01010083 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BUILDING ADDRESS: _ PERMIT NO, -
22034. CLEARWOOD CT JUST WATER- HEATERE INC 0101.0083
.OWNER'S NAME: .' - - APPLICATION SUB DATE, , or
IEL CASTE`LLANO 1764 NATIONAL AV 01/19/2001
. PHONE:, ,. _ .. SANITARY NO CONIRCUNO.
(510)293-9901
C-Z ARCHIL F,CUENGINFER:,
_ - BUILDING PERMII'INFO
P O O j ' BLDG ELECT, 'PLUMB ' ' MECH
Z
Z ' LICENSED CONTRACTORS DECLARATION _ Job Description : "t
hereby arirrm In I 1' d d p f CM1 pt 9( to ng
w a Secfan7000hat D Lion3ofthe Bu Po
ad 'fess sCode,under,Incense.
is in f11three and effect '•{,'
o .Liv elan. Lie» REPLACE. 40 GALLON GAS WATER HEATER
3 a N Dane +' Commrnr
ARCHITECT'S DECLARATION
1 understand my plans shall he used as publie hero s-
g p O Licensed Prefessiunal
OWNER BUILDER DECLARATION
a7
flareach,affhat IM1 I I tornescrord 1 tire Contractors License Law f Ih _
C C
fell.,in,reason.(Section,70315 Business andP r. .Code:Any ry or county - L
Sd
awhich na,rudies a crar,tortanstrar,, r p derrod,K torhead,ally aluctione
prior to itsas. ancN. q ' s the applicantl hpc 'u II 'g d.ntsnal
mmhe 1 Handpursuant l thep - fm c t License L (Chapter 9 Sq. Ft. Floor Area { Valuation.
(a a n,wthStat on 7000) 1 ' )pistol i if the Busne IP f n,Cnlit
or thin he is contrast trenchant d da,k farticIIgJ eserr,tion.AY lation - - $1.215
of Secular 7031.5 by, Y applicant for a rotation subjects the appy H tit io a Civil lousily. -
11 t arae man rive n d 1 dollars($500) - APN Number Occupancy Type
❑I.as ownerofthe property,or Iny enploycas with wages as lladrsbleaumpcaiation,. ?=+ ? _ It
will tl thek,and dstricture is hot intended or(offered for sale(Sec 7044, _
Bus and P f so C d rhe Coal 1 1 d t apply,to - - Required Inspections
woe
property Who build,,haropowc,Deaver, ad who drives rho k hinsell
through himplr provided(hill h'_p on t intended no 502 ,— FINAL .PLUMBING ENERGY
offered for sale,IL he ever,'be larlding ptnm
vcvau's.od wlhin ens y ar of . . - .
...nplaior:Inc owaer-Hander will nave the burden of involving that lac did not bund ur - ' 506 — GAS TEST .. -
improvefor poMoseofsole.). ' - '
1:11,as awns of dte stn exalasivel 't stain.wliM1 Ilwnw nmeims to 507 F I NAL PLUMBING
Vrope Y y aan b
eonsan the p to,o(Sec,71,14,Business and Pml'essloni,Cudep The Conlmanrs
License Law docs not apply to ani.;wart of property who hands or improves therein., d
and who contracts for such''rejects with o at,total Pit licensed pursuant to the /
Contractor's License Law. '
❑I pt 1 s II&PCfar far,
Ow -
Data
WORKI R S COMPENSATION IIECLARAI ION .. tso
a `
I licall,,offiran anderpenalty to Perritry fah f 11 g l 'I t - Y -
'• C l Rioe ,,it will rearturn it
f C tf I 1 e I I If' r W k
Comp provided by Section 3700 of m h Cods.i far the .q `
pofforniourech.the well,fer which'tM1:fallen is soacil.
01h d '11nt W k sC '
p I 1 : q ' tlhY Set n
,,,. f y Labor,C f h p f a f ol k h this p Is
issua ' r -
' J My WnrkerrC u t pInsuranceLr anJ Pall to t y Cher re
Card';: Polcyo '
CERTIFICATION OF EXEMPTIONFROM WORKERS' -
COMPENSATIONINSIIRANCE
This wall i need;h,be a.se,detW ifthe permit is for,one hundred dollars ' 'r
(SlAb or less.) s
1 eenlfy that in the Territorial alfhe work far which this permit Is issued,I '
shall not employ tiny penunt in tiny lnunner so as to become a tthad to the Workers'.
Conprnsation Laws of California.Dam .
Applicant
NOTICE 10 APPLICANT.IL after naking this Cenifcvm of Exemption.you shored -
nceneresubjectmmeWook""Compensation IF roofOr Lan e.Code,rots must y _
fonhwith rurally with ouch pmvidena nr this pemail shall be deemed revoked.
H -CONSIRUCDONLLNDINGAGLNCY
> IherJry arlrn that there .t i lendingagencyf m
the,W of'[at walk far witch Ih.l 'ma is'ssued(Sac.3097,CieC)
(� Leader,None
UQ Lend :Addy:.
1"'InifythtI have easttti. pll' t d'ton that the 1 haturactiont is ,
W [r
correct,I ou'racor oasailly with ill city unit...arl,oducard,add I ie I -rohnia, j
V tubuldan, mtrucfor, ,]hereby andriinze areparewhouniv,00fthi,ety nodular Pon
• ly the abovementioned property for inspection purposes.
F.� pit (Way agree to save,indearnity' dkeep l I ss the City Of Cupertino against ,
F V]
lisdoiddis,Idg t. t. id ts,cuses which hory'he any Way av against said .
U
City in cranah,orreof the gunfng af,hi,hirrinit. t I . .
APPLICAM'UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT, ISSUedb
SOURCE REGULATIONS., r _ y: Date '
Signature of Appliarat/Cnmranor - .Dare Re-roofs '
.. -HAZARDOUS MATERIALS DISCLOSURE.
Will meappfrnnt or future hufding necupant ams nr haudlebocandens Inata'Im ; 'type of Roof
as harmed by the Cuponino Municipal Circle,Cal 9.12,and the Health read Sol ely r . -
Chile,Seaton 25532(a)R -
eve, .'.rj NJ. _ - '„ All roofs'shall be inspected prii any roofing material being installed.. `
Will the applicant orfuture building m
p� meegdp t ordovietc,wnch '.', If a roofis"installed without first obtaining an inspeciiom,l agree to remove
rdinah,hadon,oir,hnarriom. as dufnethy lie Bay Area Air Quality Managunud
. Dist r - all new materials for inspection. Applicant understands and will comply with f
Elyacs, El N., all non-point source regulations.
1 cava rend Ito ni.dho,motional,resp e tans under Chapter 595 of the
Cl Health&Safety Code,Sections 255115,25533 and 25534.1 understand that
iflhe building doer nal currently have a tenant,foul it is any responsibility to notify they -
occupard rf the tequ ranee s which...avl he toll prior to Ixmtmw al a Cani file it
Occupancy._ . . -
_ t Signature ofApplicant '-' .. • - Date
Cora nrltu�hndace agrn - Darr " Al] roof eoverings'[o be Class`B"or better
OFFICE