03030153 CITY OF CUPERTINO CTOW
BUILDING DIVISION PERMIT . ',
BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT NO.
OWNER'S NAME: 1764 NATIONAL AVE PeRMrr Lss A
HE (510) 293-9901 SANITARY N . CONTROL NO.
OWNER'S
BUIIDINO PERMIT INFO
BLDG ELECT PLUMB MECH
'30o LICENSED CONTRACTOR'S DECLARATION
1 hereby afflw that I eco licensed under pmmslons M Chapter 9(commencing JOA Description
with Section70M)orDMalon 3orthe Bestow and Pmfcuhms Cade.and my liters,h u Ufjlha JXx yI TL IRI
in full force and effect n Y V A L Lei D
z Licanr<Class Lie.is REPLACE WATER HEATER
Date ARCHI]ECT'SDECLARAMON (50 GALLON) AUG 1 Y003
1 understand my plans shell M need u public records
Licensed Professional
b OWNER-BUILDER camps
DE Ce Cont.ON BUILDING
a 1 mad atBrm the 1 I. exempt Item the Contractor's o Littnse Law for the 6J L gY'\rl
C p O following mean.(Schon]1131.3,Business, ber, and m.do Professions Cade:Any city m mousy
a
which ltsiso a eemso re uiratin p�AMforsu demolish,lirrepair ed oaten
�1?' prlmmlBlesed pultoregothe lhetpp0amfm each prmit m Ole•,Law
ggFFp thnMRRmnudpurction7 hepmvuimuafthcConuutm'aLmmelaw sCadc)9 Sq.FL Floor Area Valuation
d^
that
exempt
Seefroure and
the
but,n3 aftheeged euendon.Any vi Cade)of _
slut M B eumpt Nemfrmn and Ue basis for the alleged eumptlon.Any violation of
Section 7031.5 by any appllw t for a permit subjects the Applicant to a civil penalty of APN Number Occupancy Type
not mom than Rw hundmd dollars($500).
❑L M owner oftheprop arty,Army employes with wagn as dreo-sore<mnPa rs.dan. 32644041 . 00
willdo Newark andthesuwousbaot landed or offered fm saie(Sec.7044.Bumoss Re uired Inspections
and Psoreulom Code:The Contractor's License law deal not apply m to owner of
property wheWildtmimprmvan
den.endwhodmasuchworkhimtelforthmughhH 502 FINAL P UMBI G ENERGY
mm employees,provided that such impmwments am not intended reoffered forma If. 506 r GAS TEST
however,the building or improvement ismld within oro you of eompkikn,the ower-
Wilda will Mn the burden or poling that M did ars Mild or impress for purpose of 507 - FINAL PLUMBING
,ale.).
❑1,es owner of Ne property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professors coda:)The Contranmrs U.
come Law docs not apply to an owner of property who builds or impmvns thereon,and,
who contracts for such projects with aeontnctor(s)licensed pursuant to the Contractor,
License Law.
O 1 am exempt under Sa. .B&P C fm thio mann
Dwea wen
WORKERS COMPENSATION DECLARATION
I hereby aRirm under penally of perjury one of the following decl.stions..
1 have and will meimeM aCmillam of Consentto mlplmu¢for WmkefsCompen.
taller,as provided for by Sation 37W of the labor Code.rte the performance of the
work fm which Wee permit is Issued.
❑1 leve and will maintain Worker's Compensation Insurance.u required by Section
3100 of the Labor Cade,for the performance of the acres for which thin recall It Issued.
My Worker's Compensation Insurance arrier and Policy number see:
Cardec Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This sectlm need not becumpleted If lite rats Isfcro a hundreddallars(5100)
or wait)
I anify that In the performance of the work for which this permit Is hand.I thall ma-
employ any Pence in any manner an As In become subject
remployanyPenceinanymanneranubbemmetubject to dm Workers'Compersadon .
Laws of California.Dam
ApPlkans
NOTICE TO APPLICANT:If.after making this Certificate of Eaemplion,you should
become subject to the Worker',Compcadon pmvisims or the Leben Code,you mum
0 z forthwith comply with such provisions m this permit shell be deemed ranked.
„z„ti CONSTRUCTION LENDINOAOENCY
[ti (Mmby elOrm Nn them haconstruction lending agency for No prtormence of
CYi .dta work far Is which Nis pertoad(Sec.3091.Civ.C.)
0.Q Lenders Name
7 z Lender'.Adlmu
V 1 certify that 1 hew mW this application and sow that the above Information it
correct.l agree to comply with all city and county ordinances and stste laws relating to
0 building construction,and hereby suthodm mprownutins ofthis city menta ups,the
W ohm-nnnuhmol propry for inspection purples.
(Wc)agree to an.indemnify and keep harmless the City of Cupnino against
m IlabiOtia,judgments.coats And..Peat which may In any My acerae against said City
U In consequence of the APPLICANT UNDERSTANDS of I
DSANhis D WILL COMPLY WITH ALL NON-POINT ,Issued by: Date
SOURCEREGULATIONS.
Re-roofs
Signature ofAOPllaR ctor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the a Cupertino
or future Haling e.Chapt Item m handle Health and
As de0ned by the Cupnino MunlNpal Cake Chapter 9.12.and the Health and Safety
Code.Section 355354)7 All roofs shall he inspected prior to any roofing material being installed. .
[:3 Y. ONo
Will On applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
MIL haz adous air contaminants As correct by she Bay Arca Air Quality Management all new materials for inspection.
Disutct7
r]Yea (D No
I have mad the hnnrNms materials requirements under Chapter 6.95 of the Olirm,
me Health&SaloyCak.Sections 25505.35533 and 25534,1 understand that if me Wilding
dean ant currently hew a tenant,met it is my responsibility in mtlfy the Occupant or use
requirements which must be met prior At issuance or a CeN0ate or Occupancy. Signature of Applicant Date
Owner or euthodmtlagem Dam All roof coverings to be Class„Bat Or better
r
CITY OF CUPERTINO o
• WATER HEATER
CUPERTINO PERMIT APPLICATION FORM
APN#
Building Address: 6
Owner's Name: Phone#:
Contractor: A/ TPhone: 2��_ Zo12 License#:
G,sf /l/Gti -c r/ Loi C /
Contact: Phone: Cupertino Business License#:
Building Permit Info:
Bldg ❑. Elect ❑ Plumb Mech ❑
Job Description:
Residential Commercial ❑
Cost of Project: 12 3 3 . a-,=)
StrLoapped On Platform Bonded
New cation ❑ Replacement ❑
Qty. if
A licable Fee ID Fee Description Fee Grou
BPWHEATER Water Heater/Vent BUILDING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BENERGY Enerpv BUILDING
BUSLIC Business License BUILDING