03010174 CITY OF CUPERTINO "ft-
BUILDING
BUILDINGDIVISION PERMIT CONTRACTORINFORiGMATION
BUILDING ADDRESS: HOT WATER INC PIiRMrr NO.
10409 BRET AVE
OWNER'S NAME 2531 GRACELAND AVE APPLICATION SUB DATE-
JAMES
ATEJAMES BOITANO 01/28/2003
ONE: (650) 298-8494 SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER; BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
�00 LICENSED CONTRACTOR'S DECLARATION
uF I hereby affirm that 1 am licensed under ppUB�v�B�ions of Chapter 9(commencing Job Description
�T1,a with SecturrOX))of Division Sof I Business gsM sessions Carle,and my license is
Few mmummeerr �y REPLACE WATER HEATER
=z-- LrrenxGd and IFI��LIED
Oz-- Oam Co r r
P—� ACPSD RATION
understand myplans
shall shallbeumJaspublicrcamds FEB 18 2003
dOyU
LLCLiemardProfessional
OWNER-BUILDER DECLARATION
e <F I hereby affirm Nall 1. .Bamlu from Nc Cnnuanofs License Law for the BUILDING
i-Rp O following rcaam.(SccGun]031.3.Business and Pmfessinns CeNe:Any city or county
a6$ which requires a permit m Cama sect•she,improve.demalish,or appear any strucwre
I Prier in its issuance,glen requires the applicant far such permit to fife a signed statement �f,Aiw
Iqq--Zo that he is licensed pursuant to the provisions of the Contmcha'e License Law(Chapter 9 Sq. Ft.Floor Area $Y"tion
$ (commencing with Section 700)of Division 3 Cline Business and Professions Code)or
Nat be is exempt therefrom and Ne basis for the alleged exemption.Any violNon of
Section 7131.5 by mry applicant for a permit subjects the applicant m a civil penalty of a Occupancy Type
not more than five hundred doll..(55W).
❑I.as owner of tM property,or my employes with wages as their aide compensation,
will do the work,and thesnet..is not intended Cr offered for sale(Sec.71Nd,Business — FTNA T!
and Professions Code:The Contractors License Law does not apply to an owner of506 - GAS TE rete . c I
speons
property who Wilds or improves thereon,and whodos such work himsafor through his
ownemployas.provided Nat such improvements are not intended oroRered for sale.It, 507 — FINAL PLUMBING
however,the Wilding or improvement of sold within one your ref completion,Ne hom es-
builder will have the burden of proving that he did not Wild or improve fur purpose of
sale.).
❑1,as owner of the porion,,am exclusively contracting with licensed Contact...m
contract the project(Sec.744,Business end Professions Code:)The Contractor's Li.
cense law does not apply to an owner of progeny who Wilds or improves thereon,and
who convects for such prejects with a contractorfs)licensed purswm to the Contractor's
License law.
El I ren exempt under Sec. .B&P C for this a..
Owner Date
WORKER'S COMPENSATION DECLARATION
1 lenity affirm under penalty of perjury one of the following declarations:
I have and will maintain is Certificate of Consent to self inure for WoiCompen-
701�700.f
ion,as provided for by Section 37W of Ne labor Code,for Ne Performance of the
rk for which this Permit is issued.
I have and will maintain Workers Compensation Insurance,m required by Section
Ne Wr Co&,for Ne performance ofNe work for which this permit is imed.
My meork �;M n nr 4c 11MPolyolicy number
CERTIFICATE OF EXEEl/MPT10N O't ORKERS'
COMPENSATION INSURANCE
(This section read of W mmplemd if the permit is for one hundred dollars($I W)
it,less.)
1 ccnBy that in the performance of the work for which this Permit is issued.I snail not
employ any german in any manner m ae m become subject to the Workeri Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:It,after making this Cenilicate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
OO forthwith comply with such provisions Cr this permi i shall be dames revoked.
z "" CONSTRUCTION LENDING AGENCY
tr .N. I hereby affirm Nat Nem is a construction lending agency for the Performance of
ai the work for which this Permit is issued(Sec.30ai Civ.C.)
W A Lender's No
f� z Lender's Address
U 0 1 certify that 1 have read this application and state that the move information is
W f+ correct I agree to comply with all city and county ordinances and state laws rotor,m
C U Wilding contraction,and hereby autonsc represenatives of this city to enter upon the
W aove-mentioned property for inspection purpases.
Coal agree to save,indemnify and keep hanot the City of Cupertino against
liabilities,judgments,costs and expenses which may in any
rpt y pewaY same again.said City
U 7 in consequence of the graining of this permit.
G7 APPLICANT UN STANDS AND WILL COMPLY WITHALL ON P INT Issued by: Date
SOURCE U TI NS, Z
XJ Re-roofs
Si amreof Applican✓Contracmr Dat
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hasardaus material
as defined by the Cupertino MunicU al Cram,Chapter 9.11,and the Health and Safety
ld�.,mdcanorll,
de,Section15532un All roofs shall be inspected prior to an roofing material bei. Installed.
❑roe P P Y g g
Will the applicant or future building acupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hamNout air contaminants ae defied by the Bay Area Air Quality Management all new materials for inspection.
irict?
❑Ycs
In ave mad dr harandous mau:rialsrc9uiremen.under Chapter 6.95ef the Califar-
H.IN&Safely Cole,Sectiou25505,]5533 and2553a.1 un&rstand thmif Ibe W i Jing
ha c a tenant,thatu is myresWneibility m ratify tor cupam fthe
'rc n hi istlasmet priorto issuanccnfa Ccnlfcntco Signature of Applicant Dale
O t
vir,
ncr oraohon"ed agent Datc All roof coverings to be Class "B"or better