B-2017-1268CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1268
10313 RICHWOOD DR CUPERTINO, CA 95014-3374 (369 08 050)
F W H ACQUISITION
CO LLC
BOTHELL, WA 98011
OWNER'S NAME: IWATSUBO MELVIN M AND AKEMI TRUSTEE
DATE ISSUED: 08/02/2017
OWNER'S PHONE: 408-996-7603
PHONE NO: (425) 636-7078
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-36 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:
(1) 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: $1583.59
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
69
369 08 050
3
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
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.
Signatur . V vv� Date 8/2/2017
Issued by: Kim Dunbar
OWNER DECL RATION
Date: 08/02/2017
-BUILDER
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
All roofs shall be inspected prior to any, roofing material being installed. If a roof is
following two reasons:
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 (Scc.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: 201
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
hazardous
material. Additionally, should I use equipment or devices which emit
shall not employ anyperson in any manner so as to become subject to the
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
-with maintain compliance with the Cupertino unicipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health &Safety Code, Secti505, 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: 8/2/2017
1 certify that I have read tHls application and state that the above information is
CON TACTIONLENDING AGENCY
correct. I agree to complylwith all city and county ordinances and state laws
I hereby affirm that there is a construction lending agency for the performance
relating to building cons(ruction, 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 inspdction purposes. (We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, casts, 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 al' b'n-point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
I understand my plans shall be used as public records.
Licensed
Signature Date 8/2/2017
Professional
07/31/2017 MON 13:34 FAX Fact Water Heater
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEFARTrYIENT - BUILDING DIVISION .
10300 TORREAVENUE • CUPERTINO, CA 85014.3206 . ,
CUPERTINO (400)777,322a+FAX(408)777-3333• lldlla f .or
PCIUI:I7MI>11Jc] ��nntl4tANtt`At. nt?I.f;Y-"1'R1CAl- I�hf1SC1?SLh11EOU5
2005/014
1.01347
MEP
mist;
PIICIFCTAnoRN,vc 10313,RICHW6OD DR'
AP^
OWNTMNAW IWATSUBO. MELVIN "0"4089967603
FrHERTA17DR295 10313 RICHWOOD DR
Cliv, 57ATr,21P CUPERTINO CA 95014
F'AY —
CONTACT HAM Katy Kehle FAST Water Heater
I'i1RNR 425.636-7084
unlnlsKKehle' aetwaterheater.corn
8-TRERTADDRUS 11715 N Creek Pkwy S,:C-106
CITY,STATP 21P BOtilell WA 98011
FrL7'
❑ owsm ❑ owmi Li+ILU unit GI 0'A'NEILAUN7 Q7?7Imump. ❑ com"ClimAUItNT 0 ARcluncl. R I..Hawali'I R I)hl -.K'PFN 7r(NAM
CONTILACTCIRNA'Ldl%
FAST Water Heater
LICL-NSENUA.STILR 7,lCf N$L'1'!'PI-
987398 1 G36
iiU A L]C
COMPANY NAME FAST Ut[ateirHeater
Kl<ehle .faetwaterheater.cQm,
T"' 426-636-7085
r'�Icssts''nt7t7Rrss 11716 N Creek Pkwy' S, C-106
c17,,srArt,zn' Bothell WA 98011
"'16425-636-7084
AR I1tT6CTfCNGIPIiP n- L — IW04SLMItITIC rte-, —
Ij PhtJY NhiAy/ PWAA , —�
si 7hli SS 07Y,57ATILZh'
II I-Ic;f
PAR
I r,
4SP, 01' , AI'h'w'I7tSl.LiKLl r1U197d1MULY
uUa11)NO• ❑fUt�rsGc;CNL ., ,
D .0=1'1N WILI)LAW 13 -vo
11F)JAk INJIMPA01 AWA J] NO
11Ili)1PC1 Lv 17 Yes
l%0L0Z'avJ; .0 No
is�iNL tltnnAY STS
ocilu;ktlsmv 13 no
"Ur:RCRIh1tW Ur• WORK ,I; ,
09
TMAL VALUATION: $11583•59
RX :' I I#VI
By lily 91gt1Wlllic boles I awilly to cult orlhe following; I am the wowity owncl'ur uutlwind ngmit to act an the pimperty clmdWs- Ixhull. I hm'e mild dlie
npplicntinll oud tllc infnrnlation 1 ]ls1'e pro>,'iacel IS COJreG. S 11811.'ICMI 1110 hCs:01111[IaFI P!' U1011t 6tl{I 1'el'lr3' ll 1P kCCllliRC. LugruC't15 Cnnlllly with'nIl npJ)I ICOIIIC luoal
ordillanc".alxl slale Imus relndug'to. IUI g psuncu rt- 1 IU 19ro l eilt'CStouRitvs bfC'upCllElw to I:nlerthl; nbol•e-iJCntilled plupgrty'Itu inapfWioit Jvu�papt'u.
Si ntureofA licantfA enc { L)mc: 7/31/201,7 ,j+
6'n PP 6 ie ,-----'--•- --� X
.5.UPPLEMENTAL )NFOMATION REQUIRED
oFmcF UsFONI.Y
i
❑i oE•IIII.nLr•�(�oit�rtau
l� mul mss
C]' STAN11ALtP —
❑ i.kncu;
❑� mmali
AI r•ffoc nwised 0611111
SMOKE / CARBON MONOXIDE ALARMS
• OWNER CERTIFICATE OF COMPLIANCE
,4 1111
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10-(�
CUPERTINO 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333• buildingna,cupertino.orq
POWIT CAVS9T BB FL ALED UNTIL TIII'S CERTIFICATE HAS.UEl
COMPLETED,STONED AND RETURNEDTO THE BUILDIIV G DIVISION.
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms
for compliance with 2016 CRC Section R314,2016 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 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 X X
the bedroom(s)
On every level of a dwelling unit including basements 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-RC Section-831-4 and CBC Sections 907 :3-i 4-and 420-6:2:Anelectricalper is recquired-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 Califprnia Residential Codes.The alarms specified below have been tested and are operational, as of the
date signed below
Address: 1030 k.'GiiJw'0.-a �i-ti/� C�U p t't YJ I CA q5 cf. Permit No.13- 0/7-12 6 g
Specify Number of Alarms: #Smoke Alarms. I 5 I #Carbon Monoxide Detectors.
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name: � �� l a�
��eAviLA-v-1-sa (9A Signature. .. Date:! y
Contractor Name:
Signature Lic.# Date:
•
Smoke and CO fo»n.doc revised 12/15/16
WATER-CONSERVING PLUMBING FIXTURES ri
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT'• BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE CUPERTINO, CA 95014-3255
(408)777-3228•'FAX(408)777-3333 buiidinq(a�cupertino.orq
Owner Name 1 ,1Viri zte.fai-sah Permit No. 13'2. Ot7"' 1,26P
ddress /0 3/ 3 /ZiC ci."72— p . CCl c c
1.- Is your real property a registered historical site?
❑ 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?
0 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.
51 No Go to Question 3.
3. Is water service permanently disconnected for your building?
0 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
0 No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
0 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 fonn.
171 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..
Please check ONE of the following:
X 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 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-conserving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
------ —My-property-is a-m. -lrifamesi-dentia-1-real=property. See-Givil=C-oele-Seetion 110-1:5.
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).
0 My property is a com.rne'cial 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 1101.1
through 1101.8,the current California Plumbing Code and California Green Building Standards Code,and manufacturer's
installation requirements, and that the water-conserving plumbing fixtures comply with the requirements as indicated in the
table on the following page.
Owner or Owner Agent's Signature: a,.A Date: T/7/2(1/ 7
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB407 2015.doe revised 01/05/17