01070115CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
B5I"ff"epMINGWOOD AV
JUST WATER HEATERS INC
16R�g P90115
VA'E§MFt SSURESH M AND SUMAN S
1764 NATIONAL AVE
`6TnWl/12dn
IPHONE:
(510)293-9901
SANITARY NO. CONTROL NO.
ARCHITECTE NGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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L._J L_J IJ I
LICENSED CONTRACTOR'S DECLARATION
�n�I���Cllptlon
I hereby affirm that l am licensed under provisions of Chapter 9(commencing
0
REPLACE WATER HEATER.
with Section 7M) of Division 3 of the Business and Professions Code, and my license
is in full force
and effect.
(4 0 GAL GAS WATER HEATER)
Litton Class Lia, p
_ Date Contractor
ARCHITECT'S DECLARATION
S I understand my plans shall he used as public records
J Licensed Professional
OWNER -BUILDER DECLARATION
I hereby vffrm that I am exempt from the Contractor's License Law far he
following mvmn. (Section 7031.5, Business end Professions Code: Any city or county
l which requires a permit to constrict, alter improve, demolish, or repair any structure
m err issuance, far
$895 _
.prior also requires the applicant such permit m Oleo signed ammnnent.
that he is fictuav!pu. -t to the proIdshems,nitheComracmrsLcenseLaw(Chapter9
(- ints '1000) fDivtmn3ohne
-. •�t;r - S• FC,,FIoorAreat
1- 9'. *3 'v
Valuation
c g r Business and tai. Anon. Cold
Or that is exempt any am and me areas fns the cxcmpnoo Any
r :
'•''• 3`6 91 TO T3 : 0 0 r s
•
lviolationnaty
Sectio
of Section e703 1 than v any applicant fora permit subject rhe applicant to a civil penalty
subjects the
ofrmntoremanfinehandled dollars, caSWi.
APN Number
'
;::li..'�'��, Occupancy Type
❑I, as owner ofdo, property, ormyemployees wimwagera�their .)asimpenwtum,
502 - FINAL PLUMBIN
ENERGY
will do the'wa k; -and the swcture"is'car intended Or offered far sale (see. ]taw,
Business and Professions Cars: The Contm"Wis License Law does not apply to an
owner of property who builds or improves thereon, and who does such work himself
506 — GAS TESTR -
squired Inspections
or Through his awn employees. pmvidetl rhes such improvements arc not intended or
507 — FINAL PLUMBING
oRereE'fui .wid It. liow24er-the Wilding ar impmvemeni is sold within one year of
omplati m the owner builder will have the human of proving that he did not Wild or
'
improve for purpose of sale.),
- ❑ I, as owner of rhe property nm lu ly c oats 6 int 1 [cased claimants to
- - ---- ---------- - _' ' """
emswct the project (Sec. 7W4 Business and Proressmns Code 1 The Commum's
' License law does not apply to an owner of property who Wilds or improves thereon,
and h ontractsfor suchprojectswith v wnrmcmrs)I n. d.pirsuent m rhe
.__. ...... __ ........-._._........ ........ .... .
Contractors License Law.
..�...._,_ _ _....
❑ltion exempt under Sec. g�pCfm his mvspn
_
Owner " Daie '• - -
`. "W�KB... ....
I:NSA'I'ION DECLARATION
I hereby arum under penalty of perjury at the following declarations:
❑ 1 hove and will maintain a Ceriticmcof Consent no Olf more for Worker's
` V/
Compensation, as provided for by Section 3]00 of theLabor Code, for the
performrnce of the work for which this permit is issued.,
❑ I have and hill maintain Worker's Compensation insumnce, ai required by Section
37W of the Chn.r'Crcle, for the performance of hhe'work for which this permit is
issued. My W rkcfx Compen[a ion insum mer and Pali y be arc: '•
.,;
Comm >t.�s.; .r e'\.+POI CY No
r CERTIIICATION OF EXEMPTION FROhIWORKERSY-^
F
COMPIiNSATIONINSURANCE
'f t '(This seer on head not he complered ifthe permit is for one hundred dollars
`o: IN ,•, i P':
ISI W ) or less.)
t
'
.'
. ., Icrnf that
I a the per( c f tae k far which thispcrail is issucJ. 1
.,. -... ... .......... •..-... ,,.. ..... _ _:., _..,. ., ., ,.. _
1
shall not nnplay any person in any m-rihou.so into bceome subjecr m the Workers
^` i
Compenzation Laws Of Califimia. Dam;
.. Ap,lotall.
NOTICE IOAPo makingftcrthCertificate
enf t fE tr ode.
.. _. ....
't t,
becomehsubjectthe Walker's you midst
perms ons of rhe Labor Cale, you must
me Worker s Colons
'
fontiwim comply wirti such provisions or chis permit shall be dmmed mmoked.
comp y or
•CONSTRUCTION LENDING AGPNCY
I h rcbY offirion that there is it construction leading agency f r the perfomwnce
t. + f
bf the work for whah tht perm t is is4ueJ (Sec 309], Cw. C.i
' '
' Lenders Name•. ,'•. ,._.__.. __._. .n.......,_. ...^.. .. _
- __._...... ..... ...__.____
Lender's Addmsz -
-
1 airily that I base mad this application and smm that the above information is
'erect,
I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter upon
the ahove-mentioned property for inspection purposes.
(We)agree unsure: indemnify and keep hnrmlewhc Chit' f Cupcninoogolmsr----
liabilities, judgments, cos, and expenses which may in any way two agnnst said
/ liC/— `•
City in consequence of the granting of this permit. _
APPLICANT UNDERSTANDS AND WI LL COMPLY WITH ALL NON -POINT'
SOURCE REGULATIONS..' t,
Issued by: Date
gnamrcof ApplicnVCmm'mzmr;Data
-roofs
,
aS
,S-i
ne of btiIdntg a p err i m or handle h z Nhas material
.Re
TyptvillNpPlia of Roof- -
'i" "' -"' - """—"`"""'"'
as defirred by the Con,anoto Municipal CChapter 9 12, ad he Hahh and Safety
•' .I
Coca Section 25532(oO7, 1,
OND`. •. T' r' -
k !
All roofs shall be mspected.prior_to.any-roofing material being.installed
earnWill theapplicantorfmu e building era which
em t h z Nous defend Bay
D
If a roof 1S Inslalled'WitH'out first Obtaining an'l nspection; 7 agree.to remove
ys Ihiequipment lyM nag
fur mnwm canis us the
by the Area Ail Quality Management
" _
all new materials for inspection. Applicant understands. and will comply with
r.
' t
all non -point source re ulanons
P g -
' 1 have rend the hazardous mater pat requ
under Chapter 695 tit theCodifia
'
25533 a Iundersmnd that
lthdo &Safety CWe,aveSections a5505at
ifthemming ynsponsi4.
ifinebuildinB does not currently hdveamnam.rfi5r it is my rtsponsihilifYmnotify Clic
it
apt rs mance f a Cenifcvm bf
op rIndmn r nen fun rate tp red
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y
Signa tare o_fA_pplicant Date
_
All roof coverings to be Class "B" or better, .
ourtcr or aathen=«l agent
OFFICE