01050023 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
III'ING ADDRESS: PERMIT NO.
10434 S BLANEY AV WA'T'ER HEATERS 0111—Y 01.05002.3
OWNISIPS NAME: ArPLICA'PION SUE DATE
PAO CHTA—PENH ET AL. 500 AIRPORT BLU 05/02/200.1.
�iDNE: SANITARY NO, CON'I'ROI.NO
(A-15) 349-3747
OO
w00 ARCI 111 ECTENGINEER'. BUILDING PERMI'I'I NPO
w^ PLOD ELECTPLUMB MRCH
N2a
I,ICI NS[IU CONI RAC'IOR'S OLCLARKrION
0 5 y o 1 herehy 00 oF,mol 101,1 olR alae pro, 1 1,Code
2 m,loll ening Job Description
¢ C d will scdilll"louol of niduionl nnhe n11si1,esx un,IPn,lcesu111e code,euln il,y�Ihcl,.c
y "'1'R'm`"""`n
Lle R REPLACE 50 GAL GAS WATER HEATER.
DDIC
C ya, iCe e Class
1 V OCu)ECLA
or
HYO 1
AItCHITrLT'S DECLN21110N
m 5 I unden and mY Plans,hlJl he 1111dal Pnbhr rcnrtds
z�¢^<
o 0 1dwF,rd Ploam,ional
OWNER-BUILDERI"I'l DECLARATION
1�+ by I( ah I I r 'III
1 C - ..1 for the
H. n which
g (S 1 7031.5,n 1 f lh , y ly ml try
F,2cal I II I 9 'll I I' )mracirri,
rc,
i re Th e"' 1 er ipl f lana Cei Law sl:cncnl
(III EIC-ed Fel II 11 1 „ d l,1 T Feel„ "F PCIF Sy. Ft Floor Area Valuation
fmnnnamis wins Swhan moor of Di,hivis Io of The alleged
mid Pmfcsslons kIlOr
I,I That he i,31 IIIb merarrelll and ma naei,rani ml tird ex,m Fill
Any vinrd,,rl $700
of Sccrmn 7mal c mil appli IT ,, apenlio subj,os mo nPPlkoA maclvll pnmlly
Ills,ImaaClnal,faahm,drrvdana�,($srro, APN Number Occupancy Type
❑L a,awaar of III Fr,peny,rr ny employe„wlm,rogcs n,Plate sere ealr.I st loll. 3E.91 1 ill 00
will do h k 2 d Ise artooreo d d... efloord to a fSee.7044
It d 11 1. Code:'1'I C I T LLA does Ca all It an Required Inspections
orthr gal IT n lin ervaorn lyu..pr hided mit scell llR'.we»elh,,Con,Call lFIIs nl. lr catch
lor i Idedo� 502 — FINAL PLUMBING ENERGY
offered for sola If:howuvur,Ilm huilding a inproverl is sold wlll,in ono ye,of
olarAcran,dl,owia,TidderwiRhacemehwdenorpnwirgmAhedldrolIor 506 — GAS TEST
a"I lar PatF....Peale), 507 — FINAL PLUMBING
❑h u,ol of Tho pn,perry,n e,sjosively conlacting with hemued nlmm�smrs to
marncl the pmjed(So,,7(st IF,,iu,e.'and Prof.i(ns C Chee)Tho ConFam)rs
L real Law does not uHP,m I owner of properly who duillly oa Inlprovd IIIereUa
and will,car(rol,Cor slmh pmlwu w"It a r aircele,s) liCCmaxl Farsram to Tho
CammucFor,IjGri La,.
1 ❑Ivorcxrinpl under Sec. ,It&PC III IF CaSal L 0
Owner DAC L/S=AO
WORKER S COMPENSATION DECLARATION q
I llarfrn,nnderjecally olPJury nae of[[to roRnwing deelamlions: DEC 2 6 2001
❑ 1 have and will alhinmin a CrIlilicam of Conceal to self-insure lot Worker's
Coulpuns;ollnn, as provided for by Section 3700 of Tho Paha Code, lea the ����®���
Perco]or of the worr w
k tahich This PC]CAR Is issued.
❑I IF Cull will l morin Worker's Culnpl:nwlion lnsnrarm, srequired by Section
3700 of The labor Code,for the F,,harrolace(it IF work tor which this Fcrair is
,.lord.MyWarkur,Colrp,ns'aliml Insnrurce carrier and Policy a heral's:
Call'i.: Pulicy No
CRILfIPICAI'ION OP EXEMPTION FROM WORKERS'
Cot,l SXFION INSURANCE
(I his sI,, Pearl nal be o lncd It Il,III is ronmC hundred dollars
($10111 or Ic,s)
I,miry that In IF pcthe natal ,I The weak for whldl this Ire,nil is i..ued.1
,hall Fol employ any Poll in anyn
11 i_sit as to racoma sabd hthe e W aIFs'
CoallIon Lewy of nlla,CallraDam
APRliralnl
NOTIC17 10 APPLICANT:11,:doer lmo6ing IF Ccaifcme 0 Esenlplio I,yon should
baFai Fhj,Cl It the Workers Cornpesatirnp ovlsiars or the hither Code,yuroma
Z lil lh Comely w dh such Frnvlsions IF,this TC,r l shall he d,cri invoked.
F .tea CONS I'SUC'TION LENDING AGENCY
Ill emdy uffln l hit l her,is it IF) allIal lending agency for the perlimnunee
W el Ih,work I which this FennF is is,ucd(Sea 3097,CivC)
Q Lender's Nrmc
z Lender s Address
f..) O I worry That I have own mix nRFlirodell and 11A,Thal die uhove irRarali it is
�+ [r cl lora I adrw Il, oluply with all city and ,,Tnly oNia-re,and slate Incas selaar,
O U to hullding con,wetian,and herehy aulti reara,enwll-is of luta City m,mor upon
the above-irenrared aepeny da InspCO'mn purposes
Ao (W)'got,IF,save.a,doPood,2 1keep h-PACT'IhICity or C 1 'IF."
F m fahlr, ad,atels, 1: a expiwhich losaylorally Cityae agnlnt:ell
U ,Z City In crllscgaerce of me grnmting or this F,rini1,
APPLICAN I UNDERSTANDS AND WILL COMPLY WITH ALI.NON-POINT
SOURCE:REGULATIONS. Issued by: Date
SignT1lre of Appleem/Cont,aOra Dore Re-roofs
HAZARDOUS MATERIALS 1)ISCLOSURE
wihIheapphwA or I a rate Cold,all rcaupAll sore or hall ha.amaa,looter a Type ofRoof
os
Coined by me C,C,t rt)Municipal Code,Chnpmr 9.12,and oho Ihealth and Sal Cry
Code,Section 25532(a)1
°Y" EI No
All roofs shall be inspected prior to any rooting material being installed.
Askwiu dlaapFfeaAarlArP haildlingrecap:111lr.aegait....Car ,,dw,,c,,,It If a roof is installed without first obtaining an inspection, I agree to remove
emit hare,dunn mrcronlruoi Pleas It,defined by the flay Area Air Qnalily MalagelllCel
Uani,to vel ❑Na all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
I have reed the Lamrinu lnmerteN equhelnenm mW,r Chapter 6,95 or the
CA,hnia II,n101&SaiclyCFAc.Sections 25505,25533 1 d25534.I ml iC,,I it he,
it(he duce rut coricmly have IF IF 1, hi it is my respanslbilhy 1l,nolilj'the
oe,or,art of Iha mq.,eal nm which.lent be all plfor m in,C.Fa_IT a ceriliwl,at
Oaupanry,
Signature of Applicant Dale
owner ar aanladrrd agrFl Dam All roof coverings to be Class `Bl'or better
OFFICE