7rlbe underPERATION9 kFlow NIA tTri WC2091464543028 12/1/3416 12/7./2417E:L. Zalag..1 ER 1 E.L. EACH ACCIDENT 9i Q()Q QQ0 018EASS-EA EMPLOYE $ 1,000,000 ILL, OISENSE.POLICY Lj1W $ 1 000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACOR9147, Addillanal Remarke 6ahedute, maybe atteehed Ir more epaae to required) Re: Evidmnam at Inauranae atitlnuanHastwaterheat+ar . o Contractors State License Board PO Brox 26000 Sacran anto, CA 95826 SHOULD ANY OF THE ABOVE DESCRIBED POUCIRS RE CANCEILLED 86FORE T14E EXPIRATION DATE: THEREOF, NOTICE WILL lib DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTI40RIZF4 REPREBI;NTATiVE LT=es Hun L /CFdvl (D1998-2014AGORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The AOORD name and lobo are registered marks of AC:ORD INS02519e+4017 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 Mcupertino.on PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN COMPLETED,W-D,, AND RET�,IR.= TO THE BUILDING DIVISION 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, 8315, 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 With Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, CRC Section 8314, R315, and CSC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: — AREA 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) SMOKE ALARM . X CO ALARM X On every level of a dwelling unit including basements and habitable attics X 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 commercial power supply, alarm(s) 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 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. 11 /1�' i G Permit No. E- 7- n I?-•- ' Address: ;� r% Specify Number of Alarms: # Smoke Alarms: Flo # Carbon Monoxide Detectors: I have read and agree to comn1v with the terms and conditions of this statement Owner (or Owner Agent's) Name: r ' € � J � Si nature.:.:...,.. ::::........... ..1.�::...... t........::` ............................................... Date:................... Contractor Name: Signature...................................................................... Lic.#........................................ Date:................... Smoke and COform.doc revised 0111012017 CUIP RTINO WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �7 (408) 777-3228 • FAX (408) 777-3333 • building(d,cupertino.org �r 12- Owner Name -� .°�, k F' i '"" 1 + 4i Permit No. � 04- 2-�- Address V'2 C %L_ i F-= F C 3 a F 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. ?'R� No Go to Question 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. 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. ,? 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.. 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 property, certify under penalty of perjury that non-compliant plurnbing 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'%umbing fixxttur.e`s comply with the requirements as indicated in the table on the following page. Owner or Owner Agent's Signature/ € t _. '3 ' Date: l"' 1' Z : ZX Unon comnleting and sisnina this -Certificate, please return it to the Building Division in order to final your building permit. SB4072015.doc revised 08126/15