03030088CITY OF CUPERTINO
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• BUILDING DIVISION PERMIT„
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BUIIDINOADDRFSSer
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AAVWnnn,HEATERS
WATER ONLY
PERMIT NO.
3 NAME:
970 E. MAIN ST, SUITE 200
PERMIT
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SANITARYN �MqLNG.
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(800)835-5946
ARCHITECTIENGINEER:
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BUILDING PERMIT INFO
PLU=MB MECH
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LICENSED COMRACIOR'S DECLARATION
Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (rommencing
In
with Section 7000)ofDivialon3of the goal= and Profession, Cado.md my lieense is
full forte and effem.
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License ClassData
INSTALL NEW WATER HEATER m
Cm nm"
ARCHI7aCr5 DECLARATION
APR 2 A- 2003
I undernund my plans shell bo used u public records
'
BUILDING
Liceued Proftnional
DBCLARA
Oat law for the
I am BUILDER
I hereby Nn I mere
exempt from dm ConusmCo
O
I. e: Any
following Mason. (Section IDnstr Bualws and Rofdcami Code: Any citym
Maso . (Sec
scourtly
which mqulma panic construct, alma, hnpmsu ore sig any N clum
,Sq. FL Floor Area
�VAbtar
Mir
UU
h Permit t a Ircol
psiarmIts slimmnco.rhu requires to the paxwo applicant for such Permit Lie ulgned Cutemem
n re
[hot punumt to the Onwlsiouof the Co
Uon,Codttt9
$
Businessland Profanation, Cada)of
(ere mencinwit or l:e
exemd
..
basis or doe ed on. Any vi
Net he h exempt therefrom and Ole boa for the alleged exemption. Any vlohtlan or
he is exempthherefan70nd the
.,A,
J i�.9r. 0 0 - - Occupancy Type
Section 7031.5 by any applicant for a pump subjecs Ne applkantlo s civil penally Of
not mom than Rn hundred dollars ($500).
0 I. a owner orthe property, or my employees with wages As Inch solo Compensation,
will do the work, and the mixture 1, notlntentledor offered fertile (Sec. 7044, Busiau
- 502 — FINALRF4jWWdlT&tI&NERGY -
and Profesalom Cade: The Contractors License law does not apply to in owner of
improves the sen. and who doessuch wart Mmu1fmugh h6
property who builds orm N
506 — GAS TEST
Own employees, provided matmch(mprommmu anamn Intended"Offered freaate if.
S07 — FINAL PLUMBING
hawenr, the building w improvemml k sold within am year of cempletim. the owner -
build, will lura the buNm of proving that he did set Wild "Improve f" Purpose of
.
n mm of one propony em exmusinly canhMing with licensed conmcton m
"wet the pmyat (See. 7044, B"i"as and parachutesCode:) The Conlrmtoh U.
ce"C 4w does not apply to"owner or mereny who builds or improv thereon, and,
who contracts for such projects with a mntraetor(0 licensed pursuant an the Conhamars
Lkenm
e on 3 B kPCFar this moon
,
au _
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WORKER'S CO m P. TION
I hereby Alum under pully of Ferjury one of tho following dechndom: "
-
1 haw and will maintain a Cerdfiesm of Consent to se10.1uum f"Worker'sCompen-
inion, as provided for by Section 37M of the Labor Code. for the performance of the
-
work for which this permit 1s issued.
[3 1 ban and will maintain Wallace, Compensation imurana, as required by Semion
.
1700 of the labor Cade, for the performance of the work for which this Permit is WOOL
My Workers Compensation Formance tinier and Policy number w:
Cmier. Policy NW
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CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sec00n mad not he compleud la the lermlt is Insane hundred dollars ($100)
or ICIL)_
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1 Certify that In the performance of the work for which this Permit is issued. I Shell not
,
employ any Fusion In any mountain as in become ubjuuo the Worhtn'Compensadm
Laws of California. Data
Applicant
NOTICE TO APPLICANT. Ir, Ater making this CenlEum of Exemption, you shouse
..
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, acme subject in the Warted Compensation provisions of me Labor Code, you must
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forthwith comply with such Frmismas or sob Permit shall be domed makes.
0
rCONSTRUCDON
LENDING AGENCY
1 ha any dram that then is a commerce lending agency for me performance of
the work for which this permit Is issued (Sec. 3097. Civ. C.)
QLenders
Name
Landers Add=
.
z
1 cutlfy that 1 Mn reed soh application rand mm sen set "bow Infosmulm k
Comm I "gra 10 comply with AI city and county Cadmium and Sam laws mining to
sob dtyloenter upon mt
cV^
building Consist mm"idlmpr
r
W
above-mentioned property far IupccOon purposes.
(We) to save, indc humnliss the City of CupaAno id inst
to cove, indemnify and kap hay
y
sJu ipae
in m w City
Ilabllitlu.)udgmenu.casu and npenma which they In my way acerae against saA City
t
7
F7
In consegxnce of the gnndnB of this permit.
APPL UND RST DS N COMPLY WITH ALL NON DINT
Issued by: Date
SOU ER U ONS %/�
l (�Lf—
Re -roofs
S oaf ApplicaMCon
HAZARD US MATERIALS DISCIAS
Type Of Roof
Will the applicant or future bollding "cupwismm orhendle humdou material
by me Cupenino Municipal Code, Chapter 9.17. and the Health and Safety
Section 25533(e)7
All roofs shall be inspected prior to any roofing material being installed.
Oyu
Jf.B loof.ls(fl$Ia))Cd without fast Obtaining an Inspectional"greet0 remove .
Will the applicant or Future building Occupant use equipment " devices which
mI.I.aurdoua air cmuminenu u do red by the Bay Arta Air Quality Management
all new materials for inspection.
t?0
Inod
yes
I he. mad the haurdims maurWsmquiremenu underChapter6.95 ofme Califor•
almk SafetyCadc, Sections 75505,35533 and 35534.1 undenund muifthe in lldesol
emmn11 hew • mneml. that It k m "ihllity m m the Occupant tri the
nu c oat elpdor i e erdne.mar a cy
Signature of Applicant Date
All roof coverings to be Class "B" or better
a.n an.<d a em,m