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B-2017-1371M/ 40 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1371 7579 WATERFORD DR CUPERTINO, CA 95014-5233 (366 17 030) F W H ACQUISITION CO LLC BOTHELL, WA 98011 OWNER'S NAME: YEN JAMES SHEN CHU TRUSTEE & ET AL DATE ISSUED: 08/17/2017 OWNER'S PHONE: 408-873-8812 PHONE NO: (425) 636-7078 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CC=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: REPLACE 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 rformance 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: $1369.35 permit is issued. APPLICANT CERTMCATION [certify that I have read this applicationand state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 366 17 030 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. Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. J ature • Date 8/17/2017 Issued by: Abby Ayende OWNER DECLARATION Date: 08/17/2017 -BUILDER I hereby affirm that,I am.exempt from the Contractor's License Law for one of the following two reasons: RE -ROOFS: 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 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) z. 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: 8/17/2017 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 wilLm' aintain a Certificate of Consent to self -insure for Worker's Compensation; as'provided for by Section 3700 of the Labor Code, for the performance ofthe 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, Sections 25505, 25533, and 25534. Labor Code, I niust'forthwith comply with such provisions or this permit shall be deemed revoked. ' / er or authorized agent: V APPLICANT CERTIFICATION Date: 8/17/2017 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 cohs&uction, 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. Licensed Signature Date 8/17/2017 Professional 08/16/2017 WED 14!55 FAX Fast water Heater Sim E005/013 103174 GENERA1.L'PERMiT APPLICATION MEP IQ COMMUNITY DEVELOPMENT DE=PARTMENT * BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 35014-3206 misc CUPER'1'INO (408) 777-3228 - FAX {40B) 777.3833 Ut IL1dIIc Cu Brtini Qrq t nr.tlk.[u11.in nn4PPI-IiAN1['AL rllu'r_(rmvtil. MMISMI.LANEOUS MUWA('T ADIMAe 7579 WATERFORD DR MNIANAML YEN, JAMES PHQr.-e 40BB738912 r. ►an1L � s ,prAnDUSS 7579 WATERPORD DR CITY, 8TA7T,2LP CUPERTINO CA- 95U14 ' fiAa------- CaNTACT NAME Katy Kehle FAST Water Heater r1ioNE 425-636-7084 f t'5PILKKehIeCdJfastwaterheater.c rri _ ,91'KMAbORM- 11715 N Creek Pkwy S. C-106 CITY-sTAU, 21" Bothell WA 96011 ' 'FAX OWNt�]t :� UA'Nllf.+BUtLDt0. •p OH'NG0.AOL'N7 (Y1VIRhiTOk E l CQXTRACTWUAUL'NT D ARC111T11CI' C3 CN111NRL'tt i Cj1}IVlll W'IR 1:7 7EiAN7' CONTRACCORWAM11 FAST Water Heater LIC 987398 i10ENSC'n'PTt C36 `°t^"A"Y"""'R FAST Water Heater p uAlt+ KKehla(Mfastwaterheater_co pAx 425-636-7086 , 11715 N Creek Pkwy S. C-106 OTY.STATIU,11' Bothell WA 98011 11'0"426-636-7084 1k i1lTfl iflN0fiQ1S @ tic Sc MINID CO PANY NAM _ — — P..tdA STl ' Ab --diy,SIATG.'LIP .. �� PAR T •h ww T Ilse Oil I.IsI'ITceUIPLIXEI Je1U1,11d1ANILY 1/UIL040' ❑90MMUCIAl. PY.UJU:Cr11AW110I.A1,7) YTF WilJANIr�ILI(pi,Ct:AI[I'a. j] t:0 1'NONICI N M I'L[xwz[Ydc 13 NO •. IiITIIUmprilr�p I] yn L1CitLUMA40 [] W 1XW—RINTIT+r ob %�Dttk `ISXLJ& 1 Tc7ALYALUAIJ0N: $1,369.35 1tr_C.TIVsnuv, IBy Iny ulgnuun> ,t leti+x f ool{IfY to eeotl,oflhe follpwillg; I u[n the prolvit5' cm-nor(if nugsari7.e4 now la w on an 1winvl' nimic c boho Ili I hnve rcnd Oil; ApplieeupR and fife ioltinuetion i Lave-pinvide'{ is ca recl. 1 have Ir.20 the Dew6plipn of Wpik an[I very(} it IF uecuin(g, CaB[ee_(o epn{illy K'i(h nll Rpp1lCaLlc losttl o1dUJip"m 21m) 00,11.111v.'s MIRIN& 10 Iul[JJ�.J 76 ns[r>acii 1 it] I'Ire. ic(ry'eSCnlntivE6 UrClL1jM1iJ* (0 Chief (C 1bU,'Cat,O[it(Ova �+Iropoly r0T folip Y Lica p1117)(Mil. Sly[>ftmtiofAppllCtmV}1gCR1: �--�' Date:— 8/6/2, 011' SUI'PLENWNTAL INFORMATION REQUIRED . ' a ' ', ! 0r17Cr. Uva ONES b OYRR.TIIF.CQLINrRIt b_ 31'ARUARD --- C7i I.ANcI: ,h1Adt?It ' 4P1:1�,hltedsllilr_2011-doc rek-I&W 06121111 j1, , 4. ` SMOKE / CARBON MONOXIDE ALARMS F. Lit OWNER CERTIFICATE OF COMPLIANCE Att 40:4,4 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•buildinq(a�cupertino.orq PERMIT CAIYNOIV FINYALED UNTIL THIS.CERTiFTCA TE HAS SEEN C©MPLETED,SIGNED RETUR EI)TO THE BUILDING 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-CRC-Section RB-14 anti-C C-Se-c-tions 907. .11.4 and-4-2-0-6:2:Ern elec-tr-ic-al peer tit is-rec rircd 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 m 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 s! �7 �• Address: 7.�7/ !^//�T4���) �� a/72/e7/�O �-� �P rmit No. ,3j--Z9/7---- /3 / Specify Number of Alarms: #Smoke Alarms. I 4-- I #Carbon Monoxide Detectors / I I have read and agree to comply with the terms and conditions of this statement Owner(or Owner Agent's)Name: Signature. . . ..... . . . .. Date: y7 Contractor Name: Lic.# Q j3.Y Date:Fiviel4e �>S/7/dloSignature �•C C Smoke and CO fonn.doc revised 12/15/16