02070139 CITY OF CUPERTINO - -
BUILDING DIVISION
PERMIT -•CONTRACTOR:IlVFORMATION: '
BUILDING ADDRESS: PER.MITN
10005 BYRNE AV HOT WATER INC 62070139
0WIW: WEBSTER B JR 2531 GRACELAND AVE APPLI"bh`1S`"Y3T fi 2002
1. °HONE:
(650) 298-8494 SANITARY NO. CONTROL NO.
O a Z ARCHITE=NGINEER:
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02 BUILDING PERMIT INFO
&u9LD�1g IC'ELL1�L' CT PLUMB MECH
1¢a
aF- z LICENSED CON'TRACTOR'S DECLARATION -I fr5
;ZvO I hereby affirm that l am licensed under provisions of Chapter 9(commencing $ 1-IF3t req
with Section 70D0)of Division 3 of the Business and Professions Code.and my license REPLACE WATER
j E is in full force and a &. / •s
z s a License Class Lic.a J� ^
LOCO Dam Convenor �����p1677
O G ARCHITECT'S DECLARAT N BUILDING
:2 y g 1 understand my plans shall he used az public records
i i p O Licensed Professional
vc OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
h 3 following n.(Section 7031.5.Business and Pnfeuions Code:Any city or scatter,scatter, $500
ca season.
O
ca
M'M1I[M1 f[ (mil la CantlN<I aIl[f improve.prove,h Permdemolish.orrle epair any swcwrc
aim 'p"ono incermcd e,ehorcquarcs theeppliso for Commrminoicense Law
(Chaper9 _ _ _---
mai hen hni;d p rsu t w th pof wins of the he Business
License Law(Chaps 9 -
- , eiaar FIa�
.1that
(commencing with n ]n ad the
oof the Buadesg aMich.Any
Code) q .� ,1 t �\ $9 "•+ . • •,' '>, . Valuation
or Shea he rs calm t taerefrom and the bash for the alleged applicant
riot.An ' ' s'" 1 '
P 8 P Y v+ohuon q
of Section than vanyapplicantforapermit mbjmnthe epPlicam mecivil penalty NPR*�
fafna male snare Eve naaar<a mn.rs Issrb). 5 1vU ecupancy Type
❑I,it,owner oflbapropeny,or myempbyeeswhhwage'aalheirrole compensmion. 506 - GAS TEST
,will"do Ihi -work,and the svuFmre is fiat intended-.,of@fed'for soil IS[c.7014,' _
B-lines'and Pnf[ssions Code:no,Comncmr's Licenu law does nor apply to an pectiolis"
a
caner of progeny W 1m builds or improves Iherton,and who does such work himself
or tM1rouggh h oemployees.e provided that M1 mro coat arc not intended year of
aRe e f sal If,h the have
timprovement' sold within one year of -
m lel on.the owner builder will have ih burden of
d P proving that he dies not Huila or
mprove for puryose of sale J. '
. .con exclusively
x si
_Z O 1:asc hes.17.1a,papery,am Business a comrmling ns Ilttnxd contractors m _ --I It — ----- - ---
onstma the docs
n Sel.7014,Business and Profusions Code:)The Contractor's iet r
wh law docs not apply to on owner of apropertycontr who builds st improves thereto,
.-and.who.aomicense rsuch-projecu.with a<omnnor(s)JicensW.punuem m.the- _.__..__..-._.. ..... .._.._-_...-_...._-..
Contranols License Law...,. ,,.... ._.. ____.._.. ..._..___.....__._..___-..._____.__......._----..___...__
%'- Olamacmptunder Sec.' ';B&PCfarthis reason
wall
f WORKER'S COMPENSATION DECLARATION
I bertby eRrm and
penally of perjury,one of the following declarations:
O 1 have and will maintain'a CemiRcae of.cgmoa i to self-insure for Worker's
Compensation, as,provided for by Section 3700 of the labor Coda for the
pirfamut+ce,offal work for which this Permit is issued.
hats aiM will amininin Workers Compensation Iniurdnce,es required by Section
3700 of the liac,Code for th pedrair a c f Ne work for.vshwh this Menu,is
.'sued MY Warbles Compe�5 von Insure anis'and Poli bet
ovnerf cY IO 3 I _ ss..al ti )! .. . ..r_..
1 ERTIFICATION OF,EXEMPTION FROM VORKER5 -• 3Y. y , 1s u, .1" ';i;5s • i {''�;
-COMPENSATION INSURANCE,—INSURANCE" ''"""
(this union need nm his completed ifthe permit is for one hundred dollars � -:LI'`-' l"•'%'l '" '�_!,:^U({;':^',T'`,j)r •---��.'_
15100)ar ImJ ,
-t I cenfly,that in the er1forinarce of the work for which this Madill issued I •.. ...... .......__...._..._.. ._. _ .
shall nor employ any pc y manner so to become subject to the Worker •f ll+' �� +'1• `
Compenseuon laws of Cidifixtrim DatApplilrund
a
NOTICE TO
APPLf after making this Cen Rcaof of_pro your should beemnesubject t theWorker"C Pnial P .oneof
the Lbor Cod,youm st I
forthwith canalpl, sid,s ch provisions or this pant shill
-�- _-- -
be deconedrc ked
..
rY'CONSereisa oNLENDING6GENCY
-� t 1
hereby allikh that the s e comwn o 1 namg v C) (o the performance' _.I'
olihe work for h ch Ms permn n issuN(Scc J09],Crv.C) "" I
(y,.0 -Lsnder s N ms 'a " ..' •' .-'.•• u., ,...m,.v _ ..._--___ _._ _._._.... .___... :...
j
�.,•� Lanese 'Aad s' •_ _ , e _ _ __. _ _-..____-
1lenity Nat 1 ha e rt d this epplicat and tat Iheuh above- f rmed.iz
h cbrteet 1 ag to mply, th ell cit and c unty ordinance;and on laws relating
Q O to budamg maid cion.and bertby authonze rtprcxnufvcs of ihrscty to rant upon
the above-memioned,pmperry fonnzpc'to.purposes.
Es 6s IW) gree m arae ndem mi end keep harmless the Ci,
y f Cupertino agvnn
r'fq Habil t o .,,ts,costs d Menses pe h y n eny w y ecru gun's said
V z Ciry c nsequenae of N 'grant g of Nis pe t. - V V
- APPLICYNT Un'DERSTA.\DS AID WILL CO\1PLY N'ITH pLL\0\-POC.T I'
SOURCE REGULATIO\S r , Issued by: Da
Signature of ApplicanVCglrsw rc•" . ..., De¢iv' + Re-roofs �.
HAZARDOUS MATERIALS DISCLOSURE
WII d1e Ipp4cart orf rare bu Idmg occupant tort or handl hazirefou ran nal Type of Roof
as def d by N Cupen Mumc pal Code chapter 9.12 and the Health etM Safety 1;. -
Cdde Oyes 255321x1^ t •:I r.' f\ 1 < i J ` 1 ..�! "., `,+'
All roofs shall be inspected prior-to.any roofing.material being installed_,
''r,will the,applicant o fuI ebuldzng occ"Pant use[quip for deuces which "' •""-^^•
emit huire saircountarn is as defined by the Bay Area Ai Quality Management If a roof is Installe'&Without first obtaining an inspection;'I'agree.to remove
District, _ all new materials for inspection. Applicant understands and will cora I with
all non-point source regulations', -
/ Califon Health&Safer Cod Sect ons 25505 25533 end 25534 I understand that ,
' 1
have'rted the nerd mu,mate els rt temente unde Chip r 695 of the
ifthe bu Itl g does of c y dy ha tenant that t s my respo +b 1 ty t ramify the / , -
r„ ' orf norb
lice. em f the equ men h ch dst be t o t imus a a( Cemf ase of
Signature,of Applicant .. . .. .... Date
t d
` d All roof coverings to be Class "B” etter
_
4-
r OFFICE