02040017 CITY OF CUPERTINO CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
'
PERMIT NO
BUILDING ADDRESS.
21825 ALCAZAR AV JUST WATER HEATERS INC 02040017
OWNER'S NAME APPLICATION SUB DATE
BAICHER VLADIMIR V ET AL 1764 NATIONAL AVE 04/03/2002
O O❑ Plr r y a.�'t v e�,..�i..)t,.....W;�,..:.._� Li l) rS rP 1�.
: •.-' .....�' ._ SANITARY.NO CONTROL NO
I, PHONE: (510) 293-9901
4 wR i BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECH
rat'
_v Z LICENSED CONTRACTOR'S DECLARATION Job Description
�yo I herby aRrm that l am beensed under pro,tstone of Chap¢r9(mmmenang REPLACE WATER HEATER.
W wnb SeCtLon70DO)of Dn'ision3ofthe Business and Promssmns Code.and my latr
e
2 u��, ;a;,,ran miss aw erred. (4 0 GALLON )
as as< Licerme Class 4c.x
Da¢" Contmaor
ARCHI3'ECfI DECLARATION
t= ,� I understand my plans shall be used as public recoils
�a-
i WttmeO Prnfnsional ..
a O`�'NEA-BUILDER DECLARATION
irNl= I bmda,s1Ena that 1 a tempt from the Contractor's License law for iM1<
v. me
t s Code city or count
(;z •following«cum (Secon]031 5. t.id ets and Profession. .Any y
which regasses a s, Is.to,aa.t.i shin,rmpmvc h .ith,fi e it sg any nmceuse
u'73Q .taan.nlwenuiegakoieg,the ihoopphcant for Cionrarmntonleangaw(Cha meat ,q(�, . -
mpini,�.pe�haa painaaaimme pr.etttona.t me eomraemfs Ltan.e law lcnapmr9 S FL Floor Area : a ....,', Valuation
(commencing with Section 7")of Do,,-a3of the Busmety and Professions Code) - 1 vq Is�l 1`. '-.1-::r:r
or that he is exempt thctefmm'and the basis for the alleged exemption Any violation -Z G /� n n n
-.i Section 70315 by any ap,lmani for a parmn sublemstheappl¢am t.a civil penely - - 1� N ber iF(,
of not more than rive hundred dnnam($500). um Occupancy Type
01.its of the propcny,nnny employees with is ngcsns their sule c.mpemmmm - NFRAy
will do the'work.and the'swaum'r not intended'.,offered for sale(Sec Tlis: "it, ,;I'
Busines',mid Professions Code The Contractor's Deco law a«a a.,apply..a 506 - GAS TESRequired Inspections!"`
ownero,h his.y Who bmldt.r t laded l thereon,and who does inch wink himself
or ibroagh sal.:If.cmPl9r5g provided that such cement is said within not intended V.or 507 = FINAL PLUMBING are
'-altered For howncq the Was ng pmvemcm is told within one year of
....-. - ._
completion,the ownerbuddcr will have the burden of proving that he did not build or
V
p1,,.....�j y.L�.r•nii..,.`.gu f:'j ,� M.i.V.'......r. ,.____ .. _ _ .. _ _ _ _
Y +
_ <onsiruc0ihe •:.•w'Y.�•n-ese •y-.,:.,J,V.
tfie propcnyl,am exdvtrvdy comranmg with bcenud
❑i.�2.water,
in Olect(See`]IW:Business nnd.Pr.lesv.nI Code')The Cemractor's �� :�,�� ... i - • ' i
Deems Law does aim apply io an owner of n ds anmprows ihercon.
u
avd.w,.commcts to,such Prolecis wMaconirumm(sl hccosed.pursusnt.m the
p o Ywbo Wd
Contractor's LicenseLaw. APR 2 3 2002.
❑1 amexempt under Se% B&P C for this hanon
Own
_ ',�"L WORKER'S COMPENSATION DECLARATION BUILDING
' I htteby affirm under Perady of pc,jury vane of pa folluwmg Jmlaral o. 'Y
�•0 1 have said will maintain a Ccmrwiae of Conscm to self-ensure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
- performance of the work for which his permit is issued
01 have and wdrmainimn Woiker's Cofnpeni,l on Insurance,as required by Sccuon
3700.,the Labor Cade,for the performance of ihc'work',or which this Permit is
"" = issued My Workefs Compensation
in ace came,and Policy number are. "
... � ,'� Ivry"f Y.•'_d 3P`p' policy No C. Si.'. i .1fr. it T..:
;;"CERTIPICATION'OF EXEMPTION FROM WORKERS'; t'
INSURANCE"""•, ' __ _ _
...._w.,..fDUS Unionn ............._.- ..-,..r .._ _..-_ ._._._.._
` °I 'eed not be complctrd if the pcmui is for hundred dollars
($100)or lest•,t. .. _., -. -._. . .. .- ,,. ._ ._-.:-_. _ ._ .. . ...... . ..._.-,.-__ __
T.1 ttroty ifiat In Se perfarmantt o,ifie wink Bis wlocfi ib s permit is untied,l .__ ',
shall not employ any ci on to any manner so is to become sub)ect lo,he Workers'
Compensation Laws or Caldmms Dice
NOTICE TO APPLICANT If,after making this Certificate of Exemption,youzhould •• '
Q Qbecmnavubywt to,bc Workefs C.m roatton ismns ofri Labor Code,you must
fonhwlrKfom y,wnh such .loos or,do, nom shall be deemed revoked
,,L.iL. rt�CONSTRUCTION'LENDIN :,.. _.
I Pe prov
prov p
y N .. , i Ihesm64a1B• ihaiIN<UsaiON LE DINGA far'•e 4•+,,vi.. - •._.: -.'
PI y a _... .-I
1 perms is issued(Sec.3097,Ov,ene the dorm �•.. +.v • ; r ISTI
D Z AGENCY':.�..,.
.ffhe ancc
%\?I`• rasswbiefi this .C) ._. ,.. .
fi Leader%Nam n l endm a -
oftheworkfny g g
W tender's Address
agree tom 1 hale read chi:city andvon and item that the above laws u.n is
QW U m build i agree to comply with all city end coup eventinanee,and tuts laws rdaeng
'U tobuddingconnored in;andherebysuection mpesemmivis of Nn city to eater upon
r W the above-memmned property for mtpwnan purposes ,.
uG (We)agmemSave, and yand keephamlets any Cnyof Cppemnoagmnst
-rn City a ls.se,usents,costs and egpcnses which may in any way accrve agamw said
U ti Oro LI cANT UNDI of sh<%rammg D W perrmt,'
APPLICANTLjLAnOTANDS'AND WILT:COMELY N'RH AI.L NON:P(11NT Issued by: q7 , A /V .�-�--� Date
"s
SOURCE REGULATIONS.' y
a Sign'a mmofApplicanUComractor;,,' Date Re-roofs
HAZARDOUSMATERIAL SDISCLOSURE. ;-
+ as defined b the Cu moo Munict 1 Code _,Type of Roof h willtheepybcantorfumm building oc cu a vat tram or handle hazardous material
_
Y Pe Pa ChePter912.andthe HesINand Safety ';• _ „ , : ,.
Code.Section 25532(a)l -•- r -,_• ,, " If':, 4.'a-,
.,Ai:Yk 1 ONO;J:P:".:`r(1.'a?,r�',1Ji11:t ' .. per.
. OYcs i .. . .
• •t't•', 'r•, .°�•tt_ .t _ ' "'
All.roofs
.Will the applicant or forum building occupam use equipment ordeviccswhich If a roof is installed without first obtaining an inspection; I agree.to're move
cm haaardou,mr contaminants as defined by the Bay Arc.Au Quality Management
Dtstnet+ ': all new materials for inspection. Appl_icantunderstand_s a_nd will Comply,with
,•ono q -:• all not.-poitit souice regulations; „,
i 1 have rend the hazardous manersh requirements under Chapter 6951.(the
Cildomid ing do&Safety Code;have a tenant,that it is and onsib1 ity to notify that
t(thd builtlm does not cumentl bavcaiewm,matnrsrn s bilit to the
g Y my yr• y
muparit of Nc requrenunis which'musi he ran piton.issuance ofd Certificate of "
°""?°",`,Y:;�, :•h;";+''a.'rt,:,yx,' ::)•,- :u Signature of Applicant_ Date
a,
°' All roof coverings to be Class "B"or better '
Owncrorr. urtaedagsrm Date
OFFICE-