02050038 TY OF
CUP
CIBUILDI c DIVISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
11656 CEDAR SPRING CT JUST WATER HEATERS INC 02050038
OWNER'S NAME: APPLICryTION S DATE
SHIN SEONG S AND JIN S 1764 NATIONAL AVE 05 07/2002 2002
PHONE: (510) 293-9901 SANITARY NO. COWROL NO.
O p0 ARCHITECT/ENGINEER: BUILDING PERMIT INTO
<U G BLDG ELECT PLUMB MECH
t; IJ
5 v= LICENSED CONTRACTOR'S DECLARATION
i Z v 1 hereby affirm that 1 ren licensed under pruvrinns m Chapter 9(commencing Job Description
ISE: with Section]000)ofDNision3.fthcBusinessandProfcssionsCodeandmyliccnse REPLACE WATER HEATER
:YE
'xis ren
o c z a fo« as erre"
License Class a
(50 GALLON GAS)
OiU DatCo r
ARCHITECTS DECLARATIONOj 1 udcrsmnd try shall tensed asPublic reroNs
)_i Co Licensed Professional
t� 're the,I BUILDER DECLARATION
a I hereby aRnn mat 1 am exempt from the Contractor's License Law for the
C?< following reason.(Section 7031.5.Business and Prokssime,Code:Any city or county
Y x G
which ,it .. ppuil lo,mushruel. he,.improve.demolish,.,repair arry,urnturn,
i 3 m prim to'its issuance,alsomourns the applicantfo uch Permit to file a signed statement, _ _ $760
Oat he if licensed p rs inrromep vision rinfth �t a Licensela (Chapterode) S Ft. Floor Area,,., - Valuation
(commencing 1hSection]000)of Di 3 fm Business dP f Code) "j', , t, s`q �'S i--•)'�1 l sl. }
or Out he is exempt shcmfrom and the bass for the alleged exemlhirm Any violation
of Section]031.5 by any applicant for a permit subjects the applicant to a civil schalt r
'of not more than five hundred dollars($500). y APN Number Occupancy Type
01.as owm,.fO,,m,.y.array employee,with wageaaameir.Ncrmn,ii,sum., 502 — FINAL PLUMBIN ENERGY
will do the work:and the structure is not intended of offered for sale(See.]Bu. 5 0 6 — GAS TES .
Business and Pr.f«smns Code:The Contractor's License Law does not apply to an "Required Inspections • ' '
Owner of proprny Who builds or improves thereon,and who dos such work himself 507 — FINAL PLUMBING
r through his own anployccs.provided that such improvements are not intended or
offend'for said If,hd-bud&the l have
impiovcm2nt is sold within*onnor year of -
mprove un,ter owner-builder will have the buNen of proving that he did not build or
improve for purpose of sale.).
❑I,as owner of me property um exclusively a .tuft!ng with licensed contractors to
c License
the project(Sec. to a OwnBuser
and Professions Code)The Contract
them n.
_ License Law docs not apply wan owner th property who) lids se improves thereon.
.:
Contractors
cL.ronwc¢for such prnj«is with.a eunu«mr(s)licensed pursuant to the
ElI m toa, Licenseelaw. - --
OIam exempt under Sec.' B&P C for this reason
Owner: Date -
WORKER'SCOMPENSATIONDECLARATION �Ir—�I� p LE®
1M1eicby alLnn under penalty of perjury one of me following declarations: ®1�3
atmI have and will maintain'a Cendicam'of Consent tdself-insure for Worker's
CoMAY 16 2002
y mPcosn. as provided far by section 37W of me Labor Coda the e
_ performance of the work for which this permit is issued.
❑1 hav<and wiff
maionsim Worker's Compensation lmumnce,as required by Section BUILDING
- 37W of the Labor Code,lilt the performance of he work for which this permit is
sided.My Worker's Compensation Insurance carrier and Policy number are:
Cam_ Pal cy N..
t CERTIFICATION OF EXEMPTION FROM WORKERS'( _ t S,'. �'l�r i, t t i i - t -
,,:� COMPENSATION INSURANCE i• ,
(Th s section need not be completed if the permit is for one hundred dollars -
nI W)or Icss.) `
. .
1 cemfy,that in the pert mmenec of the w«k fur wh ch tti'-pe t is issued,1
shall not employ any person to any manner so as to become subject to in Work,,,- .-.
Compensation Laws of California.Date'
.Applicant
NOTICE TOpPPLICANPIf ft akingtn Crif an of Ex prix you should
Z become subject to the W k C satprovisions of the Labor Code.you must
fonbw ir comply with ch provisions or this refund shall be deemed rc ked.
n .. _ . .._._ _ .. .. ....... .. . . 1
E„, ^ CONSTRUCTION LENDING AGENCY
a � 1 hereby affirm mm there is a construction lending agency for the Performance ,
�.A Lathe wad far which this permit is issued(Sec.309],Civ.C)
Lender's Name_.. _ . .. .
�.Z Lender's Address ...- _ . ..._ .. . .. ._ ._. ..
U 0 I cenify that 1 have read this application and state that the above information is
ebnect.1 agree to comply with all city and county ordinances and state laws relating
QU to building conewction.and hereby authorize representatives of Ws citymemer uponagainst said Q�
W the above-memi.ned propeny far inspection purpuse,
tiP.' (We)agrtcrosave.indemnify and keep harmless rhe Ciry of Cuperiino against V
W liabilities,judgments,costs and expenses which may in any way acerae `
U Z City in consequence of the granting of this le (nit:APPLICnn
SOURCANT UNDERSTANDS AND WILL COMPLY WITH ALL'NON-POINT' Issued by: Il Date
c. Iiji; rrornppl�ranocnntmemr . : Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
c "Will the applicant or future building Occupant store m handle hoz nadmi mcour Type of.Roof ,.
as refined by On Cupertino M pal Cod Coapt 9.12,and the Health d 5 fety -
Cod Section 25532101
❑Yes ❑n
- All roofs shall.be inspected prior to any roofing material being installed, _
Will n applica t f t building« p t uequip tL d 'cesunm If a roof Is installed without first obtaining an inspection, I'agree.to remove
remit harmarchous air contaminantsas defined by theBay Area A Quality Managem nt
DistriOyc�ct? all new materials for inspection. Applicant understands_ and will Somply with
all nfin-pointsou[ce regulations,
�a r I have read the hazardous n kits s`52anconce s under Chapter 6.95 of Ne
if the buil building
dolth&of curety ently Sections 25505.25533 and 25530.1 understand that
if the building d«a not currently haves tenant:Nat it is my responsibility to notify the
fupant of the requirements which must be met prior to issuance of a Certifies,of
Occupancy:
. . . .. _. _. Signature of Applicant Dale
ownamaam.naed erg-m' Dam All roof coverings to be Class "B"or better
f .. .. _ . OFFICE .. -