B-2018-1176 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRAC'T'OR: PERMIT NO:B-2018-1176
10325 MARY AVE UNIT 10325 CUPERTINO,CA 95014-1338(326 52 006) F W 1-1 ACQUISITION
CO LLC
BOTHELL,WA 98011
OWNER'S NAME:WANG HSIU-FAN AND CHAN JENNY DATE ISSUED:07/12/2018
OWNER'S PHONE: PHONE NO:(425)636-7080
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C36 Lin.#987398
Contractor F W H ACQUISITION CO LLC Date 10/31/2019 X BLDG ELECT X PLUMB
I hereby affirm flint I aro licensed under 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 full force and effect. JOB DESCRIPTION:
REMOVE AND REPLACE WATER HEATER IN SAME LOCATION(50
1 hereby affirm under penalty of perjury one of the following two declarations: GAL)
r. 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
Section 3700 of the Labor Cade,for the performance of the work for which this
permit is issued. Sq.Ft Floor Arca: Valuation:$1621.74
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information Is correct.I agree to comply with all oily and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 326 52 006
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 theGuRertmo Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature =�°� Date 07/12/18 Issued by:Kim Dunbar
Date:07/12/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from Bre Contractor's License Law for one of the RE-ROOFS:
following two reasons: 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.
sole(See.7044,Business&Professions Code)
z I,as owner of the property,our exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sec.7044,Business&Professions Code). Date:47/12/18
1 hereby affirm under penalty of perjury one of the following three dwelaratirins ALL ROOF COVERINGS TO BE CLASS"A"OR BET'T'ER
t. 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 office work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have rend the hnzmdous 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 Cade,Sections 25505,25533,and 25534.I will
permit is issued, maintain compliance with the Cupertino Municipal Code,Chapter 9.12 snit the
a. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(n)should I store at-handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should I rise equipment m'devices which emit hazardous
air contaminants as defined by the Bay Arco Air Quality Management Dish let 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 Cade,Sections,25505,25533,and 25534.
Labor Code,1 must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Data 07/12/18
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 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 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 ARCHI'I'EC'1',llLCLAHATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date Q7112/18 Licensed
Professional