B-2017-0656CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0656
10137 N PORTALAVE CUPERTINO, CA 95014-2322 (316 21 042) F W H ACQUISITION
CO LLC
BOTHELL, WA 98011
OWNER'S NAME: CHANG JOHN N AND HELENA K TRUSTEE
OWNER'S PHONE: 408-253-7651
LICENSED CONTRACTOR'S DECLARATION
License Class -Q-M Lic. #987398
Contractor F W H ACQUISITION CO LLC C 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.
fell 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.
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 4.26.17
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
t. 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 (Sec.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).
I 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.
3. 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 4.26.17
ISSUED: 04/26/2017
NO: (425) 636-7078
PERMIT INFO:
X BLDG —ELECT X PLUMB
_ MECH X RESIDENTIAL _ COMMERCLAL
JOB DESCRIPTION:
REMOVE AND REPLACE 50 GALLON WATER HEATER IN GARAGE.
Sq. Ft Floor Area: I Valuation: $1542.19
"N Number: Occupancy Type:
316 21 042
PERMIT EXPIRES. IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: SEAN HATCH
Date: 04/26/2017
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 of Applicant:
Date: 4.26.17
ALL ROOF COVERINGS TO BE CLASS "A" OR
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 25505, 25533, and 25534.
Owner or authorized agent: , V'M
Date: 4.26.17
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
UQ/ L4/-LU17 MCN 13:34 FAX Fsp-E Water Heater
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0006/016
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GENERAL PERMIT APPLICATION � M E P
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
19 30300 Tt)RRE AVENUE f CUPERTINO, CA 95014.3265 m1sc
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SMOKE I CARBON MONOXIDE ALARMS
OWNER CER -f PA®MCT IFICATMPLICOMMUNITY DEVELOPMENTBUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO,CA 95014-3255
(408) •
! I d 1 n g e— -c-u R e- ffl-n-0 -c-r9
777-3333
(40B) 777-3228 •, FAX
Alarms for
PURPOSE required Smoke and Carbon Monoxide tification for the ii Lstallatic'n of all 0.6 and 907.2-11-2.whe-re no interior access
a self -cer
This affidavit is R1015, 2016 CBC Sections 4-9
compliance with 2016 CRC Section R314�
for inspections are required.
R�TJON hall -be provided-wiffi Smoke - Alardwan�drtCa�ts
Is
(yexceecGENERAL IN'F0ti-fa 'llings S xistingg
Existing sing le -f
Ie -family and mul inti -family dwellings alterations, Or repairs to e .
Monoxide alarms. When the valuation of additions, .2.,,.5 and 49-0.6 require that Smoke Alarms and/or
$1000.00, CRC Section 8314, R315, and CBC Sections 907
. Alarms be installed in the f o1lo-"Ving locations: COALARM
Carbon Monoxide S ALARMX
AREA X
— ��icinity of the
t_ area ill the immediate'v :
separate sleeping eet of bathroom door) X
Outside of each se Ms shall not be located vithiandhabitab
Xbedroom( (smolke alal',fit
. 'tincludin.-basemeleattics X
adwe cr uru
On ever level of ------
ithin each slee ir-Icr loarfl t contain fuel -burning appliances and that
d in dwellings which do no smoke alarms - Shan comply with
Carbon alarms are not require 0 ibined with
C garage. Carbon monoxide alarms con'Fire Marshal.
do not have an attached 0 0 approved by the office of the State
CBC Section 420.6 and shallbe apprO _ - may be solely battery operated.
r units with no commercial power supply, alarm(s) . or alterations do
:)Iy. In dwelling operated where repairs
P ower Supply= permitted to be solely battery y means of attic, basement 01 crawl
vell,n, units, alarms are . d for
In existing cl_� 0 ceiling finishes 90'/ b _dt'srequirenot result in the removal of wall and ce o 2.11.4 and 420.6-2. An electrical permit
CRC Section R314: and. CBC Sections
sp ace. Refer to
alarms which must be connected to the building win -119 referenced above has/have been
'by certify that the ala"rm(s uildin'
As o�vner of the above -referenced property, I here d in compliance with ffie California B 0
installed in accordance N,,,itj-j the mall -df actuyer's instructions "" been tested and are operational, as of the
al Codes. The alarms SP ecifiedbelo,,,v have
and California Resident
date signed below- AL
Address'
Specify Number of Alarnis',
I have read an
��'s) Name:
ovine,' (or Owner -
Contractor Name:
Olg:-Ot Permit NO 19
get: V1 IJ D"
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C' # CaYbo11'v\1ono'-'-id1- DetectOys'G3
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Smoke Alarms:
arlrns and conditions -of this statement
agree to cc)mply�,viththet& ' / Z4
Date: ..... I .............
..... Llc.# ......... .............................. Date-: ...................
lature............................................ ....
Smoke and Cofol_,.doc revised 01110,E-01:
CVPE.RT1K0
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinga-cugertino.or4
Owner Name U73 G' mI" i3 Permit No G7 — 0,6s:6
Address C� l % 1`) 1�' a (%.-Sam r) II2 C_ I CSC
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1.101.8 do not apply. Skip the rest of the form and sign bottom of form.
9 No 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
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.
-W 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:.
Fk My property is a single fancily 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-conseiving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
❑ My propertyis 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 plumbing fixtures will be
replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 110 1. 1
through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's
installation requirements, and that the -,nater-conserving plumbing fixtures comply «Tith the requirements as indicated in the
table on the following page.
Owner or Owner Agent's Signature: t_�_ .%, , , ""� Date: 1�7/ 31 /za t ❑ 1
Upon completing and signing this CertificatSe', please return it to the Building Division in order to final your building permit.
SB407 2015.doc revised 0105/17