B-2018-1096 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1096
10053 CRAFT DR UNIT 10053 CUPERTINO,CA 95014-3455(375 02 025) F W H ACQUISITION
COLIC
BOTHELL,WA 98011
OWNER'S NAME: Han Henry And Moe Yu Yu DATE ISSUED:06/28/2018
OWNER'S PHONE: PHONE No:(425)636.7080
LICENSED DECLARATION BUILDING PERMIT INFO:
License Class C36.C10 Lic.#987398 X BLDG X ELECT X PLUMB
Contractor F W H ACQUISITION CO LLC Date 10/31/2019 —
I hereby affirm that I am licensed ander the provisions of Chapter 9(commencing —MECH X RESIDENTIAL—COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in fall force and effect. JOB DESCRIPTION:
(N)ELECTRIC WATER HEATER;ADD(1)RECEPTACLE
I hereby affirm under penalty of perjury one of the fallowing two declarations:
r I have and will maintain a certificate""""'t to self-insure for Worker's
\
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 ofthe Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$1543.19
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 375 02 025
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 WORI{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 Cup a Municipal Code,Section 9,18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 06/28/2018 Issued by:Jasmine Archbold
Date:06/28/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt front the Contractor's License Law tor one of theRE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a rooris
a. 1,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 isnot intended or of fond for inspection.
sale(Scc.7044,Business&Professions Code)
z. I,as owner of dre property,am exclusively contracting with licensed Signature ofApplicaut:
contractors to construct the project(Sec.7044,Business&Professions Code), Date:QWWO 18
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTERr. 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
z. I have and will maintain Worker's Compensation Asurarea,as provided for by I have read the lmzardous 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 Cade,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(n)should I star a 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 conhamimants as delined 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,l become subject to the Worker's Compensation provisions of the fire Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,l must forthwith comply with such provisions or this permit shall
be deemed revoked Owner or authorized agent: '•`)
APPLICANT CERTIFICATION Date:06!28/2018
1 certify that I have read lhls 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 Indemnity 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 ARC
FIITEC'1"S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
SignatureLicensed
Date 06!28/2018
Professional