01080067 CITY OF:CUPERTINO t
BUILDING utvrstonr PERMIT CONTRACTOR INFORMATION.7
"" '• •BUILDINGADDRESS "" ! - 1 i 1 I'I'i" ''.': ;;i' _PERMIT NO.
10186101080067,'-
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' __CAROL LEE ,DR�, � JUST WATER HEATERS;;INC ..: 01080067 •
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:. '..-..... -:Irv... ....J•_. _ _.... .. .... ... _.. _,,.. _ ... . .. APPLICATION SpBDATE .............
O A ... . .... /� AVID 'K"AND" OLIVIA"'C " =',
1764 ':NATIONAL -AVE 02001
PHONE: SANITARY NO. CONTROL NO.
(510) 293-9901
.o ARCHITECT/ENGINEER: BUILDING PERMIT INFO"
BLDG ELECT PLUMB MECH
az� C1 L_j I1_1 1_1
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z y i LICENSED CONTRACTOR SDECLARATION
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Job Description
Ih by fnnthat Iaml enact derpmisionsofChapter9foommenog REPLACE WATER HEATER.with Section 7000)ofD n 3 fthe B in d Professions Code, my license
is full f and t ro '
LanamwClua, c.0 40 GALLON GAS WATER HEATER.
alD t ..
ARCHITECTS DECLARATION
? I dusmnd ly plans shalhbe u J p blit records
f oyr'
w c.OO funiumetl Prokesbim .. -
°' 'Y ,OWNER-BUILDER DECLARATION
1 hereby mflo. hat I an w.mr,t from he C L elr. Lwemw Law for the
following mason.(Section 7031.5,Business and Prof:. n Code:Anycity.or county-
F 2 O
which na,does a permit t ngruc,,alt,improve demo)ch;or repmr anY strvcn re 1 :. ,,.4 ,. :I 1
i3 ._port is sn..a1 qinsistPPI Lfr,all riufl gedliamat -
that he s licensedp orto,n p visL s ftM1 Cnv t sL en La (Ch Pter9. Ft Floor Area,
v _ Valuation_
- rcmm Dong„tth Se to 7ono) Div n3ftbpB .ln ePrgm.,ion Cd) '� d'r "�q'' s', .L
^ of P P< j ed ex mPt n Any violation APN' .
a e ppl cant L a civil penalty '
of"hat
a more
afi are Irra m,ts bona rh '� Number • 'cr Jr. !:Occupancy Type... .. . .
o Lh t h m t th'f an th b [ ,LM1 Ileg
of m re tlwn five h direct dollnm(5500) - ,
❑l a f th ppe ty rainy mpl ye to-wagesLh I p , .- •
wwillme k- thestructure notintended r.offered f J ' 7as- 50 T - FINAL PLUMBING
e pa s and P r si c e ,Tne C m
om <to s L<en L a i apply Spey to o ”' "' 5 0 6' GAS TES7Requ;red Inspec[ions _
o e of p p dy Whob ilJ mpro es th d wh d h- k h m If
o through ,hown employes provided that h prov t not intended r
_ici d for sale.If,however,the bu lding ar'mprovement is s Id w th n one year or .......•. --.... .. _._..:.... ._-) _._.._. ........... . .....
<°mr ive I.,the owner me.)r w II have the huNen of prov ng that he did not buil)or
improve for purpose of sale.). -
El 1.as owner of the property,am exclovispycova<fgwthlce contractors t
const -L th p 0.) t(S 'IBOJ B ne d P of on Cod Tic IC L t r
L L d L 1 L an f rz h builds p thereon,th
..a d h nt t f h projects_x Lha t tnKs)I d.p v uat Lhc. .. .._.. ._ ._. .. .... -,_...
Cont t L nw L
❑1 pt odic S ' " I affi PCf Lns �/
Owner
,p t
WORKER'S COMPENSATION DECLARATION
ti
I herebyaf r dai pemtly of peryJ yo enF the following dI urians:
❑ 1 have and will maintain a Certifc t f Can..,io self insnre for Worker's
^Cmrpensatuom as provided for by Section 37W of the Labor Code, for the 'I
.performance of the work for which this Perm i is issued. • - - ,-, ?• 'I t
°1 have and will'm t.'n Worker's G P t' I " c- 9 ired by Section "
-37W of the Lplam'Codit,for h..pe f m nce odthe work f which this permit is b
issued,MYWeaker,C pe i n firourprecc ad Policy harasser arep
_GahFrs r CERTIFICATION OF EXEMPTION FROM ,. ,!
y
^ WORKERS 7 i n t
GE
COMPENSATION INSURANCE
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This sedan` d t bcompleted if the permit Is f one hundred dollars Ll . ..
'I ($IW)im le,+) r -
shall i l employ a "
* 1 cert f that Person n any mans to bxb subject to�th.,i
r It
�. Y P< ance (the rkfr which th PrtnL ea 1. ., .. . . ,_ ..._. .;.I, Ge .... .... .. ....
uh eW nkerF .,. ..
., C arsosoLon Laws fClf Dore „ „ _ t - _ -, "
.Applicant ` ,tr
'NOTICE TO APPLICANT:If, mak Certificate of on you should `u
become subject to the Workers Compsonsation
p 'ons of the Labor Code,yourmil
Z 2 Po, th c ur l with s h tial)be deemed rooked.
PY P th pro n.
CONSTRUCTION LENDING AGENCY "- "9 I "I
1 hereby,ITrm that them is aconstruction lending agency for the p::rlbr mane t
W > '41hu inkforlich the pe t , s d(S 3097Civ.C) ..-.-_ - .. _..,.... .
y:0 ' C Jr Nam.,.... _.. .. _ ..4 .... . _. ...___.._... . ...... ._. .. ....__ "
Lamdha,9,Add''I 1, .. t..:
V O ,I cordry that ime read the application end state that the b rnfirmairon is
ty F
co noct I agree to comply,with all city and county ordinances and state laws mining
�,O do bu lilt g t u n andh shy a_uth z p c i f e Ith's tly,Loenarapin _
Ith bo a menu property- .. p t p ,es
y (W)agem.n tudimmhiod or,
n I �.the City (Cprt gainst
it 1 dg nt. L rte pens hch yn any ) c eaga t slid
� (7"t t
Ctyne se9NN ingotth Sano
; CUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT,
DatSOURCE REGULATIONS, Issued by: e ._
'
;Si +D' to• Re B roofs
'' it
° HAZARDOUS MATERIALS DISCLOSURE .
so def d by th C ca unn Mhn e ui TIC d Ch pt 9 I d Ln H alth a mut nal Type Of ROOf- - -" -.._ _.. ...
W II th ppI m fim cbuilding occupant Lrhdl M1 orJo
d Safety _
to
Code,
S etl n 2563 ( I , All roofs shall be inspected-priorr
to.any roofing,matena]being installed
W 11 th apPl caro o r L bu'Id g p t se eq p t a n hl If..a roof Is installed without first obtaining awins ectron '`I'agree'tareinove
cut,
thzMo rc L t sdefndb th B Aie A , ,, g P
DI L L Y Y Q ry nt,tiag t"
all new materials foo."mgpection Applicant understands and will comply with
°Y I y ❑Ng¢ q Lrcments de Chapter 6.95 tint
all non point source regulations > y -•`•' '--. -•--�`
1 ha e r•ad:the h zanl r r
Cin
fomt Heahh&Saf L C d.Sktinn 25505 �SSJ3 and 255JJ I understurd th t •;I
ec'ubuJdmg dot not nE}have'a tewnL thantismy responabaty Ldnmiry the t.
oecupam Rth iegmrem ( hich'mvst im met pri°r L° .ounce nL9 Cerlifcate of. "
°a p Si na[yre of licant_., _. ,,._ Date
.. _ g _.A PP. - .
e
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All roof coverings to be Class Bor'btter'
Dame
'' 'o ne aumodzed g t- t ' ., g -
. .rn.:. ........ . . ... OFFICE ...__-... ... _ ... _.,-... . . ,_..... ._, . ... -