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01110033 CUPERTINO CITYBUILDING DIVISION' IT CONTRACTOR INFORMATION: PERM BUILDING ADDRESS: PERMIT NO. 10580 CASTINE AV JUST WATER HEATERS INC 77 yB 01110033 DAOL ASKOUNIS PAUL L AND FRANCESC 1764 NATIONAL AVE APPLICATION p PHONE: (510) 293-9901 SANITARY NO. CONTROL NO. R C C z0 ARCHITECf/ENGI,NEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MF.CH L7 LL=] 8 y 2 LICENSED CONTRACT'OR'S DECLARATION Job Description ii,_p , Ihercbyaltinnthalamli«n¢dundcrprovisionsofChaptcr9(comtilencing REPLACE WATER HEATERP ,wish Scotian JfYdO)of Division J of be Business and Professions Q>de.and my license in ran fnree and erre«. (5 0 GAL GAS) 6 ' is Class tie.n 'O'n Date- Contractor I C G ' ARCHITECTS DECLARATION {, I understand my plans shall be used as public records I as,o O Licensed Professional ' t OWNER-BUILDER DECLARATION 1 hereby affirm tbar 1 am exempt from the Caroni I License Law for the < following mason.(Section 7031.5,Business end Professions Code:Any city or county ' Y t--O .which requires a permit to conumst.niter,improve,demulish,or repair any structure -- _ u°67 3 m rPnor t.t inumance,alba"tilOwthe.,lamorl fo such pc 't m file a sigted statement _. _.. - _ _ _ _----- Val .-- - mat paa,l«mwprs ImlheProvvronanrmec tiatnreL<enulsw(eM1aptn9 �a i Sq:•Ft FloorArea.,I• I Valuation aon g _msat, 170n0)of Di 3f theBuxtnexpp aad Prpfesann,coo f,.,�;� R_ _ 3 \.t :.✓t'..tF ) :(�. or that he rs exempt memfrdm and the bass for me allage8 eiemytibn.Any violation o s' ' -of S«tion 703 LS by any applicant fm o permit sobjcrn me applicom to a civil pewiry- mrnmmnrcmanEvenamrcaannarslsstw>. APN Number 4L..>::Tcn Occupancy Type ❑I.aso oar of the PmponY•arOn,ma,Icyce,wilh wages a,lheh,Plecompenm0oa. 502 - FINAL PLUMBI G 'ENERGY will"do"the work;and the structure is"not intended m offered for.]a(Seso'7D14,' 506 - GAS TESR, 'Busim,is and'Profession,Code:The Comian RacmCs License Law does not apply to equired InspectlOns°o' "- owner of pmpeny Wnti builds or improves mcrenn,and who does such work himself 507 - FINAL PLUMBING . or mynagh his own employees provided that such improvements are not intended or. _ _.__.---.. _ __ _ .__._ _.___ offend fo'r sole ICnawe.e�,the ba Iain --- ...:.. .. .-_. - - i 6 or improvcmeni is sols with n one car of omelet un rhe Donor bu Ider will have the burden of proving that ne did not build or •^C- improve for Durµisc of sale.). ,asownerofthe pmpony,am exclusively ronuamiogwith licensed Contractor oaaorsm "_--- --- - --- - irl IJ„I .. _ -= onswa the Pros«,(Sec.70Mf,Busiowner of and Frty who ills or The improves trc neon, f "e.°.`s ”" _ License Law does not apply to an owner of a cowry who halide s improves mcrenn, ,.aod,who.ivntisetse Lot.ch prolems.wim a contract«(s)licensed p 01 a.torn License Src „ o _ ... - ❑loco pt nd Sec ' " ,B dPCNorth 'src con Owner ' 1 Date - WORKERS COMPENSATION DECLARATION 1 hereby affirm under pc ally of Perio"y,oric ofthe following declarations: ❑ I have and will'mainim.aCcnifica l'of Consent•ia self-insun,for Worker's Compensation, us..provided-for by Section 3700 of the Labor Cade,-for the ' perfo nee of Ih k f h h,h's pe t ed ,01h d will t Wokc C ' pc t In a,ne"moodby,5'tion 3700 of the Labor Code,for the pefforommer,of the work for which this pe- n is ismW MyW k s Cmwsemsafiom lmtcourncamierind Policy bar arc: .. _ Carver Irx §lt:il 14 1 :J PolicyNo ._. .__ _ li CERTIFICATION OF EXEMPTION FROM WORKERS "' j'jii ..c:K_ l. [• If,II.\: -. ..:,..._....._C,OMPENSATION INSURANCE-''" ^gy''''p% nneed m becomleied if the ----- --- (Sl Wlor less) p Permit is for one hundred dollars 'r, 1clotfythat in the Pe ina of, work for which this ct ts'. d,'1 -'".`."'•^•'•'^'.•. •^- Countempty anyPersonn Ymanna s t 'becb a subject theworkers' I - ,.Cti iIOP'h":^grin PP of Clif rote Date _.' . Comps sat on Is x ' NOTICE TO APPLICANT If, ftc,main,thit Cn'f am ofE pu n you should been uby it th Wok tsC pc ton pro ' ns of lb<Lebo Code y66 must zfonho th comply with such pros s ons or Ws perm t shall be de coed invoked. .. Cq r6 is i i'f CONSTRUCTION LENDING AGENCY a ; "Thereby effran that me construct lendingagenry Forth perfo ante 1{ ,i ,U W..a .fill. ork for hich this permit s 'cd(Sec 3097 Gs C) ""- 0. in ..Lender hlm ..... ..,.._.,y. .,.. ., .. p .`I. Z Iknde Addle Ufc G I nfY in.,Jh selead mi sept t and tt that be above f Ynis O U t t I gree s comply th all.city.and county m ante and stn laws rel ting Wilding t s on a d h rthy i th rim ep tot of m city to enter poo F ,he eW t on d o f inspection purposes. him i. � prPpe z x Is,)agree t save hand a alis k«p hannl ss ale City of Cupenino ag'nettZI z liabilities,itjudgments. me den wh ch y any way against;nst said Usk Cityincosq nee ofine Nan,ng f tVHJ< t " pPPL1CAYf UNDEkDNS. SA,JD NY:, C. ,IPL'(N'FTN AI,L hON:PoL\^Fit' _ _ SOURCE REGULATIONS - Issued by: Date - uaN of Appl anUC t n r t t. + D t Re-rOOf$ - -. - Sg HAZgRDOUS MATERIALS DISCLOSURE Writhe eppl'ant«futurt bund og oce pa t tort. handl haraN ,con al --Type Of Roof. CMdefined bYm C }1 I1 \ } m H Imo dSafety .: --'..-_:-. penin.M contest Cade Ch pt 9 12 d � - , cmla ov[zss7z(e). t oN 4 < tiq� '("ff 5zx f t)i': rL"{P. i. ' y {'if`',,°,..�a :t,'. ._.All roofs shall.be inspected.prior,to,a ' roofing.matenal.being metalled._ �no' Wsitheapplmamo fuwrcbultlmg« pan��scequPmemnrdeviaawnich If a roof is ifistallediwithout first obtaining an inspection;I'agree:[o remove t hvaN a r comm ria t d f M b m B A qct III Mane nt calir❑H`ealt&soR Codu.Secauons25505 r25533nnd255 s1 �Ra all new materials for inspection. Applicant understands and will comply with - D ria i rte ><f ONo ,, t iI _- _ - -- all non-point source regulations. P the if the boldg does nm counci vc1- jot mat ism - - mat _ -. -, -._. .. .._ .__ ytespons blly t, .ofy,the -- .. . . .. ._ .. .. moon t f me q rcme t which must be met p r to c.sumle f a C nifc rte of C. " . ,•,v - - _-. ".-._. .. _ Signature of Applicant _ _ . __- _--. Date _ Owner?fa sionacdngent All roof coverings to be Class "Bii or better ' -OFFICE- -- - . .. .... _ .