01070106CITY OF CUPERTINO'
BUILDING DIVISION , ' PERMIT
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CONTRACTOR INFORMATION:
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BUILDING ADDRESS:
PERMIT NO.
;10387 ANSON•AV
WATER 'HEATERS ONLY
01070106
cl OWNER'S NAME: "' - " -
ISRAEL JAY E AND ELLEN W TRUS`
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500 AIRPORT BLV
APPLIC TIONS BDATE
07%23/2001
;PHONE s ,'
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(415)349-3747
SANITARY NO CONTROL NO ..
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ZO : ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECH
LICENSED CON] RACTOR'S DECLARATION
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Job Description
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1 hereby affirm that I am licensed under' provisions of Chapter 9 (commencing
to caths t 7000)ofDt a 3ofthe B dP fess( ca and my license
- REPLACE WATER HEATER. -
<'is fall force anaerf )
-CI
(40G GAS WATER HEATER.)
-a License L N
'Conn.,.,
U ; Date -
ARCHITECTS DECLARATION
,ej # 1 r d [and ntY plans shall be used . public recum
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p ( Licensed P fessional .".. ` r ••
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OWNER -BUILDER DECLARATION'
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J' 1 hereby affirm this[ I an, exempt form the Contractor's License Law for the
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a following Mason. (Section 703115, Business and Professions Code: Any city or county-
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C which requ res a permit to conswet, alter, improve demolish. p any structure
,'. prior tots Issuance, also rectums the applicant for such Permit file a algnedstatement.'
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'ti -y Sq. Area -,
' Valuations'
— 'ortheslrindpus ttothepro'onsoftheContractn L' Law (Chapter 9
m ngu%th5 i ]000) f Division 3 of the Business and Professions Coul)
'exemption,
,Ft ,Floor a �,
d. ,
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o that h exempt therefrom and the b f the allegedAny violation
of Section 7031:5 by any vpplicanl for a permit subjects the applicant m a civil penalty
,ofhe, � than five hundred dollars (5500)- -
APN Number -
d , ,y''l Occupancy Type
SOI lith property. or my nnployes Ih gsa'rh' 1 p .m n
— A PLUM BIN
ENERGY. '
e Tndw k e the evorwre Contractor's r mended nse e f es n (See tona'r
Bin
B s d P k, an th Cnae. The License Law does not apply roan
, 506 — GAS -TESMequired Inspections -' -'
Owner
caner of property Who builds or improves thereon, and who does such work himself
or through h employees. provided that h improvements
e e is are t intended
507 — FINAL PLUMBING i
offered i
s off d f rale If h thebriding - p of s sold— IK one s f
..-_. ...,.__ _ __-_.__ _. _..., _ __., -_ ._...:. .... _..,,.
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completion,improve lurposehe owner -builder will have the burden of Prov n8 that hedid nm build or
t„
t' -
for
improve for purpose of sale.). � "�
Las rte fm" n ami. I I contracting d r l r
P Pe Y exclusively
_.. •. _. ._...._.-.__.. ... ___......_ ... - ....,__..
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, construct theproject ISa ]044 Business and ns Code:)
ode
on Cod 7ThContractor's
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FIN d. E D
' L cense Lew docs not apply to an owner of property who builds nnpraves thereon,
a ty
,A
] .anJwho.rs wdh.a.rnntmctorts licensed .pursuant ro the.
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ContractorLicense Lawuch.porjecrs
I
0 pt neer Sec B&PCfonhis Boson
_,_..,. _.._.__...__.
% J',7.20 01'LFl
O One
WORKERS COMPF-NSAI ION DECLARATION
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Ihereby5ffrm d<rpennityofp0uryonenfthefll gd lamtias.
BUILDING', -
' ❑ 9 nave snd''will 'mniniain �a'CertBrin of Consent'to sel6insure for Worker's
Compensation. 'as -provided-for by;Section-3]W of,tbe Ltdor;Code. for the
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' perf Hance of thework fwhichthis fo si (''issued.
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OIh hod Ilett t W ke,sC p i nIn a q red 6,S ion
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3700of the Labor C dc, for the peim a e of [he work for which this Permit is
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' Issued. My Worker's C mpe t Insurance c a ndP ynumber
Carte .- 'Palle N
f
nl,M ` by E {I,; ) t U II
/ ri CERTIFICATION OF EXEMPTION FROM,WORKER9
" COMPENSATION INSURANCE
} e {, 5a'9
'f ((This lection`Bed net be complemd If the imml is for one hundred dollars
-' �I 1""'I` „ ):C'
($I00) I.$)
Y rh perfort'n cd f Ih wink for Which thispc r' issued. I
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shall
hall notcoreto ay person In any manner s m becbm b3eou ra the
o
'S .SE
,• Compc I Law sofClif :Dte
• A
PTICE._ _
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:NOTICETOAPPUCWmkp, ft kingmsCrtfct should
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rise WorkefsCaiopemt he bur Cadyou
the Labor must
,
s 0.1,ohaof
� fonnwirh comply with such provisions or this permit shall be deemed rcvoked..-
foromembjepy MWike.
' LENDING'AGENCY
hi" , CONSTRUCTION
" I h reby affirm th t th m ion. t t n lending agency for the perfommnce
'.:' ! ;, "r ,
s of0 .,it for thispsorasissuedIS 309]Civ.Ci -
' ...L'ender shame—..: ., .,.i .,. __....._ t......: s .:.
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Leader',Address'.'
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1 certify thio I have read s appl and state thio has above information is
c
o6 .1
"wo complyad he all city and county momi,vtes and state laws relating
d co
m build ng heorla"Aorlierepresentmives of this cirymenmrupon
albove-mensmed pohd
'li aha -t tsp pentf .asset nP Po'
s (W) him. I. a dtr fy dkeeph I IbeCty fCprtlm against
1 I d r t and pe se Which y, ny y accrue against said
,
City ine
City n ronsequenea of the gr r g of this pe r
t
SOURCANT,ULATTO ANDS AND WILL COMPLY W(THALLrNON-POINT'
- ' SOURCE REGULATTONS ' r r Y
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1 suedby: Date
Slg treor Applicnviu t t .' ,': `.��' ;Dare',..;,
Re -roofs
y. ; HAZARDOUS MATERIALS DISCLOSURE
.: call thepplicamo f m build jagrocti r t or handlehaza d u material
_. ,Type of Roof-. -
asdefined by the C pert Municipal 0 d Chapter 9 12. and theHealth and Safety
Cad She �O 2553(a)sl
„s f
f )
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41 -
V ..�i .ir i
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_Yes .,
All roofs shall be mspected.prior to_any roofing matenal.being installed
s, M1 W II the applicant future building p t,4sc ,u proem rdevices which
d
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If a root' is installed without first' obtaining' an inspection; 4' ugree)to'remove
contaminant, ant a r
Di lh s ndby rM1 Bay Are Lt Qua] nag
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all materials for inspection.A Meant understands and will c omply with
11 Me .1new
.,
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all non -point source re ulanons
p' g
:, l I a recd �Ih h undo mater al ne a nems o d Char 6,95 f the
Pef,
t'_, .,
G til forum Healthgdoe,&S (et Cad Sections 2550525533 and 25534',00deramnd that
.;fifth b'IJ toY repo samilay to no 9ofaCenftch the,it
mlyhasp l Tact
u oro fth r Iona
dMmx1au
' p I i i nt h ti mast be met p nr to is f C n f Ie of
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G" p y (
Signature of Applicant Date
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All roof coverings to be Class B or tietter ' ' '
Owner or Thor zed^ g m nate
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