02020032 CITYBUILDING DIVIiSiONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
869 CANDLEWOOD DR JUST WATER HEATERS INC 02020032
OWNER'S NAME: - APPLICATION SUB DATE
MIKE CHO 1764 NATIONAL AVE 02/08/2002
PHONE: SANITARY N0. CONTROL NO.
(510) 293-9901
ARCHITECTIENGINEER: BUILDING PERMIT INFO
O
BLDG ELECT PLUMB MECH
z I�
LICENSED CONTRACTOR'S DECLARATION
Z y? I Hamby affirm the,I ora licensed under provisions of Chapter 9(commencing Job Description
,a E� with Section 7000)of Division 3 of the Business and Pmlessions Code.and my license REPLACE WATER HEATER.
r Y I is in full force and effect.
5 e < Licanx Cmxx Lia.a (5 0 GALLON GAS)
i 3 s V Date Contractor
ARCHITECT'S DECLARATION
t=org 1 undernana my plans eholl be used as public records
anp O Licensed Professional
d OWNER-BUILDER DECLARATION
R I hereby a(Bmt that 1 1. exempt tram,he Cosigns Code:
License Lew for the
t 3< following rwwn. t ]031.5,Business and ve.de Professions Code:Any city m county
I O p construct, improve,h permit
t p y aweture
which requires Permit
� .prion , also rt9 imsthapplicant for such pennuo fl grad mtemem - - - --
u. mai the,to h a rsuhm to the ma , s ohne Contracron's License La (Chapter 9 S F,t,Floor Area ation
(commencingwth Sect 7W0) f Division 3 of the Bupnm aper ns Cndm (:!'''Nil_�z ,'9'i.�':x L'4; ':_i'l ," .I( .y• .
or Na,he is exempt therefrom and the basis for the alleged c4empdmi Any violation
of Section 7031:5 by any opplicont fore pertrm subjests theapplicam t...ivil penalty
of not mom than five hundred dollars(S500). A b r Occupancy Type
ID 1,as owner of the property, o wiihwagea.,lmr,.Iacmopxnw,ion, ENERGY
willdothe'wm1a.and the s a xtend r or sale(Set,7W , 602 FINAL PLUMBIN.
Business and Profexsions C' :The Con is en s aP 506 GAS TESBequired Inspections"'' "
use
of property Who buil or improves t and o doe
tic or
or throuphhis own employ dinar , .imps mai in ceoor _ _ ,_ _.;- _FINAL- PLUMBING _ ._._... _" .._. ._.__ ..
offered or sale. f.howeve he mg or rovem it o
completion,the cumer-buil will he vc I a of p he
improve for pugnse of sal t'
❑1,as gwner of the property,ata 1j, -. __ .. ..
,. con ti with liens ___._.. _ ..._. _. .. ...-.._.._ _ -. . ._ .. .
co eters t
License the project(Sec.704q Business and Prn es as Coder memo
emichal
License Law toes no,apply m on owner of propcny who builds or improve therco
.. I .ata contracts
and-who for such Projects with e.contn (s)contractors,Rcemed.pursuant to.the
- Contract" _Contractor'sLiven
s License law.
❑1 stn exempt under Sea: B&P C for this reawn
OwI6 Data
WORKER'S COMPENSATION DECLARATION
I hereby M.under,penalty of perjury one of the following declarations:
❑ 1 have and will maintain o Certificate of 3700 o ,t uLatim,m for Wcur the /
:a Comrmanc o he provided for by Section 3700 of the Labor Coda for ,he
performance of the work for whim this pemti,is issued.
❑1 have and will maintain Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is
s rammed.My Workees Compensation Insurance carrier and Policy number are
:
policy No_! ........ _
CERTIFICATION OF EXEMPTION FROM,WORKERSV t-
... . ...,- .._COMPENSATION INSURANCE:',"'".`;'_: . _........_`__.-_..___....__
' (This section need not be completed if the permit is for one hundred dollars
is 100)or lase.)
:1 certify that in,he performance of the work'for which ihia permit is issued;1
•xhell''nbtcmploy any'parson to any mannerw as to become subject io the Workers
Com,mornion laws of Califomia.Dam
Applicant. _ .. :... . .... .. .. ... ......
,NOTICE TO APPLICANT:If,cher making this Certificate of Exemption,you should
0 become subject to the Worker's Compensation provisions of the Labor Code,you mus,
forthwith comply with such Provisions or this Permit shall He domed revoked.
s`^ which this permit is issued(Sec.3097, iv.C,) he performance
CONSTRUCTION LENDING AGENCY
Ih by uffrm that them isgg agency
Lender's
eth rk for C
land r s Nem e. a construction lend n n for
.� Lend Address
•
V-O 1 ttnily that 1 have read this applicat on and sum that li above mfomiuon is
Dai torten.1"gree to comply with all city and county ordinmtecs and state laws mlating
to building constmctioq and hereby authorize repreiemmives of this city to enter upon
� W .the above-mentioned property for inspection purposes., /��
`y C1a (We)agree m save,indemnify and keep harmless the City of Cupertino against /v t s �^ \
it W liabilities,judgments,costs and expenses which may in any way accrue against said'
V City in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALLNON-POINT Issued by: Date
SOURSignatu,mof ApplicabVContractor 'Dau Re-roofs
„ HAZARDOUS MATERIALS DISCLOSURE
will Ih"applic nt or future building occupant store or handle huardo s material Type of Roof
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety .1
Code Semon 25532(a)7.` +`,. ,. ..
"Yea
❑Na„ , All roofs shall ted be inspecp66r,to any roofing material being.installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree'to remove
em i,huerdous air contaminates as defined by the Bay Area Air Quality Management
DisriaO va ❑No - - . ' all new materials for inspection.. Applicant understands and.will_comply with
all non-point source regulations. . „
1 have read,he hazardous materials ps ireinenti uMei Chapter 6.95 of the
California Health&Safety Code,Sections 25505.25533 and 25534.1 undernwd that
if the building does not currently have a tenant,that it is my responsibility to notify the '-
occupant of the requirements which must be met prior to issuance of a Certificate of
:. OccupancY. ..
Signature of Applicant Date
ow xray.utharixea agent Data All roof coverings to be Class"B"or better
=: '- .. .. .. ... OFFICE . . _ ..