B-2016-1376 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1376
10598 WHITE FIR CT CUPERTINO,CA 95014-4245(359 05 13 1) (F W H ACQUISITION
CO LLC)
BOTHELL,WA 98011
OWNER'S NAME: HE LIMIN DATE ISSUED:02/16/2016
OWNER'S PHONE: PHONE NO:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#
Contractor(F W H ACQUISITION CO LLC)Date X BLDG —ELECT —PLUMB
I hereby affirm that I am 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&REPLACE 38 GALLON WATER HEATER IN EXISTING
I hereby affirm under penalty of perjury one of the following two declarations: LOCATION.
1. I haveand willmaintain 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.
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:$1290.00
APPLICANT CERTIFICATION
I certify that I have read this application and 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 35905 131
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 PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will
comply with all non-point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION.
Code,Section 9.18.
Issued by: 1444
Signature Date Date:
OWNER-BUILDER DECLARATION RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is
following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1. I,as owner of the property,or my employees with wages as their sole inspection.
compensation,will do the work,and the structure is not intended or offered
for sale(Sec.7044,Business&Professions Code) Signature of Applicant:
2. I,as owner of the property,am exclusively contracting with licensed Date:
contractors to construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 1 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 HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance,as provided for California Health&Safety Code,Sections 25505,25533,and 25534. I will
by Section 3700 of the Labor Code,for the performance of the work for which maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
this permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous
s. I certify that in the performance of the work for which this permit is issued,I 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
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Sections 25505,25533,and 25534.
exemption,I become subject to the Worker's Compensation provisions of the
Labor Code,I must forthwith comply with such provisions or this permit shall Owner or authorized agent:
be deemed revoked. Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is 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 Lender's Name
to enter upon the above mentioned property for inspection purposes. (We)agree
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address
judgments,costs,and expenses which may accrue against said City in ARCHITECT'S DECLARATION
consequence of the granting of this permit. Additionally,the applicant
understands and will comply with all non-point source regulations per the I understand my plans shall be used as public records.
Cupertino Municipal Code,Section 9.18.
Licensed
Professional
Signature Date
VLJLID/Gino Puri 0: aiq r-RAr'apL water ngacer QVVJ/ VV-2
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228 FAX(408)777-3333 -building@cupertino.ora
❑NEW CONSTRUCTION ADDITION ALTERATION/TI El REVISION/DEFERRED ORIGINAL PERMIT Iv
PROJECf ADDRESS ,W��`�a � USS •VB� APN p
OWNER NAME c P -tVE _ 6-MAIL _ `✓
STREETAPDRESS i •� t1 _ /1n CrrY.allb) � FAx
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CONTACT NAME Al PHS 6 L 3 '1O,S�l
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STREETADDRess WCITY TATE, 'Ifl `LV c A)tW
OWNER ❑ OWNER-➢UILDER ❑'OWNERAOENT ONTRACTOR (3 CONTRACTOR AGENT ❑ ARCIIITPCT ❑PNGMPER ❑ OEYELOPER 11-rENANT
CONTRACTOR NAME v t � r• .1 LICENSr;NUMBERIl q>O art UC>•N•t�'yr� BUS.LIC 11 !OD
COMPANY NAME �t. !_,�•1, �/V ::-MAIL. "t• 3—} t). _ .PAR l/v..
STREET ADDRESs l` -
S�M� �.[t f' f� CITY,STATE,ZIPQPFW—
PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.Lic it
COMPANY NAME EMAIL FAX
STREET ADDRESS CITY,STATP.,ZIP PHONE
DESCRIPTION OF WORKkr4+ - �l Q �
4 v CY ' V IIS
Yl. ��►s �`� ca��oiN
EXISTING USE PROPOSED USE CONS1lG'rYP6 I IISTORMS - - A
USE '1'YPt OCC, 5Q,IT, VALUATION(S)
EXISTO NEW PLOOR DEMO - TOTAL -
AREA. AREA AREA NET AREA
BATHROOM - KITCHEN OTHER -
RI1MOV81,ARPA RRMODP.LARP,A REMODRLARP,A
PORCH AREA DECK AREA TOTAL DBCKMORCHARRA GARAGE AREA: DETACI
ATTACH
10 DWP,I,LINU UNITS: IS-A SECOND UNIT vqS SF,COND STOnY YRS
NO ADDED? NO ADDITION? E3NO
PRE•APPLICATION []YES IF YES.PROVIDECOPY OF IS THE BLDG AN ❑YES 4 �`I,Y• IY NINE
TOTALV LU TIOPLeWNIN(IAI'PLp ❑NU PLANNING APPROVALLPTTPA MCNTAR HOME? ❑NO r•Y"• •. � ,I'I X• t
By my eignaturo bolow,I certify to each of the following; I am the property owner orauthorizcd agen
t
to act on the property owner's bohulf l havc read this
application and the information I have provided is correct. f have read the Description of Work and verify it is accurate, I agrcc to comply withal[applicable local
ordinances and state laws relating to buildin construction. I authorize representatives of Cupertino to enter the above-1 entified property for inspection purposes.
Signature of Applicant/Agent: Date. v (40
�L
SUPPLEMENTAL INFORMATION REQUIRED ;%`•t' tr:.it,, r., ,;�,, ,, �,�r,Y:.�l 4�1, <� rr)�, • ";; !';�'""�,tl
.1, r,3r•� Is .;�
_New SFD or Multifamily dwellings: Apply for demolition permit for I� , Q� ,,��, �j I•ix, A
existing building(s).s Demolition ctmit is required rior to issuance of buildin I to+ {' jv;, ti`v ''I
E EC )• P 4 P g I, l (.��e^'.2 1 aFF••kk l t+ L'r
1 2y�ti
permit for new building.
,� � JEF/;p'liS9�'�„
_Commercial Bldgs: Provide a completed klatardous Materials Disclosure I. � ;�i ^^tb,;l•,I ^9t ,,(pit '? U '{��g� d rwy,a•rry",'i4��si�
UM„SR'•r r IaT'Y(;;,tj•,lk, ,lc t 9`V.I�I�K,I'
Form ifany Hazardous Materials are being used as part oftllis project. 1I ' ;rQ,ytl!`,(b�PD1„}1I,r}E.7 fy I�.,,i�,,r�r(�
'
_�:O ofPlanning Approval Letter `�41�
61'
PY g pp etre•or Meeting with Planning prior to
submittal of Building Permit application. ,`" M�►A l 1, , lrf lrsi�tg� fi.� � ,f
„, d„1 GA t v PI',<ra 4' '�tfIfr r a;;r'111;•I
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D1dgApp_2011.doc revised 06121111
PERMIT FEE RECEIPT
Case # B-2016-1376
Date Printed: 02/16/2016
CtSPER°TII+!@
CITY OF CUPERTINO-FEES RECEIPT
' Permit Summary
Case Number: B-2016-1376 Permit No:
Project Valuation: 1290,00 Date Submitted: 02/16/2016
Permit Type: Building
Address/APN: 10598 WHITE FIR CT CUPERTINO,CA
95014-4245(359 05 131) Receipt#: 201280
Scope of Work: REMOVE&REPLACE 38 GALLON WATER HEATER IN EXISTING LOCATION.
• Contact Type: Applicant
Full Name: HE LIMIN
Address: 10598 WHITE FIR CT CUPERTINO CA 95014-4:
Contact Type: Property Owner
Full Name: HE LIMIN
Address: 10598 WHITE FIR CT CUPERTINO CA 95014-4:
y��G/3s ,<, t# / X „ Y/,.' Y/`ypr ;-.�; / 1y,?� �" � ! � �.fh•a S
, ......«< _. / .Y.......✓9 ,,. -:::,o ,,.,.,,..._. hR1 w,,,.--:. .cam. `X�. ., w�„ '
Bldg Stds Commission Fee $1.00
Plumbing Water Heater Fee $29.00
Strong Motion Category 1 $0.50
Administrative Fee $45.00
Travel and Documentation Fee $48.00
PME Permit Fee $48.00
MV 011
Plumbing Water Heater Fee 02/16/2016 JASON HANLEYBROWNTAST WATER HEATER Credit Card $29.00
Strong Motion Category 1 02/16/2016 JASON HANLEYBROWTASTWATER HEATER Credit Card $0.50
Bldg Stds Commission Fee 02/16/2016 JASON HANLEYBROWN•FASTWATERHEATER Credit Card $1.00
Travel and Documentation Fee 02/16/2016 JASON HANLEYBROWAST WATER HEATER Credit Card $48.00
Administrative Fee 02/16/2016 JASON HANLEYBROWN-FASTWATER HEATER Credit Card $45.00
PME Permit Fee 02/16/2016 JASON HANLEYBROWVASTWATER HEATER Credit Card $48.00
FEE TOTAL $171.50
AMOUNT PAID $171.50
N m M m o BALANCE DUE $0.00
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_SMOKE I CARBON MONOXIDE ALARMS �
OWNER CERTIFICATE OF COMPLIANCE FIL
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION `
COPERTINCl"
10300 TORRE AVENUE- CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408) 777-3333• buildinaCa.cuoertino.om
Pertriit liTo & ��.
� n ,�--._``ter j
:Address ios-q k W6:-tL �t r- Covi-f to-(',.°(dna,#of A1arnis S_ a e:- 9 `carbon Mo ioxide`
PERMIT CANNOT BE FIS; .LED ANI� Ct3i1�1ETED UNTIL TMS CERTIFICATE
HAS BEEN S _QNF A��RI'T LJRN 4D TO THE BUILDII�IG DI 71SION
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing siulgle-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:
i
AREA SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)
On every level of a dwelling unit including basements X X
Within each sleeping room X
i
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 j
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply:Ili 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 electrical permit is required for
alarms which must be connected to the building wirh-Lg.
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 have been tested and are operational, as of the date signed
below.
-----`—1 have=read and agree to comply with the terms and conditions of this statement
i_Cxm-er(or Owner Ag`enYsy Name:
o
h-"n_ —Si nature... ......... :, ....,.............................................................,......................Date: . L. ... jgOlt
Contractor Name:
Signature...................................................................Lic.#......................................Date: ..................
Smoke and COfor•m.doc revised 03/18114
OWNER CERTIFICATE OF COMPLIANCEIs
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 0 -e2,ONh
(408)777-3228 FAX{408)777-3333•building(�cupertino:org
Owner Name r r+ i? Permit N o R,�-o f 6- 1 3`l t
Address `�
r_ Q -1 J- 4J �e- `t,
rC,4 U
1. Is your real property a registered historical site?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
x' No Go to Question 2.
2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property or its
plumbing,installation of water-conserving plumbing fixtures is not technically feasible?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building Division,
Skip the rest of the form and sign bottom of form.
No Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
❑ No My real property is built and available for use or occupancy after January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
Yes My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
5. Please check ONE of the following: ,
My property is a single family residential real property.
See Civil Code Section 1101.4.
On and after January 1, 2014,building alterations or improvements shall require all non-compliant plumbing fixtures
to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,2017,all non-
compliant plumbing fixtures shall be replaced with water-conserving.plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
❑ My property is a multifamily residential real property. See Civil Code Section 1101.5.
On and after January 1,2014,specified building alterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures,
On or before January 1,2019,all non-compliant plumbing fixtures shall be replaced with water-
conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or
improvements). -
El My property is a commercial real property. See Civil Code Section 1101.5.
On and after January 1, 2014,specified building alterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall,be replaced with water- conserving
piuiribing fvctares throughliel3ui01nfegaicLess ofwhe er property un ergoes a terations or improvements).
- has the owner or-owner's agent of this property,cerEifyunder penalty of perjury tha:::
Iuinbng fixtwes will be
replaced prior to date specified above with water-conserving plumbing fixtures in acivil Code Sections 1101.1
through 1101.8,the current California Plumbing Code and California Green Building ,and manufacturer's
installation requirements, and that the water-conserving plumbing fixtures comply wents as indicated in the
table on the following ageeet's a ee/ y rc� f�,
Upon completing and signing t ertifrcate,please returnM110eBuilding Division in order to final your building permit.
SB407 2015.doc revised 08/26/15