02030122"
CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
10387 AVENIDA LA
JUST WATER HEATERS INC
02030122
OWNER'S NAME:
APPLICATION SUB DATE
KIRK GOULD
1764 NATIONAL AVE
03/21/2002
PHONE:
(510)293-9901
SANITARY NO. CONTROL NO.
i O Oz
ARCHITEC MNGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
1 hereby 1
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Job Description
P
�r�
whitSection ) of that oro ofthe B under p and sins C mr and mmenNng
Professions
REPLACE WATER HEATER.
!.<
lforceomoect.ionanfineeas;rte,.anaPror<saionacnae.andmyhe<nse
fan Came ana effect.
is License
Leen onto Lie.x
(75 GALLON, GAS)
c-
Date Contractor
ARCHITECT'S DECLARATION
4
Irk
- I undemmd my plans shall W used as Public records
C C Lmcnxd Professional
o v -BUILDER DECLARATION
that I a
1 hereby a(Sect that I am exempt from @< Contractor's Liccnu Law for ,he-
? Q following naso.. (Seaton and Professions Code:
can or county
cons ri9uainms
h,orAny
F o wh;ch rtquires a permit to mnztmn, ober, improve, demolish, or repair any strvemre
3 = . p o , o q ,M1 ppfcamforsuch nofleasi dstaumem
9 , ,. , Valuation
Ft. FloorAreat`.
I
'•: t'y i t ':..
l
p . o(Ihe Conuanols L Genu Law (Chnpnr 9
(commencing InSection]onmofD
(cam 1 gsMPm a the .'on Sof the Business andel ProfessionsCold,
or that hers , ,Mrerrom and the basis for the aIle exem
latis,
.-Sl. (_a
of non ]031.5
31.5 a
any applicantll for a prnni, subjects the ,o a cavil pcnahy
not iv
of not more than ave hundrtd dollars ($SW).
A umber ... Occupancy Type
Dl, as owner nflhe propcny.o, my employees with wages an their rule compensation,
509 _ f
will do ,he work: and the'nmcmrr is not intended or offered for sale (Sec:
Business and Profession, Coale: The Contracmr's License Law does no, apply Io an
506 - GAS TES Vequired Inspections ^� - .
owner of propeny Who buillis or ornpilocs thercon.and wor does such work himself
ora,mlih his own empty prn,id,dON( tsch on,ro,emeno, arc no, intended or
507 — FINAL PLUMBING I
offer d for salt. If hbwcvcr nie hu Ido '-
A p r I : lel ton one year of
- - - _ ... _..-.. __-....__ ._.. .... -._.. _., .. _— ... .... - -- --
rompininn the owner bu Wer will have the burden of proving that he did not build or
" • ..
improve for pmpou of sale.),
am cxsinessY cont lard with he do dorsra
coLesowner pLtec p(Sec.
- ..
the (Sec. Fo
7 Business and Professions Cade) The
i l tmcmr a
.
- - Licecon�nse does a
License Law docs no, apply man owner of property who solids or seimproves thereon,
improves
-� _and who contracts. for such projects with ennnamor(s).licensed.pursuant to the
%' i`O f LS. . a, ,.. ;
Connacmra License law.
- ------ --- - --
: ❑lam exem, under Sec. ' ,B@ P C for this reason
r�.aNIpp. tt�' •`-3;-
Own Dare • ` -
- WORKER'S COMPENSATION DECLARATION
" Iherebyapr
ffirmundernahyofperjuryamt
on,
APR (� 'I 16
A 2002
D 1 have and will maintain a Ceriificare of Consent io self-Insun for Worker's
Compensation, as pmvtried for by Section 37W of ,he Labor Code, for the
_ performance of the woh for which this pcnnit is issucd.1,
BUILDING
D 1 have andawill maintain Wdrker's Coinpen.sation'Iniurarice. as iequirW by Swim
-
- 37W of the labor Code, for the perfozrnance'of the work Yon which this isomiWis
-
_ - humid, `y Worker's Compensation Insurance co1.rnier and Policy number are
Cam PolicyNo..
r- CERTIFICATION OF EKEMTIONFROMWORKERS
`.".•syc .i A la?'•: `::. d, t, .1
_ •ENSATION INSURAN'', `` 1
COn1P ..,. .Ce
aniss section need not be rompleieL if the permit is for on<hundrtd dollars"i-
�
(51W)Or. lms.)
- -
, I n fy th , per( c of th w k ( hah penmt ss'Un l
------
ers
shill t ploy ype wit y mannersol as ,o become' subject to ,he Workers
u
` y k i
Compensation Wwa ofC ff mra De,d
'
-Applicant, , .
- -"' _-----'-- -
NOTICE TO APPLICANTIf ft knion Cmfi roof Escmpt on.y ou should
z'
Mcomesblcu,neW rke C pen o,ionp n. of the Labor Code, you most
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1
forthwith comply with such Provisions or this permit shall be deemed msokrd
'CONSTRUCTION TION LLNDING AGENCY)
-,
1 t th a' lending agency f theperformance
r-,
lkfor whichd (Si'.
of me walk for whim this perm i is issued (Sic. 3097: Civ. C.)
this
"
Isriders Address
'
0
I comfy that l have d this apphecoon and state that he above information is
/
F
liric , 1 agree 10 comply with all city and county ordinances m
d state laws relating
r)
W
Pa.
to Wilding . i t' y d hErelayo amhornoc mptmiyci of this city to enter upon
the ahnI -dp e,nde p Ianpurpo
(We) ag
/1
-
fn
nd m'Yyond kehph
Way Cupertino Mannar
liabilities, ) dg is n
o may
d pontes which m y ;n any way a against said
ti
Clyl ugUNDE ST gm I g fthis p min
r
APPLICANT UNDERSTANDSAND WILLCOMPLY WIT. ALL''NON-POINT""'
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SOURCE REGULATIONS
1
Issued by: Date
-
S,gnatureof Appl¢am/Commene'' ` " -';•- •-"Dam;";
- �' '"
Re -roofs
HAZARDOUS MATERIAL$ DISCLOSURE' "
-pylic
Ih m or Tutu b Wilding occupy I s,o'ie or hantlle hazvdo s m ."mal
as
-Type of Roof
dewit
ed ni
f by the C pco Municipal Coee chapter 9 12 and the I calth i rainy
- - - - - - - - -. - --. • _
_ -
Cryli Sect 255t ()o e -
i .w � i 1 : i ♦ :..I .'
-
All roofs shall_be Inspected prior to any. roofing, material being installed.
"Wll the applicantor future king oc pm gmpm , ase ezwMch
mi, lmrard us air contaminants az defined b3 the Bay Area Air Quality Management
If a roof is installed without firstobtaining air inspectioh;•hagree.tareinove
octal"]
- ❑Y ❑ry ..
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all new materials for inspection. Applicant ubderstands and will comply with
_ P. PP..
_ ,:.. ;
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all non -point sodreeYegulations. ;;, „ - ' - _
s.>
1'h a ad,he tiaiardo s.mmeneL requirements udde Chapt .6.95 bf ,he
ml
�.
@ Safety Code, Section, 25505, 25533 and 25534.1 undersmnd,hot
ifthe it ing do
if Ne building does no, currently have a terwnt,that it is my nesponsibili,y to notify lar
-,
Pan requiremen
�u n , of ,be ,s which must be me, poor, m issuance of a Cenificale of
Panty. .. ... .. ..
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"' ° '' -•' ' "''' " -" ''•' �'•- 1.
Signature of Applicant _ Date
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All roof coverings to be Class "B" or better
Oxner of auNonard agent- Dam
FIC