02030151 CITYBUILDING DPviaiorvNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
11445 CHARSAN LA JUST WATER HEATERS INC 02030151
OWNER'S NAME: APPLICATION SUB DATE
,dhBONNIE HIRSCH 1764 NATIONAL AVE 03/26/2002
ONE: - (510) 293-9901 SANITARY NO. CONTROL NO.
to O_O ARCHITECf/ENGINHER: BUILDING PERMIT INFO
a U G BLDG ELECT PLUMB MECH
Gad r� u 1- u u
5„Z LICENSED CONTRACTOR'S DECLARATION
i a—O . 1 hereby of that 1 am licensed under pmvisions of Chapter 9(commencing Job Description
„F� with Section 7")of Division 3 ofthe Business and Professions Coda and my license REPLACE WATER HEATER.
ys is m nn tone and effect. (7 5 GALLON GAS)
a a a License Class Lic.a
O a U Data Coact
ntror
1 :a.G ARCHITECT'S DECLARATION
:d.0, I understand my plans shall b,used as public records
N
+a.0 Professional
Profcssio,
OWNER-BUILDER DECLARATION
¢i 1 hereby amrm thin 1 1 stent son be Cosions C'a License law conte
Z a following mason(Semon Clurs M ifln=asmpr Professions h,or Any city or county -
I S o which requires a permit ro conAme6 vheq improve,demolish,or repair any swmurt
2 ...prior,oiuissuance,alw,equirtsthe vpplicant for such pumiuofileasigned smrnmcnt - _ _ -_-___ _-_ -
thathc,islicensedpoomantto the provisions of the Contractors License Law(Chapter 9 S FP. FloorArea:,..
(commencing wiHSection 7")of Division 3 of,he Business and Professions Code) <,Fw•'� '' q' ,k. i )�:'r- Valuation
..._...- .. . .
or that he is exempt tM1erefmm and the basis for the alleged exein ,iori.An "s r(. ss. d ;,)"• )... - -,LY•_•%,.. I.r.
0 g p y violation
-of Smion]031:5 by any applicant for a pcmdr subjttB the applicant to n rnil penalty-
16?1C)Q4c) in
, of nor mart than five hundred dollars IS5D0). APN Number Occupancy Type
❑I,oex
eorofNepropeny,°r my employees%rh wages as their sole compensation, _
will'do do,work.and the mmmute is not intended orofferedfor sale(Sec:7014,
Business and Professions Cod=:The Conundrum's License Law docs not apply to an 506 - GAS TESlrequired Inspections'''
owner of property Who builds or improves thereon,and who docs such work himself
or through his own employs.provides mat such imnam,is sold w i not intended of 507 - FINAL PLUMBING _
' oRemd f however.the bu Iding o p t' Id il' (. ....._ _....... ........_ ...._...._ _._ .-... . ._ .__ .._..__. .-_ _ __ -_. ..
'com Ieuon,the owner budder will have He buNcn of yea o ^ , s
° for 'sale.). Prosin6 That he did not build or
improve puryoseo
PropeY Y contracting with licensed contractors - ..._-_-___. .._ .__._._ -......._.. . ._..___........_;._...
I.as owner of the n,am cadusivel co Praain
License
et the project(sec. to a,Business dna Professions Cade)The Contractor's
oared, .'. . . . :
License law does not apply man owner of..1mny who builds se planum Hereon,
and: h r cu for.such p jccts.wiH u comracmr(s)tattooed pursuant 1.the. .... . .....��(a yA _
_ G" Y� .. _. ..-._. .. ... ___
Cont t License la tlr'�q"
❑I em - pt unser See ,B&P C for this reason , . Lai
Dwiar Dare .. MAY 2 1 2002
WORKER'S COMPENSATION DECLARATION
1 hereby oihrm under sm.1ty i f perjury one of the following declarations: p
❑ 1 have can will maintain a Cenifcote of Consent t6 self-insure for Worker's u�LD�PI
Compewation, as provided for by Section 37W of the Labor Cade, for the BUILDING
performance of the work for which this permit is issued.
❑I have arid x ill mainmid Wdrka's Compensation Insurance,is seGuirtd by Section
3700 6f the Labor Code,for the penmm urat f the-work for which this permit is
issued.My Worker's Compensation insurance earlier and Policy number me
I 1' ,.''PolicyN . yy tt .. ------
Came
. i _ ;!:.. i.
CERTIFICATION OF EXEMPTION FROM,WORKERS "
.... ... COMPENSATION INSURANCE"^•_ - '"
'
it (Thn o need on:be complete),f rM1e perms is for one hundred dollars
(81 W)or less) ��
lijill,
Ifytbi sea ren frh' kf- M1r ssucd 1 - - .. - .•' - -•—.
n riPI Y Y Pers^er in Y nrrt as
to become
u b ar%to the Work , } ;;Y:
Com :r
Compen.ar°n Laws of Cabfam o.Dem
.Applicant f, -f _ ,y
NOTICE TGAPo the Worg If, fl Compardnig ison.
CsinsofthC< pt °u should -
become subject to He Workers Colons Or uon prvvniolo of the labor Cade,you must
Q O Forthwith campy with such provisions or His pcmtit shall be deemed revoked.
... ,_. . -. .. .. . -._,.... .__.... .. ..—..._. ....
Fri .... CONSTRUCTION LENDING AGENCY ,
a, I hereby offirm that there iss constructionlending agency for the performance
-,.., of LeHe workfwhich - .it is (S. 3057 Civ.C.) - - -
Q Land Na - . .:.•. t. .. ..... ... . ..
.7. z Lanka'sAdd s �
1 certify that 1 hallread the application and state Ihauh<above mformahon is f
ira'.F 1.building
agree to comply with all city and county ordinances and state laws aiming fs
�]L) to building consnucrion,add hereby dulhorim representatives ofthis city to enter upon
. W the above-memionea Property� for inspection purposes.
inindemnify 0.' (Wejeg,ec to se, and keep hamttessthe City of Cupertino as"'.lost /
'fn liabilities,judgmcnu,costs and expenses which may in any way accrue um a said
C.) ^ City in consequence of the Stenting of did;permit. ' 11 "' !'
_ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALCNON-FOINr I
% SOURCE REGULATIONS.. Issued by: Date
Signature of AppbcamConrmeror .... . ,•....:•• -Date:: 3` Re-roofs
HAZARDOUS MATERIALS DISCLOSURE '
Codee mtbY the Cupertino
oor mMunicipala❑wNola Code,
e,Chaaptt tn9ar12'iwId ithe Health and iSmoef rym t TYpe.otf Roof....-,
C a'.D2553Y( ) ' >Ysa
- - -
ill
'hall
All roofs shall be inspected [o any roofing-material being.mstalled.
_Will the applicant a.m,ar future budding a'p'MyAme e.AirQnot Management
If a roof is installed without first obtaining an ins ection';I-agree-t6'remove
it_Will t mm t in defined Ey m B y n Air Quality ry M agemrm g p -
ixam' all new materials for inspection Applicant understands and will corn 1 with
❑Y al ❑N all non point source regulations
P.Y..
1 he a.He haaardous mat Cls req rcmena undc Chapter695 of the 1 t s
Califo a Hedth&Safety Code Secuom 25505 25533 and 25534 1 understand that
if the Wilding does not currently have a tenant that itai my responsibility tonotify rhe-
°crops ttb quircm t. which most be t p' n issuance f Can ficarc of
' Occup cY,,t
Signature.of Applicant Date _
-wu-1 upossocialagent sesta All roof coverings to be Class •`B"or better
3 n
OFFICE.'