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Home My WebLink AboutB-2017-19346J & CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1934 20336 NORTHBROOK SQ CUPERTINO, CA 95014-0566 (316 39 013) F W H ACQUISITION CO LLC BOTHELL, WA 98011 OWNER'S NAME: LEE YAU-SHING AND KUO FANG -YIN WENDY TRUSTE DATE ISSUED: 11/09/2017 OWNER'S PHONE: PHONE NO: (425) 636-7084 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-36 Lic. #987398 Contractor F W H ACQUISITION CO LLC Date 10/31/2019 X BLDG _ ELECT, X PLUMB' f 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) 1 hereby affirm under penalty of perjury one of the following two declarations: 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 _10erformance of the work for which this permit is issued. 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 Sq. Ft Floor Area: Valuation: $1380.04 permit is issued. . 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 316 39 013 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. Ad Si ure Date 11/9/2017 Issued by: Abby Ayende Date: 11/09/2017 ,6NER-BUILDER DECLARATION I hereby affirm that I am exempt from the 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 t. 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 stricture is not intended or offered for inspection. sale'(Sec.7044, Business & Professions Code) z.. .1, as owner of the property,.am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 11/9/2017 1 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 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 permit i. issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certifythat 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 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 Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cu pertin Municipal Code, Chapter 9.12 and exemption; I become subject to the Worker's Compensation provisions of the the Health & Safety Code, revoked. er or authorized agent: APPLICANT CERTIFICATION Date: 11/9/2017 j I 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 constrdjction 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 tlie 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, raria. expenses which may accrue against said City in Lender's Address consequence of the' ranting of this permit. Additionally, the applicant understands and will comply withiall non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18.1 1 understand my plans shall be used.as public records. Licensed Signature Date 11/9/2017 Professional