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B-2017-0945CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0945 10435 ALICIA CT CUPERTINO, CA 95014-2634 (342 45 028) F W H ACQUISITION CO LLC BOTHELL, WA 98011 OWNER'S NAME: CHOI UISIK AND SUJA TRUSTEE DATE ISSUED: 06/14/2017 OWNER'S PHONE: 408-375-2591 PHONE NO: (425) 636-7078 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Q -.N 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) 50 GAL WATER HEATER - SAME LOCATION 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. 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: $1667.10 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 342 45 028 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. Signaturey < Date 06-14-2017 Issued by: Kim Dunbar OWNER -BUILDER DECLARATION Date: 06/14/2017 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 roofing material being installed. If a roof is t. 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: 06-14-2017 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. 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, Sectio505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 06-14-2017 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 06-14-2017 Licensed Professional 06/12/2017 MON 12:02 FAX Fast water Heater 1 0 0005/017 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELORhENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 9,5014.32ff CUPEtti11 0 (408) 777-3228 - FAX (408) 777-3333, bIldh ga0UD0 r .orm Isc V6.1_UMIAM0 1-1 MI -HANICAL MEUC'7RICAL M Nu,,cl:LL,4LNE0 S 1°itWl',t1 tiltnkF�g 10435 ALICIA CT ''N" 3 2 - �T — ''2 b e', NIANAArk CHOI, ERIC l'H°"f 4093752591 r•MA1L CTR&F.rnI1DRG.SS 10435 ALICIA CT _ CITY, sTATr,�1r CUPERTINO CA 95014 PAx CONTACT NAME Katy Kehle FAST Water Heater 01 LOW 425-63$-7084 �'r.'"ILKKah10Mastwaterh0ate r.Corn T minin ADDAUSS 11716 N Creek Pkwy S. C-106 C11Y,5TATE. ZIP Bothell WA 98011 FAA ❑ (YA-49 G1 VWN0,1111rLItTk 13 OwNGRA011S] CONFRACiOR ❑COMACIORAUINt 0 AACItIrLCI' ❑ L'NUINLL'k 0 11i7.r1URM ❑ Tr:MP.Yl CONTR4(TORNAML• FAST Water Heater LICUSLNUMBIEk 987398 I.If'EmsL'I�'PL' C36 31us- fft,� COMPANYNAIAR FAST Water Heater r'"dA11' KeUhle0faastwaterheater.com TA" 426-636-7085 S'IicJ:VJ AI)I*XS5 11716 N Creek Pkwy S, C-106 cirl,sti,an.zu' Bothell WA 98011 PNON"425-636-70134 AH4(1rTf['TrLNC1\'Ll;]t'CLO E LICENSE M1R1DC CCI 'SPANYNAME,' bMA _ � r 11 p"a USE Ov I'IticaUl:FldX_0 11W1;I14WAILY IIUILIPJNQ ❑ l mfaxoml' PY,MLt;I'1Hk'tl.lA_wil 0IT-4 vmAN 1KUKIPAfll nttl-A ij FO 77, M, QTFS !'LtxaUxtk�'L' Q NO l�PIILbIn�nN CT'sT:S 1!K'IILf:k` DESCR)IMON Ur- tvnRk 170 ,-IV Y 1 1 V'1bG��Y3dL4l1.fC] / ` _i la- TOTAI. VALUATION: $1,667.10 lay illy Slgnlilulr bolo*. t ecrllly to eae}I of the follo+vinl ! 1 104 LlIe Iuolr.Ity ownet or uulLoriaed ugcut to act an the property owner's l>chall. I have rend this Application and the Infolnvaiion I lmv providgd is colreel. l 113M ill 1110 MWTIpilon orWrok mud verify it ie Iiucuince. I agree IA eompl), Millt alt a(1pllcuklk touul OT4613necl au;l stale laws relining to 110 1( g nsuocd A. 1 lit] lin wiliv wnultives uKupelturo to enter the a60ft•OWlillcd property I'm inapciriloll purpascn. S1gnlltWpofhpplfeAltU,�r6et1(: I)nls:• 6/12/2017 SUPPLEMENTAL INFORMATION REQUIRED oerlCE UseONu• W E� �� 0�'It11•Yllk•C`(►UA'1'1?N E%I�ItA�S � 17.�91 MJ S9Ar:l1Al:It� ---- Yf� L.tItt11T�,_�_ ❑ MAJOR ilJe1',Lll.ccAph 2011. floc Irlvsfll 06121/11