030801501
CPCY OF cumi TINO`^
't fir' F' "�, �""
CONTI>aR�INFORMATION
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
HOT WATER INC
PERMITNo.03080150
OWNER'S NAME:
2531 GRACELAND AVE
PERMUTI5SUEDA7E
E:
(650)298-8494
SANITARY NO. CONTROL NO.
ARCHITECTIGNGINEER:
BUILDING PERMIT INFO
BLDG EI,ECr PLUMB MECH
0
LICENSED CONTRACTOR'S DECLARATION
1 Mrcby affirm that I nm licensed wader provisions of Chapter9 (commencing
Job Description
with Section 701U) or 1Division ] of Nc Busidesness and Profcssinm Code..and my liccnu is
mfull mrce,na e_n�r -&?
License Cep ` Lic.p
REPLACE WATER HEATER
Date U Cuntraclor W
ARCHITECTS DECLARA ION
1 understand my plans shall M owed as public tcurd,
Licensed Profeed.mnl
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 7131.5, Business and Proressime Code: Any city or county
which require a permit to construct, slier, improve, demolish, or repair any somehow
prior in its issuance. also requites the applicant for such treenail o rile a signed statement
that he is licensed Pursuant to the provisions of the Caramel.,s License Late(Chapter 9
Sq. Ft, Floor Area Valuation
(commencing with Section 7000) of Division 3 of the Busing and Professions CLxle) or
Nat he u exempt therefrom and the basis for fie alleged exemption. Any violation of
'17c;22092 00
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of
APN Number.not
Occupancy Type
more than re hundred dollars D500).
----
Q I,uowncrof Nepmpeny,ormyemploycewithwageutbcirwlecomMnution,
will do fie weak. and N, slrucmre is nor intended or offered for sale (Sec. 70( Business
and Profession. Code: The Conmcmri Lt.. Law dW nut apply to an or
502 - FINAL � kJ�c RGY
w
owner
property who Models or Improves themon. and who dao such work himself or through his
506 - GAS TES
ownemployecs. provided that such improvements arenotimndcdoroffered formic, If.
however, the building or improvement is sold within one year of completion, the owner -
builder will have N, burden or proving that M did not build or improve for purpose of
sok.).
.50% _ FINAL. PLUMBING
f /�
1
1. as owner of the
❑ property, . Business exclusively conmsimea with licensed conoacmrs m
to j t Professions
caus
1, s
La oe ds or nations
daemon. and cause law dao not apply to an owner of property who Wilds of improves
pply(Sect an niofproandperty and
for such projects withacontncmr(a)licenud pursuant to the Cantneror's
Contractor's
whence
L.
Law.
0 1fac
Q lam eacmpt under Sec. ,B&PC for Nis recon
Own,, Data
-'
WORKER'S COMPENSATION DECLARATION
I hereby aRren under penalty of perjury am of be following declarations:
_
an and will maintain a Ccnincare of Clinical m self -insure for Worker's Compen-
provided far mi section ]700 of Or LaMar Code, for Ne performmm of tM
for which Box permit is eissued.
i'.as
an anJ will maintain Worker's Compensation Insurance, as required by Section
3 W of th, LaMar Cade, for the performance of the work fof which this permit is handed.
MyWMkxei CCgpnpsion m Insurance caller and Policy number am-
m:
Came
Cartier. `�/�f� i�v✓n Policy No.:
NFROM WORKERS'
CERTIFICATE OF COMPENSATION
COMPENSATION INSURANCE
.fes j
V
(Thu section need not w completed if the Permit is for one hundred dollars I$ half
6 J
or less.)
Nat in the p work for which this permit is issncd, l snarl not
manners
employ any as
employ any person in any manner so u m Mcomc subject o the Workers' Compensation
Laws of California. Data
Applicata
NOTICE TO APPLICANT: If, this Ccnin of Exemption, you should
becomeh Compensation s of
provisions of tde Cede, you most
l to the worker's Coons
col. meedLaborr
forthwith comply won such provisions or thi+Permit soon M deemed revoked.
or this
..
CONSTRUCTION LENDING AGENCY
I hcrchy affirm Nat from is• cuemetina lending agency for tM Performance or
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lenders Name
Lender's Address
I certify Nat 1 ban read Nis application and sol that the about information is
corms. 1 agree to comply with all city and county ordinances and stat, laws relating to
building construction. and hereby authorim representative or Nis city m enter upon Ne
.ban mart iuncd.O. c st far ca cNon purposes.
(We) agree to save, indemnify keep I
and umless Be City or Cupertino against
nil, costs and expenses which mey in any way eccmc ag+inn said City
liabilities, once
o
m cpnscgmnec of Nc granting of This Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-li
SOURCE REGULA NS
Issued by: Date
.,! /
—'t !I ���y U3
Re -roofs
Signature of plscandfContrecmr Date
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will be applicant or future building occupant store or handle hazardous matenal
az Mrncd by the Cupertino Municipal Code, Chaplcr 9. 12, and di He+IN and Safcty
ewes] Section 25532(s)?
E] Yea; C] No
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future wading occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
havaNaus air contaminants at defined by the Bay Area Air Quality Management
all new materials for inspection.
¢I?
QYcs ON.
I have real the hanablis materials mquiremenu under Chapter 6.95 of the Califor-
nia HcaIN &Safcty COM. Sccdtw 155(15.35533 and ISs3d.1 undcrsNnd Natif IM building
does not currently hate a tenant that it u my respomibility m body tM tamOP.L of the
reyuitche IT. I(n txmer�pnmmissumeeafaantreme of a�eyp/a/�cr
Signature of Applicant Date
�A%.CIL C/1]/ GS
All roof coverings to be Class "B" or better
Owner ur,uthofixa agent D,rei
CITY Of
CUPEI�TINO
CITY OF CUPERTINO
WATER HEATER
PERMIT APPLICATION FORM
03 6g>D /S-0 0
APN # iri-.�2 �
Date:
BUILDING
PPERMITFEE
Building Address:
PLUMBING
l OQOG S OiJ ZiQ C -
Energy
Owner's Name:
Ph #:
o
Business License
BUILDING
Contractor: Phone-
�A ,� 6�-61 Z9�5'-8Y9�
Li ense #:
7c�3Giz
Contact: Phon .
C rus v�c�l-fes �sa1 Z��,oy
Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb MD
Mech ❑
Job Description:
Residential (P Commercial ❑
Cost of Project: of,
700
Strapped ❑ On Platform ❑ Bonded ❑
New Location ❑ Replacement P
Qty. if,
ADDHC$ble Fee M
FPP TiPCI`�'1 TY�lln
BPWHEATER
Water Heater / Vent
BUILDING
PPERMITFEE
Plumbing Permit Issuance
PLUMBING
BENERGY
Energy
BUILDING
BUSLIC
Business License
BUILDING
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