B-2017-1372CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1372
10522 ESQUIRE PL CUPERTINO, CA 95014-1318 (326 44 026)
F W H ACQUISITION
CO LLC
BOTHELL, WA 98011
OWNER'S NAME: QU DAYU TRUSTEE
DATE ISSUED: 08/17/2017
OWNER'S PHONE: 408-504-7184
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
performance of the work for which this permit is issued.
\ (`
100 I have and will maintain Worker's Compensation Insurance, as provided for by
i
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 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
32644 026
3 26
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.
p
r gnature V Date 8/17/2017
Issued by: Abby Ayende
Date: Og/17/2017
OWNER-BUILDER DECLARATION
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:
r. 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 ofApplicant:
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:
9
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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
a. 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
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person 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
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, Sect1 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
VJ`l
"/
be deemed revoked.
er or authorized agent: V
APPLICANT ANT CERTIFICATION 10Date:
8/17/2017
1 certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
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, 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
1 understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 8/17/2017
professional
03/14/2017 MON 15-17 FAX Fapt Fader- Hea- Der
-A
I&002/0Os
-102389
GENERAL PERMIT APPLICATIONMEP
COMMUNITY DEVELONAI-ENT DEPARTMENT *BUILDING DIVISION
90300 TORRE AVENUE - CUPERTINO, CA 96014-320ti
CUPERTINO (408) 777.8220 • FAXt408)777-3333 -I�t1111 m Isc-
511i111I OMel �I:unIJ!`tlnhll!'nl nuI ri-rui!-87 I %mr.v IR
pllp]P.CrnODRk'5C 10522 ESQUIRE PL
AI'Nn N/'_– LN,
OSNNPRNAME QU, DAYU
1410RE 4085047184
E. --AIL — � .
s7RUr AaZAR,19 10522 ESQUIRE PL
Cliv, STATF:,21P CUPERTINO CA 950113
, FAX .— ---
ODi+ITACi TIhA7EKaty Kehle FAST Water Heater
'�}�10N1' 425-638-7084
U°'A'`_KK�fller&?fastwaterheatsr.com
$7RF.VrAOQRESS 11715 N Craefc Pkwy S, C-106
rtrv,srn7r�, zip Bothell WA. 96011
13 oviwu ❑ 011'Nr '.1WIDLR ❑ awimmilN7 lY>wrRAC10R n C0�9kAC7DRMFN! <] VrCIl1Yt•Cr '❑ L'Ht}1kr£k I' 11 btxl:wrFe 13 TF'Hq
wnrrlvcraRNAtaV FAST Water Heater
L[CL?ISExUhInliA 987398
'tcl"sa'r�rr- C36. AU9,11cn
COMPnNYKAIAE FAST Water Heater
KKehle@fsstwaterheater.com Tex 425-6364085
57tucrA[lDkM— 11715 N Cresk Pkwy S, C-106
cnv,srntl,tn' Bothell WA 90011. rlru�E425-G36'-7084
nR urerelJ�rlal�r°rxs�� c ilcorscxtl�+ney.•--. -- hIS. LIC x
—1
CD PANS NAME` E -MA — .- •IAT " —
57 7 A�R .SS --- -- - -1 17Y, S7ATLI,ZIP
Usk Or- C vj-)m•ngt'I,EX'
IsUN-DINO QOOavdrinCIAL1
Q YCS
t110MNWRAPAI:HN1t,A 13 NO
1.1totcl N Cl YES IS THE DID-1AV
Moril)Mvp Q NO: Lq'NLEkROME) ❑ ��7
D£FC'R1P7tON 01"NOR), i
vi
TOTAL VAIMA11ON1 ;593•.94
k1LCI VI!D Ily:
B.V my si.-naturc below, ] nbitiry to rech Df the Ibllowingl 1 pgt 46t1 plupmy pa'nar clr uuflrofIzed agcpl to act no the propertyoyer is behnIA I hnve rend Oils
ullplianlibn nod the inffinll lion3. hale pre!Nided is con'cct. I have mad the I)nxi iplion of walk Pllf) vlel'iiy it ib Occome. Lnflree In 011114$, mid) hlrupplinollIQ lurid
Dtdinarluc WIYtI 6111tu IOSvII rdlhtiliQdV tkJg •nnylntcl l n. 1 nl ,710. reptcyetlfntit'cs of Cupertino to Color lbu.Above-idendnod property tbrl,ursp�vlipn pprpo;u.
SignomleoFApplicanVAgcnC r --- bhte; 81IV2011; --- aK
wj,m-15Mtr;NTALINVORMATIONREQUIRED
'
•
oF`ncsusr.onl.v p
I, II (11'klt:11111{•("RIIAYIit1
'�
f.�l s�AICDA1zn
�
L:I� I„17uu� ��
I'
!� �!; �.4�l1;l�.LlrscAiJpi_?0/1.r;oclrlUs�dlJ(%Flf�J
� I ,
i
SMOKE / CARBON MONOXIDE ALARMS :
OWNER CERTIFICATE OF COMPLIANCE
401..4, COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUPERTINO10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(a cupertino.orq
PERMIT'CoN(JT BE 1INALEI)oT'TIL°T?EuS>CE1tTIFICATE ETAS BEEN
COMPLE D, NEA AND RETURNED1 O TRE`.BTALDING DIVISION
PURPOSE
This affidavit is a self-certification for the mstallation 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 R314 and CBC Sections 907.2.11,4 and_420.6.2 An electricaLpermit is red,�ired_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 ll ��++�� r f Jh �p
Address: fog 22.. 14ire, pL• epe,thno C4 ?co I� Permit No. f"�/ j/3 7L
Specify Number of Alarms: #Smoke Alain's: J S. I #Carbon Monoxide Detectors. f 3 1
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name: �� V Date: l
Signature . go7
Contractor Name:
Signature Lic.# Date:
Smoke and COform.doc revised 12/15/16