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B-2017-0928CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0928 21868 OAKVIEW IN CUPERTINO, CA 95014-1146 (326 19 107) F W H ACQUISITION CO LLC BOTHELL, WA 98011 OWNER'S NAME: CASEY ALLENE H TRUSTEE DATE ISSUED: 06/12/2017 OWNER'S PHONE: 406-250-8881 PHONE NO: (425) 636-7078 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Q-3¢ Lic. #987398 Contractor F W H ACQUISITION CO LLC Date 10/31/2017 X BLDG —ELECT X PLUMB MECH X RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: (N) WATER HEATER - SAME LOCATION I hereby affirm under penalty of perjury one of the following two declarations: t. 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. J` I 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 Sq. Ft Floor Area: Valuation: $1490.44 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 326 19 107 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 per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. 1�� Signature 4r Date 06-12-2017 Issued by: Kim Dunbar OWNER -BUILDER DECLARATION Date: 06/12/2017 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 fust 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: 06-12-2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER t. 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. I 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 shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous 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, Sectio/ns 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall , A "11 be deemed revoked. Owner or authorized agent: V APPLICANT CERTIFICATION Date: 06-12-2017 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) 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 DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 06-12-2017 Licensed Professional 06/05/2017 MON 15:45 FAX Fant Water Heater U004/011 95616 GENERAL PERMIT APPLICATION MEP C01.01MUNITY DEVELOPhSENT' DEPARTIv1ENT - BUILDING DIVIS10N 10300 TORRE AVENUE 4 CUPE=RYINO, CA 86014-325r1 CUPIEFtYINO,,(4013) 777-3228 - FAX (408) 777.3333 - l3ylld10Q0 IJQ0 In .0 e> -W- Fq- -0 �z t? 10d.- 1tu mwn Mh7PfIIANICAL MELECTP.1C'ALLmisa: LANEOUS pllolerr AnDilms 21868 OAKVIEW LN, APN II 3 Z& 01VNLRNAME CASEY, CHRIS 4062508881 r;•IdAlt. _ S1'arNrAL)Dltl-�s 21868 OAKVIEW LN, CITY, $7ATF ZIP CUPERTINO CA 95014 FAX CONTACT NAME Katy Kehie FAST Water Heater I'11C?NI! 426-636-?084 `'h'A1y(Ke We0-fastwaterheater. com gl%P.rrADTAM- 11715 N Creek Pkwy S, C-106 C1TY,STATE, 211) Bothell WA 98011 FAa ❑ L.WNix 0 OWNLAWILDIIR 0 0WNEkA0LN7 CWMAUCIR ❑ CD.\-1UC-1tkMLNt ❑ AnnHt}rr © v'NaiNRA 0 UIV1i1bY1:17 0 7RNANt C0NYKAC1'0KHAN14 FAST (Nater Heater 1.1[I-'NtI:NtJhIPI:R 987398 ].ICLTISL�'li'Pl� C36 COMPANY NAME FAST Water Heater FAWI. KKeh(e0fastwaterheater.com fAx 425-636-7085 STREFTAL71NiM 11715 N Creek Pkwy S, C-106 C111',STATE,YIP Bothell WA 98011 P"(A" 425-636.7084 All III rORNOINI''%TA L 11C'GNSC+MPubLICt�--- .� CD iPAM' NAM-' ST,,11ii'TAD 'SS — -- .r C1iY,SIATli.L1P -�Va� lWS L1C9 (ISE 6v 171wuLFAX Q MDI-11TAMILY i51-1111&40' ❑CCIfA &ACLP,L PRO1LC1:INWIL.I)LAM) ❑ YES VIDIAN IVILNIA(T AtUiA NO plturl-cl IN 0 1'rS YL0W ZONE Ij No Ist"tWi IAN 0 vlL5 )IIL'IILI:X HOMO [] No DY.,CCIRLIMIDN OF 'IV011R TOTALVAlA1A11UN; $1,490.44 I72 I IY: By my rigputurc below, l certify to eatAt of ihr Inl lowing: 1 wn lhr probity owner ar uutllarized agwll ts7 amt nt7 Ihr proprRy owacr'b bcllnh: 1 hour rcutl thin npplicmlinu and dx infolntelion I have p1bvided IS 4oluct. I Ilave ICOR 111C D S.I illlifh br wmk nntl LYri6, it is Rcculm, I Ague Lo aolupl�- w101 all ilpplic6k lorill 41411nnnl:C3 4R1K) tilmlc I111va rCluLiuy. l0l`ImF11171:ti1 1 1141411 LI7YC IL'pl'BbCntal7,vLi U1 Cul*r w to uElLer IhC tlbovu-idundfed pivinly fur biripmLlon I1.1gmses. Signmtum DfApplicaiWAgrM. _ Daty - _ _ -- 615/2017 SUPPI.CMENTAL INNORNIATION REQUIRED OPFTCE USE ONLY 0 p►InI.T1ts.CbllrrinK � %! �� S9AN'1lAltn I.1 L,Utfll: ❑ MAJOR Afl" tlise.pp� 2011.doe I•vvimi 00111 i CUPERTINO PURPOSE 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 • buildingCcDcupertino.org PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE" HAS BEEN COMPLETED, SIGNED. AND RETURNED: TO THE BIIIZ3DIN I'D ION 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 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) X 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 907.2.114 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 Address 4' c hZXI, 0 Permit No. L Specify Number of Alarms # Smoke Alarms 7 # Carbon Monoxide Detectors F/7 / have read and agree to cQrnl)ly with the tercels and conditions of this statement Owner (or Owner Agent's) Name. htIZlJ �' C-- A, Signature Date: Contractor Name: Signature Lic.# Date: Smoke and COform.doc revised 01/1012017 WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (40M 777-33.13 : hi filriinnnri martinn nm Owner Laine Address 1. Is your real property a registered historical site? El 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 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? El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. Skipthe rest of the form and sign bottom of form. No Go to Question 3. 3. Is water service permanently disconnected for your building? El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. DeNo 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. 2rYes 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.. 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 Mures 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 iinproverrients). ❑ 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 u__ On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conseiving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). ❑ My property is a conanzercial 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 eater- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations of improvements). I, as the owner or owner's agent of this property, certify under penalty of perjuly 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 watef-c 'nsei vm 1trnbing fixtures comply with the requirements as indicated in the table on the followine pane. 7'� Owner or Owner Agent's Signature: (:<! L/L,- Date: 1-1-17_ Upon completing and signing this Certificate, please return it to;.YAuilding Division in order to final your building permit. SB407 2015.doc revised 01/05117