B-2017-0616CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0616
10301 PHAR LAP DR CUPERTINO, CA 95014-1177 (326 39 062) F W H ACQUISITION
CO LLC
BOTHELL, WA 98011
OWNER'S NAME: FOOK PAMELA CHEUNG WONG YAN TRUSTEE
OWNER'S PHONE: 425-636-7084
LICENSED CONTRACTOR'S DECLARATION
License Class CM- 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.
DATE ISSUED: 04/19/2017
PHONE NO: (425) 636-7078
BUILDING PERMIT INFO:
X BLDG —ELECT X PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
I hereby affirm under penalty of perjury one of the following two declarations: (I) 50 GAL WATER HEATER - SAME LOCATION
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.
d,\",%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. I Sq. Ft Floor Area: Valuation: $1610.50
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 Cup1ertin Municipal Code, Section 9.18.
IM
Signature t iDate4 19/2017
V
"N Number: Occupancy Type:
326 39 062
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Kim Dunbar
Date: 04/19/2017
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
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: 04/19/2017
hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A"
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
sball 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 04/19/2017
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, Sections 505, 25533, and 25534.
Owner or authorized ag n : i/
Date: 04/1912017 U
CONSTRUCTION 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
04/17/2017 MON 15t39 FAX Fapt Walter Het<ter
U004/016
1=4
GENERAL. PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENTDEPARTMCNT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-32516
CUPERTINO (408) +777,3228 • W (409) 777.3333 • misc
VSIPLUMBINb 17IMPtHANICAL I�IIdLLt"I'lilt`.n1_ I�xttzs rt r �rurni�
PIIOIIIrr A ItDR9110 10301 PHARLAP DRIVE - 7'7o
rWNEV.NAME CHEUNG, PAMELA reDl'P 4082163707
r•MAn. ,.
srR kr�snDRr s 10301 PHARLAP DRIVE
CIYY, 51AT11.71P CUPERTINO CA 95014
PAX
MTACT NAME Katy Kehle FAST Water Heater
P,IDNE 425-636-70$4
1 11,h1AlLlfKehle; Biwa#®rhea#er.c4m
$TRUTADDRUN 11715 N Creek Pkwy S, C-106
CITY, STATR, 71P Bothell WA 98Q11
PAN
0 owxmit 0 Uit'llmaur.DPR ❑ 01KNIMAWN7 COV'IItACIDA ❑Cc&l(zrtMMAGkNr ❑ ARCHITIICI' ❑ 11HUM11L'R ❑ Dr.V1;v YtJr ❑ -mwo Yj'
CONTttACrDANAMli FAST Water Heater
LlmsrlfummR 987398
IIC€MSII'rt'Pfs C36
Bus-uCh
COMPANYNAb16 FAST Water Heater
I E.Mh71' KKehle faatwaterheater.cQM
rAx 425-636-7085
111** -.1'`1* --i' 11715 N Creek Pkwy S. C-106
CITY,B•IATILZIP Bothell 'WA 88011
""425-636-7084
nit fllrrerrrN1411, LICGtfsGfnmtb�L.•--� �—•
(_0 PANY-141.1r E.1dA
Inis.ciC
PAX
USE bP kll.101-11MALYP&aAK.'1'SNwaD[Anv
AIJILp1N& ❑1WMMMCb\1.
YCH
UWANWWACI?.ALUA Md
Plt{SPIICI IN l YES.
r'LDCVl ame 1:3 No
,%i11Vra1tSnAN ❑ 1R
Timm lawomv [] .%�o
DESCRIP910N Ob WORK
TWALVAI.UAIJON: $1,610.50
k IV D
By my visnaturc Maw, I ccrtify to each of lbe following: [oro the Irrotzr+y awnor' ur arum0rlrcd agoll tL+ alce It tte 1lidjYL'tt j' btvl7Cr�51Y.ltall. 1 have rcnrl tlhiu
aippllentloll nod die htlbmwaLloll 11aft p+r+•ided is coaccl. 1 have orad ilio Description or+h'b,k and vgjij r it is occul ole. I agree to comply with All Applicable local
ardirranm alA slate laws relodup, totui + i rg Gnatruali , I nl eine 1ela+at Wflfl%V6 orCulferoGt010 enter the above•identilied prottcrty for inspection purposes.
5igltaturl of ApplicalWAgcrrr. >NL l>artc: 4/17/2017
5111°PLEMEN7'AL IN 0RN1ATI0N REQUIRED
OFFICE USE ONLY
Q nt•RIITUR.t`4Lmrttk
G
p &T•hN11AkD
U I -,Hatt;
❑ MAJOR
A10,j i.scApp_20t1.rtocrPtiseyl06121lit
SMOKE / CARBON MONOXIDE ALARMSh,
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO,CA 95014-3255•
CUPERTINO
(408)777-3228•FAX(408)777-3333•buildingCuicupertino.org
i x f , ' s -a a a fR u Au .4�i i i t ' r, c ._ t r _
VX
5 PERMIT CANNOT BE FINAIIED TJN�I TL;T1 hCERTTF CATS S BEEN
,�a-����� � f ' "� ���r< ��i,�z�, "�s r� '� a „r � � '� � e
f - QQNIPAFI TEDZ SIG1 EDoAND URNED TQTMAV DN�1fdkr = :
�lsrt - �,. �.�_.ruz� _ u�a' - ..,�. ,- i+t 3u �` ....�..��-.a.,2.. �t�"v'�� r.3�ak��"'�'��'�.��''��'0 s. .�t�ts.
mRRA�...,,,fit;.. ^k,. .`::,;�^`7s;^5;.:..ro.. .< ...,w �-^, '�,m.,^ xf...r.:,:n ;•k�'Ka-mz;q++c, :v.;ssT'!mraz".3; .,r...,. :,,.�CSf*5r",'3;-,. ,,,:«if 'Y>'..,-,:;''.45"+s ., r '.. ,
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 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,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 SMOKE ALARM CO ALARM
M_
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)—(Smoke alarms shall not be located within 3 feet of bathroom door) .
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 C �C 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. Gef
Address: to3 o/ jH k. 49-P aiStv &�T/�v0 Permit No. �� 20/�.� p' 1119
Specify Number of Alarms: #Smoke Alarms: L.221 #Carbon Monoxide Detectors: °
I have read and agree t1 omply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
C_tga. G Signature... .... .. ... Date: . /./..O o
Contractor Name: J
Signature Lic.# Date:
•
Smoke and CO forrn.doc revised 01/10/2017