02010080 c
CITY'OF CUPERTINO.
'BUILDING DPM PERMIT' '° CONTRACTOR INF.ORMATION:__ ._. . .... _ -. .
•..
BUILDING ADDRESS: -_ - _ PERMIT
20198 : CAMARDA. CT''. . WATER HEATERS"ONLY' "' `' `' • 02010080
C, OWNS&S NAME ' "' '' - r" - APPLICAT ON SUg DATE "
YUM SU I AND YOUNG J TRUSTEE & 970 E. MAIN ST, SUITE.,2 001118/2002
�•40NE: - SANITARY NO. CONTROL NO.
" (415) 566-2209
-ZZ ARCHITECT/ENGINEER:' - - BUILDING PERMIT INFO
F BLDG' ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
f Z v_2 5 Z "'1 hereby affirm that l am licensed under Provisions of Chapter 9(commencing Job Description
LtA lth scctimi 7")of Dirvoma 3 of the Bminellrosi Professions Code.and my license REPLACE 40 GAL GAS WATER- HEATER
m y is In full fOr[C and�Rc •-
ss< Licenu clJSc(�`� L- LI[.k`, 7.3 .. ....
i O DoleConiranur"
u O "ARCHITECT'S DECLARATION -
v,
4 1 mWemz.d my Plans.hall be used as public records
iis
OC Lcen. d Pofe,irmil- - - -
°' f OWNrR BUILDER DECLARATION `o :l s to I hereby spirit that 1 exempt from the Comracmr s License Law for the - - .. .. _ ,
t Z< follox g¢as m (Section]031 5 Business and Professions Code Any c ty ur county - $700
S F c which req res pe structure -
3 m Pnmw n eM also q sh ppT<a tfor ch p< smfile Bow int me t. ... _ __.. ._.. . ._ _..... ........
Nathe al¢ dp mIt Thep os fN Cot mss bccnse Li (Ch t 9
(mm &. 'tnStoJpf10) fD' solflhBSinessadPfe�sonxepod ) ;351�1614 �f0 ,. _ ' _ .. Valuation„ -.. _,.. ... .
or that he - pt'h rcfmm and the bass f th II geJ exe pt o- A y viola on
of Sut ]0313 by Y applicam for a perm t bl is Ne nppl e m n evil ..try
of
pot more Na r .arca amiars(gsW) - 50'�PN' N'I?T�F4LPLUMP I GrENERG ccupancy Type
❑Iia Rh Pro P^Y nY, ply Ih get Ih pens Inion. -
II do
he k tllh vba a t t d d fife J f 1 (S<c 9044,
B '.mess d P r ane cone Tn c t t ucenre laws t pply t an '507 --.F I NAL PBdrj113;�A Ai4peclic ns
o nc
r of property Who builds or Improses thereon,and who docs such work himself
or thorough
th n employ Pm dsl Nat uch pea t arc a t dM or _ -_ -.
IoRercdf le lf'ti Nbd ld n8 P s . IJlh yar of _ __ _ _._. ... ____.-_ _ .._ ___ ._ .._ _._.. ._....
umpla an,the aw cr builder will have the burden of proving shot he did nos build or '
improve for purpose of -
O L ns owner of Ne grope^y am exclusively d Professions
ore)The Conaator's ��0'�l ECna E S`��
License
oess et Nc prose.(Sec,]044,own&o and Professions Code:)The Comnreon,
C:and.w L d t apply:o an owner of pr pent who build. improves thereon,
wti ties or Law. h pro)ens wish a c Imfs)licensed p am w�Ne .. z... ... ....... . _J__. _. _ _
Conlin tors LicenseLaw. 1 n/ - -- --- -
❑1noce pt rde, ,.B&PCfobi,..on "t'AUG' "0 2002
WORKER'S COMPENSATION DECLARATION - - BUILDING .
I bby R d pen ly f pe 1 rY f the following declaration,
•] 1 h d II t C nificam f Consent m self insure for Worker's
WA Comp sato., as provided for by.Seaoa 37W of the Labor Code for the
performance of the work for which this permit is issued. -
�I have and will maintain Worker's Compensation Insumri[<,as ra3vi1ed by Section
TW of the'Isbor Code.for she performance of the work foiwhich this permit is
issued,My Workers Comp s o L. ran center d Policy
n 'be.
I1
Policy No;'t 'CERTIFICATION OF ION NFRM,W2ORr�KERS-
COMPENSATION INSURANCE
....
"" ' ' '
L'
Thi, i need nor he compiemd if he permit is for one hundred dollar '-
'
t
1 c m employ
inti theperformancein any
of N o k fo h h N perms is9ued;I
shall not empl y y feta y er s m become s b)at t lh Workers
Compensaoon Lows of California Oct,
Applicant . .. -,
- NOTICE TO APPLICANT If ft ft aid e MCetff re.of Exemi ` -�- _ - �-
V•
' Z becomes subjectto the Wok Compensation Pro,s sof the Lothar Code.yyou shmusdt. - � - -- - � .r
0
forthwith comply with such provisions or this permit shelf the deemed nar.ked.
'CONSTRUCTION LENDING AGENCY
C 1 by urT rNthatcontact. lending agency for the Plifmmence
ftheworkfor xh ch Nissue
is permu is )(S 3097 Civ.C.) `
0 Lender's Name.. . ., .. _-
�.Z Lende Add .. -
V'� .. -
1ccruf,'thnhlh prior this ppl' t d .are Nnh boe info
,
W [.. boiren I g e t mply Ih II c ry a d my o 0 enc a❑stat I lanng
O U t Wilding u l nandh bt cuN prcsctt - fN ctYt ( upon '
Ne abo t rW m n f
tree IS' IW)agrees plvec d fyd ke pl�nl ss th'Ciiy ofC gem o' nst
V1 labilii p . . xh h cy .any way gains,,.said
V Z .City inc Jeq alsofth g ds g fill pc t
APPLICANT U\DERSTAYDSA ILL COMP YWIiH ALL NO POI Y 1
SOURCE REGULATIONS (����QZ Issued by:
Stgnm fAppl canJCo r a°r,J��' RK• � '-, D Re-roofs
+ . I HAZARDOUS MATERIALSDISCL05URE '' '
W 11 Ne. cant or fumrc bu Iain s
part gee aPamsmrc nnndlena�rdaa t
Type of Roof _ _ _ _
as defined by N Cupcnino Mun c pal Code.Chapmr 9 IZ a d N HeaIN and
Safety ry :-' - � _ �' - -
Cotl40Y ....(al
.All:roofs shall be,in
spected.pnor to.any roofing materia] being installed.
W ll aid
applicant f t e b Id' gm p t q pm m o a a which If a roof is installed without first,obtaining an inspect3ofit J agree;to remove
� ha rd Inv c tam t defined by thebay A A Quo ty M gamer,'
' '"" �,I�y ,_ all new materials for mspecnon Applicant understands and will comply with
q�Y all non-point source regulations
9 .1 haricread Nd hazardous m rad 1 gwrcmems under Chapter 6,95.6f she
Cal for,i Health&'Solely Code.Sections 25505.25533 and 8534.1 undersand that
ifdm Wilding dacSnbi eri ert hnsx o ream.Nm it is my rtsPonsibiliry b,not the
l.'. . occo ant of the Mquiremems which must W met prior m issuance Cenifcarc of
... pane - . .;
Signature of Applicant Date _
ownm ar aawo^= :� ae All roof coverings to be Class "B"or better
r
_. ..i
OFFICE