02020124i
I
.. _. .OFFICE
CUPERTI
CIBUILDI
CONTRACTOR INFORMATION:
G DIIVIISSIONNOPERMIT
BUILDING ADDRESS:
PERMIT NO.
6387 ATHERWOOD AV
JUST WATER HEATERS INC
02020124
OWNER'S NAME',
APPLICATION SUB DATE
SOZEK JOHN S AND NANCY L TRU,1T
1764 NATIONAL AVE
02/28/2002
-:1E:
SANITARY NO. CONTROL NO.
(510)293-9901
ARCHITECD/ENGINEER:
BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECH
My
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LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that l am Elenttd under provisions of Chapter 9 (commencing
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with Section 70XqofDivision3aftheBasi ... sandProfessionsCatle.ondmyliceme
REPLACE 40 GALLON WATER HEATER
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is in full forte and of ecl..
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License Class Lic. p
F
Date Cuntrocmr
ON
ARCHI'TECI"S DECLARATION
1 understand my plane shall be used as public records
Licensed Professional
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a11
OWNER BUILDER DECLARATION
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1 hereby affirm that l amempl from the Contractor s License Law for the
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following maven. (Section 7031.5, Business and Professions Cade: Any city or county
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which requires a permit to convect. alter, improve. demolish, or repair any stmaure
V for filesullied
$796
53.
t issuance. q theapplicant such Permit statement
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k,,_f
• Valuation
tnmletslb l pursuant inthe provisions of theContractors License La (Chapter
c gins- I ]VINO fD '. orf the Business ndP k. iCodel
or that
or Natio a exempt is y
to Any
appli and IM1e bmf, for Nc alleged a
fit C307 b V�l".iV V YL •" ::I t'`
any licom l Penson
of Section 7031.5 by any applicant for a permit wbjm the applicam to a civil Penalty
,of no, roam Nan five hundred dinars ($500)'
S 0 �pN ��AL PLUMB I
BNERG Pccupancy Type
111, as owner of The progeny, or my employees with wage, us their sole compensation,
will do the work. and the structure is not intended or offered for 'szle'Sec. 7014.
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507 - FINAL pEUNS4tj(4Pections
Business and Professions Code: The Cummemr's License Law does not apply to an
owner of property Who builds or improves thereon, and who does such work himself
of
oth fM1 his own empinyces, art nil intended or
raided that such eniert
erect
offered for Tale: If, huwevei, the nuildin br Ito '� fie soW'withili one
r g prn is of ycld or
-
iimpletion, the owner -Wilder will have the harden of proving that he did not build or
of pro
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mprove for purpose of sale.).
0 1 '-a, ii �'[ fac-propeny,'vly contract g%'NI sed col ti. to
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construct t the. p jcct (See, 7014 Business d P f TI Cann) Contractor a
.
License La J I apply I of property M1 builds p themer.
.
_and
h VaN for, uch projects with a carnations) licensed pursuanin the
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ntraemrs LicenseLaw
01 am exempt under Sat' , B & P C for this reason
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Owner � '• ''' ` � � Date'
WORKER'S COMPENSATION DECLARATION
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I hereby aRnn under penalty of perjury one of the following declarations.
01 have'and'will maintain a Certificate of Cuomo to self-in,nre for worker's
Compensation, as provided for by Section 3700 if the Labor Code, for the
performance of the work for which this permit is issued.
01 have and will maintain Worker's Compensation Insurance, as required by Section
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3700 if the Labor Code, for the performance of the woik, for which this permit Is
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sued. My Worker's Compensation Insurance carrier and Policy number are
_
Comer 4 POI CY No. -'
y. CERTIFICATION OF EXEMPTION FROM WORKERS'
. - i a r I tt, 1.- >
_COMPENSATION INSURANCE' I,
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-' - (nis saction need not be completed f IM1eprom,-
p is for one hundred dollars
IS IIN))or less)
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, Ianfythat iy;,a, r pef a Tilt h hN.pcnit sued.l
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shall not employ my'f ti f any manner sou to bacnme subject a he Workerx
to
Compensation Laws of California. Dae
-Applicata
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-NOTICE TOnPPLICALT.ILaf¢r rocking this Cenificam of Exemplian, you should,
foaM1wifb bthsuch rs Coionsoruonprovlsionsl the Lahr Code:you must'
5Whwoh
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compto with
comply with such provisions or Nis pinnil ,hall be deemed revoked.
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CONSTRUCTION LENDING AGENCY.
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t
a 7
1 bendy lending agency for the Performance
that then Iso coned
ti
which
of rd work for which this permit is issued (Stt. 3097. Civ. C.) '• '
(See
Lender's Name ..
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Lender's Addres�
l eenify that I have mad this application and state den the above information is
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contact I agree to comply with all city and county ordinances and state laws relating
m building
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consbuaion, and hereby authorize rcprescromive, ofmis city metier upon
he xbave-tnargmpenyfor inspectionpurposes.
(W<) agree
ee to m save, indemnify and keep harmless the City of Cupertino againx'
liabililics, )udgments, costs atb expenses which may in any way dame against said
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City in consequence of Ne gmnlingoi Nis permit'
'APPCICA`J'fUp'DERSTM•DS'ANDWILLCOMPLY
WITHACLNON-POINT
SO URCE REGULATIONS.
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Issued by:
Date
Signature of AppbeanVContraclor Date
/
Re -roofs
to ' MATERIALS DISCLOSURE '.
tun .
Will
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Wifire apple -ma future tanking w
ocevpant afore or handle rerdoas material
as
Type of Roof
defined by fn C Pen Mu P I Cod Cn pl 9.12 and Ih He hh d Safety
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Code Satin. 25532001',.N
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1_ 117
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All roofs sfiall be inspected prior to any roofing material being installed.
w me apgtieanto rmnre dfaamg p use equipment or devices Wilt ch
mit bMid' atar contamtnxnts as defined by the Bay Area Air Qualify Management
If a roof is installed without first obtaining an inspection, I a ree to remove
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all new materials for inspection. Applicant understands and will coin I with
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all non -point source regulations.
hate read Ne hadadous materials requirements under Chapter 6.95 of the
California Health & Safety Code. Sections 25505.25533 and 25534. 1 understand that
if the building does not currently have a 11mnt:Nm it is my responsibility to notify me
u of the requirements which must be met pnor to issuance if a Cenificate'of
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ant
c
Dec.p ncy
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Signature of Applicant Date
All roof coverings to be Class "B" or better "
Owner oraathen:ad'gem , Data
.. _. .OFFICE