01040160 CITY OF e nPERONNo CONTRACTOR`INFORMrtATION ,1r ti
PERMIT
BUILDINGADDRESS' "` ;,,. IT NO. '
7549 'BARNHART .PL JUST WATER HEATERS F 0I0409.EC� -
OWNER S NAMEAPPLICATION SUB DATE,
YU EUGENE- I_ ,AND ELAINE, ,E A764',.• NATIONAI--AVE0/30!200.1
HONG: - - - SANITARY NO. -CONTROLNO. ,
D K'Z ARCHITECT/ENGINEER'. . - - _ - - BUILDING PERMIT INFO
•F-O'O BLDG ELECT PLUMB NIECE
G f ICI NSED CONTItACTOIt S DECLARATION 1
Fsho1 n by fl mrd tarried d p t Chapter 9( g "5 Job Description -
IISa 7000) ID 3odis,I IP'f:: CNe.and rayl '
fall « . REPLACE: 50' GALLON,'GAS WATER' -HEATER.,
.� Li class 1 c b
�0, DateY O< , A14CHI I IL I S DECLARATION
SNJ I understand mypl ..hell be.,ad as public record
'
he Li"real pane,.oval �
OWNER BUILDER DFCI ARAT1ON
ca=ZinIhereby ff that I r theC tab :L' L fide
,< farming reason (Soclim,7031.5 Business J Professions Col Any city or county
is hich requires a pennit to .I'net,alterp retail n pacity structure .' _ t
a 3 as pr t t .q It,,applicant I h pe I I I I signed dstatement
(list hlicensed n ,tothe provisions sitn Contractor s License La (Chapter9 Si Floor Area Valuation
- b ' g 'd Section 7000) fDi' J l tireBadnessd First .:i .Code) 1 1 A'"
or Ilett he I,exe npt theraffinto and thbe -.for(he allsged escurann,Any sto ur on
"of Sealmn 7031.5 by any spplwarn f,a pr 'I hjc,,,the appl raal sir a c,il penelly
f not nom thin five hundred dollars f$51g1). APN Number' Occupancy Type ,
El s e (if the pery, Y pl > towages theirt p 'I .-r„�. 366].6075. 6,4t"1'' - -
"w II do the k i d the structure is noI intended B red for sale(See.7MA - - -
- B ,d Pr,f, I Chile:Th C t :1 I d w t apply to ` Required Inspections
ofp-p Iy WI b ld: p' tl -d m d : n- kn II' 502 — FINAL. PLUMBING ENERGY- '
orthrough h s own e pluyseb.pros ded that such improvements v m
m intended or
offered for.nm.If,m veve,,the building of hnpc....bear is sold wimin one year of 506 GAS TEST '
"onpletrn meowasol Jderwllhoc In M1 e ofprov proving Ind orb build r
mpmve rorpuEarsn r:le) '. • .: SQ)T. .-` FINAL PLUMBING
❑1,it,owner.1 the property,em exclusively contracting with licensed contractors tar - , -
. . enetruct the project(Sec.7044,Business and Ponewlo r,Cod,)The Contractor's
License Law does not apply to an owner of property-whe builds or improves thereon,
i- and who contracts for such projects with a commnon s)licensed pursuant to he -Contractors License I s - „
01 had asampt mida,Sce. BRPCfor dis.ohnian
Date
WORKERS COMPENSATION,ULCLARAI ION” t
;hereby % J pc by f radic,oncefthe f II " 6 1 I r
❑ i have all..If ReHablia a Cerlikene or Consent Ir If f r W k
Compensation, as provided I by,Section 3700 of the Labor Code f the
performance of the work for which this lrabut"sissued - -
.
011, 1 cc,s requ red by 5 edon
3700 of the Labor Code,for the perfo'trance of the,work for which this parent in
sued.My Worker's Camponsation Insurance carrier and Policy number are
Cf -•. Pol cy"Na: U ,
1.
CERTIFICATION OI'EXEMPTION FROM WORKERS' -
COMPENSATIONINSURANCE
(This"ectim need oat be completed it tire permit i,,ruche hundred dollars
($100)or less.)
1 certify that in the perfornnmee mfhe work for which this scran is is ucd:I r
shall not employ any person in any manner so as m become subject to the Workers
Co.senemion Lows of California:Dale -
- Appfcauf
NOTICCTOAPPLICANTIf' lorm'k glh Cnr 'I IE pu y .I Id
6,'z ,bc m ,uhj vutheN k C p st p..Asian,ofth Labor Code,you mad
C) forthwith comply with such provisions or this permit shall he deemed revoked" - - -
r
F .fir .1_W CONSTRUCTION LENDING AGENCY
1 hconstruction
crehy arch this phud"ng ng y f Iha perfnr r of the work for which this permits,med(Se3lHTCr,C)
�] LeJ Name
V.� Lender,Address t .r
I aenly that l have read this ppl I d slate that tiienbove informationis
-R Ey a ".I mass to comply wkh.11 buy andconany softeners and sharela relung
0'f) Inb ld'ag nuoUtcfen add hereby auto presentative of be,ciy In rate upon - -
' r,] the those mmefined property f :p f Pirrone.
- '
VO4 bl'I(W)J ran t d _fy dk ph I::th Cry tCp l' against ,
: J 6 e 1, is d p se which y" any ay" c aeunssaid -
.�•� City"n querve fshc immune ofsn permit. -
APPLICANT UNDERSTANDS AND WILL COMPLY W11 H ALL NON-POINT '
SOURCE REGULATIONS. _ " Issued by: ' Date
` Signnmrc of Applicenr/Commenor, -� Date .. ,Re-TOOfS
HAZARDOUS MATERIALS DISCLOSURE-
'
- "Will the applicant or fmure baild'mg recursion store or handle hazardous malenal Type Of Roof " • ,
as dented by the Cupertino Municipal Code Chapter 9.12,sad the Health and Safety
Cede,Section 25532h)'f X - - -
°Yei , 0 N All roofs shall be inspected prior to any roofing materialrbeing installed:'
Nell 11 alPlb I future building rnapat.use eq i I devices hid
-em tl rmika,tit eo fmiber,as derned by the Bay Area Ab Qaw,y Mamgeme„ Ifaroof is installed without first obtaining sip''inspection„T agree to remove
District' all new materials fordfispection. Applicant understands and;will comply with
El Yes :t oNo _ all non-point s'oureeregulations. - a •
s I l ave read thei ardurs materials I nenls'undar Chapter 6.95(if floe t ” -
C adomia Health h Safety Coll Sections 25505,25533 and 25534,1 undefsrand Ines -
iflnebuildmgfres"or currently Rbe a tenant,tnnl it is by rasponslbbisr R,Ratify she , -
s '
c p I f[lie requirements which must h' set prior m is f Certificate ol'-
occupant
c pate} Signature of Applicant bate
Owner or omm..raed agear Data All roof coverings to be Clan`s "137'or better
OFFICE'