B-2017-1620 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1620
1088 MILKY WAY CUPERTINO,CA 95014-5009(362 20 010) F W H ACQUISITION
CO LLC
BOTHELL,WA 98011
OWNER'S NAME: WILLIAMSON DONALD AAND JANICE KINNEAR TRUS DATE ISSUED:09/20/2017
OWNER'S PHONE:408-718-2769 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:
REPLACE WATER HEATER IN 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.
J 2. 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
permit is issued. Sq.Ft Floor,Area: Valuation:$1459.39
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 362 20 010
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 Cino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date Gkk I Issued by:Phuong Devries
Date:09/20/2017
OWNER-BUILDER DECLARATION
I hereby affirm that I ant exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any offing 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 ins ction,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) J
2. I,as owner of the property,Am exclusively contracting with licensed Signature of Applicant: :t
contractors to construct the project(Sec.7044,Business&Professions Code). Date:
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 MATERIALSDISCLOSURE
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 1n the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should 1 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 asdefined 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 sitbject to the Worker's Compensation provisions of the the Health&Safety Code,Sectio 25505,25533,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: .
I certify that;l have read this'application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with,ell city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the'perforinance
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 tpon'the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify andikeep harmless the City of Cupertino against liabilities, .
judgments', 'casts,and expenses which may accrue against said City in Lender's Address
consequerice.of theigranting of this'permit. Additionally,the applicant understands '
and will co'hiply with'all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18.l',. . , ' I understand my plans shall be used as public records.
Signature Date Licensed
. Professional
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GENERAL PERMIT APPLICATION .
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COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING Di,./iSION, ' . ,', • -
i000.TORRE AVENUE•CUPERTINo.CA 95014-32.5;i •
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(408)777-3228•FAX(408)777-3333W beliclinceveurrerIu16.olg
CUPERTINO
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Signaturc of A pplicantA,jenr_ ___!_ ..:i ,L,_ "
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Date: . 9/19/2017
SIPPT.,EMENTAL INFORMATION REQUIRED ,
, OFFICE OIL ONLY
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\\ , // SMOKE / CARBON MONOXIDE ALARMS -io- go. . ,
OWNER CERTIFICATE OF COMPLIANCE
,/,-r.f9, COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
4. 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
'CUPERTINO (408)777-3228•FAX(408)777-3333•buildinq(a�cupertino.org
PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE SAS BEEN ,
' OMPLETED,�SIGNED,'AND RETURNED-'.= ING ON
THE BUILD DNISI
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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,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 separte;sleeping area in the immediate vicinity of the X X
bedroom(s)-(Smoke alarms shall not be located within 3 feet of bathroom door)
On every level of a dwelling unit including basements and habitable attics X X
Within each sleeping room'' - X
Carbon Monoxide alarris 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 existingdwelling louts, 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 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: / 0 6‘g
d N! /L/ Y a ` Permit No.520 i 1——
Specify Number of Alarms: #Smoke Alarms: II #Carbon Monoxide Detectors: I 2 I
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
2ii) LL 1 61aA) Signature ...
/ ; Date: 7 ,
Contractor Name:
Signature Lic.# Date:
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Smoke and COform.doc revised 01/10/2017