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B-2017-0883CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0883 20713 GREENLEAF DR CUPERTINO, CA 95014-1907 (326 56 009) F W H ACQUISITION CO LLC BOTHELL, WA 98011 OWNER'S NAME: MISRO SARAT C AND BIJAYA L TRUSTEE OWNER'S PHONE: 408-255-1648 o 1 1 .,1t 1 &.4 13 License Class C-36 Lic. #$$ZM 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 Vperformance of the work for which this permit is issued. 2-J 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 theZ no Municipal Code, Section 9.18. Signature � Date 6/2/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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: r. 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 6/2/2017 ISSUED: 06/02/2017 PHONE NO: (425) 636-7078 BUILDING PERMIT INFO: X BLDG —ELECT X PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: REPLACE 50 GAL WATER HEATER - SAME LOCATION Sq. Ft Floor Area: I Valuation: $1542.19 APN Number: Occupancy Type: 32656 009 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Ayende Date: 06/02/2017 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 6/2/2017 "All HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505125533, and 25534. Owner or authorized agent: y Date: 6/2/2017 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 05/30/2017 TUE 16:16 FAX FOAt water Heater U008/019 N`) 94988 GENERAL. PERMIT APPLICATION MEP COMMUNITY DEVELOPA4ENT' DEPARTMENT • BUILDING DIVISION 10340 TORRE AVENUE I CUPEriTINCI, GA 850'I4•325:i C U P E�RTIINNO (406) 777-3228 - FAX J408) 777.3333 • I,-iuIII u c .ar misc NGLUNIBINO MMEC'HANIC'AL I_IELLC TRICAL LJAUSCELLANMOUS Nllbll(C`T AMAMI 20713 GREENLEAF OR � AFN a ,-z-(o M "OkNAME MISARO, SRAT, PHO' 4082551648 STRFU rDDREN$ 20713 GREENLEAF DR CUPERTINO CA 9501a F^x--.---.------- CONTACT NAME Katy Kehle FAST Water Heater """"" 425-636-7084 1 l'IIAILKKehle .fastwaterheater.com SIRRr:TADDRUS 11716 N Creek Pkwy S, 0-106 CITI',STATP ZIP Bothell WA 98011 Fnx ❑ OWNUR ❑ OWNLA-BIM llR 0 OH'NCRMIPA'T I OYIPnCIOR 1]t0-%9RAC-1U:.sG1Nr ❑ OACKITITV Q LNu1Kit ❑ ll ❑ 7GN:,uI CONTRACrORNAML FAST Water Heater LICRNt6NVINHA•p 987398I'lCtNSLIVI'l) C36 .r,Ire COMPANYnAHK FAST Water Heater FM"' K ehluBfastwaterheater_u. FAX42 - S-1FU-1AAI)M=acs 11716 N Creek Pkwy S, C-106 Bothell WA 98011 nP. IIrrK7(1YCA.\I-?TT... C 1 [CI']!SL fn,rdflllL- ^- .,-,....."^ cr, p NVN A. ' -- � rMn P1Oi`E425-636-7004 IAA' 1.IC' d - rnx USF: OI' 0-Dm-UUYLE9( Q MuI.11I:&k1L1' ImLmNa. pc4MFIhKCI I- AROILCTYNWILI LAND ❑ YriSI'K(HL'C7 LIMARl?7LRI'M1CAIUA fl NO LN rFS 1'L[7ut)zUK,: © NU mrn[orn.AN �L7 Yn LI)INLi:RHOAIE! ❑ +7 DUCRIMIDN Of WCIRK �j> �i'� },J ,�/' - LVY°�Cni�SI`L1.lrl 1%l�S/1-411,14` I -M AI. VALUATION: $1,542-19 kraCT.lt�ilJ H1'; ,�,� f by fny signuturt bolo v. I ccnlfy to each of the following, I urn the pro1r11y owner or aullimizcd agco) la net on the prupcny owners Irhnlf I I ve rend [Itis hppllcollell Md tba 111fn1Yllpllpll 1 III eC piTtYldnl {S COITCCI. I IIavC ICvd Ole Dcwl ip ign or wollc and Vclilj it ip luecumte, r apyoe In comply with nil PlrplicuNe lvvvl O1dvl:InCCS AWI SI'Me JAIvS rNlptllLa tOtUI '(1n.%liftt1 II• I it, I7 .o jgwcmim(i+tis ofC'uJwilmo lu enter IhF nbm c4denlilletl prvpert)' fU mvpmtlull purl Am tali, :iS�IIlIfUI>: U(','y�l{YIICAI)L'r'1pjCt11" _�-, Due 51301201 7 SUPPI.EMIL-NTAL INFOIZAAnON REQUIRED (IMC[' INC oNts �+ 1 171 D1'lilt•TIIK•(-OUNrkrl I l exl•,tr:�5 -- n &'IA�UAItD —D L,11iCh ❑ ><I.unu lfl:T,L{f.<r: Spj> 2hf l.iluc mvgsed 06/11111