02090157 .0T, Y,OF CUPERTINO
'BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
�Y�' t°�lsRNE AV WATER HEATERS ONLY PERMr"090157
M1FTSOEJAMES E AND VALERIE 970 E. MAIN ST, SUITE 200 APPLIGTYJS DAij002
E
•, PHON (415) 566-2209 SANITARY NO.L.5/ CONTROL NO.
q OZ ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u U L--_l
S L i ? -• " LICENSED CONTRACTOR'S DECLARATION yRCeO Ilon
rOZ_0 xIhereby aRm,Nmlam licensedunder
ped profssi Chapta.and.1 license REPLACE WATER HE�1'EK' p
Fwtw wiN cation]000)of Divii of NC Business and professions Code,and my license
y E.,S is in roll force aa(11f{PCI1.� /r e 7
ne as 6 License Clazs f-�aC�V Lic.p `rs..l
s�3 d O Datc c4 f cs.,.i Conlraz
er ' ARCHITECT'S DELL AT
t g J understand my plans anonl b p as public 'Em
�Y
W i p '4<enud Prafeuional
c.
OWNER-BUILDER DECLARATION
u w I hereby Elffrri rbm I am exempt from the Commcmr's License Law far the $700
t?a following reason.(Section]0315,Business and Professions Codc:Any city or county
lE a O which requires a permit m construct Elite,,improve,demolish,or repair any someone
a3 npon,to its iuuaiat'lilsorequies Ne applicant far such patois to fileaslgoe!stationers ____. -_.__.._._ ___
- ,tha,heli.licensedpaisupanudmepruvisiansoftheCommerm"LicenseLaw(Chaph, 9 !1 Valuation
(commencin®with Scuiod,]Uo0)ofDivision3af Ne easiness arW Professions Code) tri nill4!41 1. \!RAO\.�'�e37.i>•'Iia' 1�. �•
or dial 6c i5 2.icmpi thcrefrom'aad the basis for die allegel exemption.Any violation
of Smioh 7031.5 by any applicam For a permit subjecs the applicant to a civil penalty
I or not more than five Hundred daxa,,a5W) DUZ A-PE.bJENUy- Occupancy Type
506 GAS TEST
wiBdo;Nc wor6e Pmpnr.ur my emplorees wiN wage:as Ndrsole Lompnmdoq -
❑1,d owner of
and Ne'xIc: re is notimeLice a feredLaw does act(pply]BG1;' -' - _ ei,W64 - ,- ___---.
Butowner of ped surly s Who
builds
o The Contractor'sthereon,
License Law dos not apply m an nspec[iohS '`" r'
weer of his ow em builds or improves t Hereon,and who encs such work himself
o s
or Nrough h employees.y provided d Nat such improvements menss Elm not onetime or ;
-offered,for. I- If 6- ,h b la
completion,theowner builder will have he band n of pmvmgsthat he did not Wild or
improve for purpose of soled.'
OI a uN .pmpeny,dm Business
exclusively dPocontracting with Cad,:)Th contractors t NOV1 3 2002 r- I:r:-'i ---
Locen i the Fruits'(Sec ]044,owners and property
who
Cod'1 Th Contmaor s 1C V L L Li.PG Ll 7� \
License Law docs nota I man owner of n :!✓
E .)";� apply grope y who builds or Hereon,
-.. .. .and_who.canwce forsuch.projenx,wiN.a comrucmr(a)licensed.Pursuant.m.the. .._.._._._.-_.___..._._..._.____.._...._..—.__...___.__..........-------------
Connector's
Licenw Law. 1 1 1 ----
1.!y}'_ 0lameaempt undm Scc.'L:r' :'r\C = .'g&PC for di, reawn Bv'L® AI!"F-,
.. �; 7[�tl''1�a11
t WORKER S COMPENSATION DECLARATION
-11,exabyroffirromaderp olty (Pel ryoneof Ne foil gd Iagti"ns -
❑,I have aad will'm nt n a'Cenificue f C sentlo If far Wok is
).: .Compereation. as prov,Jed-for by Section-3700 ofthe Libor Cade, for the
'perfomunee of the work for which this permit is issued.. ,
I h d -"11 s int Work C ben t . s o 1enc< q red by Section
�J70()of the LaborCode,hoddie prf imanc fthe- work foe which this'permit is
lam d My Work Conape sat a lassurance call and Policy be '
One i �t Pulitr WE, ; -rk i'- l S ,'L• ai
Y Ij
IF A.. OF EKEMPI]ON FROM WORKERS �r l}�\ I.. .� S0.0i, at ,S"J aa}, a. AC..I.
•CQ4IPENSATION INSURANCE^4a°`
V'It ITh m t n need not be'complcicd d me perms rs fo one hunJrcd dollars - .'1.t:, r , (l; -t,.i f;1.:
151011 m less.) i'
II. .
r
-
n+a,It myii nth pfo c 'iifN work! whichN pe , rouge ! , .,
shall ,limply pp In y romp s 10 becbmc bleat th Work s O.. ^" i f 1Sl Lf.i;\S'i;'1': ,.
Co
loam
o pmt 'Lives of Calif is Damp' ""' ^
( a
pNOTICE I cleaver b gN Crile!, fE "C r "'-' --'--- --
should
Z &come hj t ionic,W clues C pe int p 'aces arch Lab r Cod you m st
zO forth nM1 comply wi, ch pro.as ons or lbs permit shall be deemN revoked,
P•(4 1'� ' pCOM1STRUCTION LENDING AGENCY - - -;1 i.:.,' .p n;
rcb firm
that
in i o stone, lending
n
a > r. g agency r the performd \- , I
P" of Ne o A f wh ch N pc t issued(Sec.3097 Civ.C 1
Prig Lcndr-N'me'::_. __v: ._.... _ r....c., _
Londe .Addie.
r 1 rYry N r I h d N s pPl'cat ❑smm shm N ba f rmve n' //��//II _
0titFr to buildingrte t I g t gly N II city and ry oN -icc J m relating t i n nd h by mhoi p of bfN'. yt tar pan
}
W the a.. e i d propenY f pee io puryos
(W 1 g emsc dem fy dA Ph ml . a a fC pc. oag od
Fr y City j dg cora,cost, nJ p s which may any w y c gains,said
U_Z
City qh D9RST g nt g fmiz rant "'
APPLICANT UNDERSTA\DSA COMPLY ITH ALL NC PO .T'
SOURCE REcuIiATIOs G; - 9 ✓Z Issued by; Dale
r Sigwt rcb!A......r-Com a :;i Re-roofs
HAZARDOUS FIA ERIALS DISCLOSURE -.
,,;4 '.w u m ppbLan r t weble'Ps occupant score or na me b m s mat ial. _,,,,Type of Roof._
as defined by,the Cupertino Mu o pal Cade Chapter 9.12.and dve Hcalch and Safety' ---- -
Cade Sat rt 5b2a '{+ _. a x' . 75 SCit� r �'N 4 cep c� t T.. s `, -
0Y a f '. a'� ok5A1T.'ks ..
All.roofs shall be mspected.prior_to any roofing material being installed._..__. ..
`nt` veli N ircontaminants
moo future defined
Wilding pant u. eq ipr t arae nen If a roof is irisialled without first obtaining an'ihspection;Pagree`�to remove
nm nano az def ed b N B Are A
emit hal-rJ he o Y Y Quality rc,which
Management
District' all new materials for inspection. Applicant understands and will comply with
....tall rion-point sourceregulanons,� ;•,r,.,' f , _--.,r.a. -- -
IBave
read theety Ct t dale mq treCELmens ua& chapter 6.95 of the
if the
Wilding
tcurCd S mm�s 8505 25533 and 25534.1,understand that
'i ifthe puildingdaes nrncuirzntlyhaveatenanCNatitismyresponsibility tormlifY the""_"" _ "" " " "- - -' -- - -- ---- _.._._.._.
occupant of the r menti xnich mus,be met poor to issaaritt of n Cenifcate of ----- -- --
ire
~ p c
Signatu_re_ofApplicant,
> — .,9 Hz -" _ . ... _ .._.. . Date
° N ]ea cut
1 arc All roof coverings to be Class `B"or,better- -
"OFFICE