02090142s
1
CITY
{ DING DP DIVISION PERMIT
CONTRACTOR INFORMATION:
`1nt"'92NETTI CT
JUST WATER HEATERS INC
PERMITao2090142
Dx7�'1fF�1'W'MLUND
1764 NATIONAL AVE
APPLICATIG762V%Z002
PHONE:
(510)293-9901
SANITARY NO. CONTROL NO.
OZ ARCHITECTAENGINEER: a
BUILDING PERMIT INFO
p
BLDG ELECT PLUMB MECH
IJ LI L=1 C__l
i4
Z LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed under provisions of Chapter 9 (commencing
REPLACE WATER HEIS cription
with Section 7") of Division 3 of the Businewand Professions Code, end my license
is in full force and offices.
(40 GALLON GAS)
Licence Clan Lic. g
Da¢ C ... ....
.rr ARCHffECf'S DECLARATION
,g 1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION"I
E-- h,D1�1100
hereby atfrm that I am exempt from the Commoner, License Law fm the
followingreason. section ]031.5. Business and Professions Code: Any city m countywhich
rquires a permit to construes, alar, improve, demolish, or repair any ewcmse
prior to its inuance, also requires she applicant for such permit file a signed statement
- I- 6.iiliceµ=kJpiinuanttd(h�'piovislonsoftheContmnorsLicenseLaw(Chapar9
Icommepcinjwilh Snotion�7UfNAl of Division 3 of the Businen Popticeions Code)
S, FI. F10 ,Sreaf
q' -t? 10h'x,y
C
Valuation
pod
or Choi he ii e' in thecefibM end the basis for the alleged esempdbn. Any violation
-) )'Ti I� q.,Y p;0,k<1s
3 2164 9 0 3'0 . 0 0 -
I
-of Section ]031.5 6y -arty opplicat I for permitsubjttn d¢ applicam m a civil pcmd
Dirt more thanfivehundml do ars IS500).
APN Number
'PCB\n-�O Occupancy Type
❑Laaowmrafinepropeny,orm'yemployees with wages asthew to compensation,
502 - FINAL PLUMBIN
ENERGY
-will 'do' the work, -and the structure It' not intended' or Offered for sale-(Sec:']04J,
(Business and Ficiressim, Code; The Contmcmr's License Law does hot apply to an
"-"' ----- --
g�� "inspection§ 1'�1 S'
owner of property Who builds or improves thereon, and who does such work himself
507 - F I NAL PLUMS I NG
or through his own employers. provided that such improvements am not intended or
;offered for �le'if; however: Ne bit Idmg err improvemem fd thin one yeard-
--' —'-- --' rn , ,- .,t,
' a
comply ,she owner buddtt will here the burden of pressing sh t he Ria not baud m
improve for purpose of sole.).
a0the prolx:rtY, nm exclusively cammning with licensed surmounts to
a construct the project (Sec. ]044, Business and Professions Code:) no Contractor's
O /I O N .Ip y
' License Law does not apply to an owner of property who builds or improves thereon,
`r\7
=_arid.who commcu.for.such.projmn_witha.comrahantu Aieensrd pmsuant.m.the.
._.-..._..__.
_. ._._ _.. ... .___._.------------
Comracmis License law.og,.gv, a.w :'" r0'n sY
0
01 am asempt under Sec)' �B & P C for this reason
{ WT ORKER 5 COMPENSATION DECLARATION
I hereby e(fum and PeI.nalty of pe0 ry one of nhe.follow ng dcdua[i -
❑ 1 have vnd'will macuturt n Cenificae of Conam to self -insure for Worker's
- Compensation, -n, -provided for by -Section -3701) of the Labor Cade, for the
- perfomiance of ihe'work fo `which this pcmnit is issued...; s
01 haJe'snd will maintain Wilker's CoMpe utb (I'...once v required by, Section
- 3]+N'of ihe Labor Code f° the, perfor n e of the work f which this pe it is
' Issued. My Workers CompensationJns rant Gamer ane P I cy n mber son: '-
Comer Fyti j:)(�t i itrf`•1tiPotr<yN .ROM " 1. t
';
eIL-Ii
;r CERTIFICATION OF EXEMPf10N FROM WORKERS
'r ��'-r"'fir`"'- COMPENSATION INSURANCE`z�•'6J
section need niri be esimplmed if the is far one hundred dollars
'i 1" - lit`'
permh
(SI0o) m lesal
,
_mss 1 41 mnIfY,thui an the perp,mnSnm of the - oh for wh ch th i perm t s issue
Ir not Fof, all any person In any rnanhe, so we ui become subject to thd Workers
Comps sots n laws of C I f m:a: Dafe n
'Apppt ani_ ,._ :
a
INOTICS TOAPo the WoTIf COmpeakngsoheCen beam fExemption, d, ymlmula
making
becameh tics provisionsbf theLaborCode, must
the Worke'Is Cnmins
r.�.Ts't Y:l :, ba. sit
comfy
forthwiNcompLY'a'iN such previsions or this permit shall be deemed revoked.
or
3 •.d l a a CONST RUCTION LENDING AGENCY
` I hereby Rrm tha there aconstruction lending agency f i the perfomwnce
- 't
a aiVa I, Twhchthspe r r ed(Sec3T9] Cis C) 1.
0 -Lender. Name-._._ .. .....:.. 1 _ x.._ ... ._ -.. 91,In s, .._
.. __
' LendeYsAdJ' t' ...,
n 1 -1 c nify that 1 have read this application and state that the above information is
carmR Degree to cpnply with all city and county, ordinances and state laws mixing
to Wilding consuuciioa, and hembyatuhome iepreanudves of this city to enter upon
the above-mentioned pmpeny for inspection purposes,._,
W 1 a�m"e to save demmfy and keep hatmlas Ne City of Cupertino a8mnst
� liabilities, judgments, costs and expense which may in any y ace a against said
CIO to consequence of tie g2 rrng of this permit '
APPLICANT UNDER§TAND5ANb HILL CONVEY WTIH ALL;NON'.P0'Es`F
- 9b6R(!EREGULATIONS ,l ' ,
Issued Date
y
$gnalure of ApplieanUConuatlor'r;, - _ "''�"" h oda- -
Re -roofs
1. HAZARDOUS MATERIALS DISCLOSURE
Will the eppl"manta f t bmlding occupant norc or handleshueadou nrumsl
..
,. pe of Roof -. .. _ _., .... ,..._..,.�._.,_..
n deb eked bythe Canadian Municipal Code Chapin 9 12 and the Health and Safety
355�2f 1t 1.
Cod.Sci Y°N t
tI.
1 (; sd'I.j }P f. t�l.f 1` 1Tx. /.'d i. d. t,1�11811v I1
Yen r >l.,r+
r_G .1.
All roofs shall be inspected rior.to.any_roofing material,beinginstalled. _
Will thsappi camo to.. Wildingacapaatpace -pet device, which
stall
If a roof is installed4ithout first obtaining an inspec[ton� I agreeto remove
haaardous'all mmmo ss as defined by the E y Area Ali Quality Management
D.n t
all new materials for inspection. Applicant understands and will with
•
-comply
all non- Dint source re ulationsi .
P g .. rllrmx n'"17„r_:
4•.
s 1 hu e_ reaElthe hamrd mmenuls regmarr nts oder Chapter 6.95 of the
Calif._ a HeaIN &Safety Cod Sections 25505.25533 and 25534. I undemand that
-sof die 4ui1din8 does not currentlyhave ° tenam; tha is ii mY rtsponiibility Ind
o notify the'-
r6&cupie
of the he ailments which must he met pridr, issuance of a Cenificaa of
' Occupancy. j,. f. ... .;., ..
Signature of Applicant Date.
-- . _... —
All roof coverings to be Class "B" or better r' t'
g
Owra r umbar ted Date,,,,