03010124 CITY OF CUPERTINO a=_
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:¢
/'tee e �`, . •,�„
BD I LDING ADDRESS: JUST WATER HEATERS INC PERMIT NO.
6566 CLIFFORD DR 03010124
OWNER'S NAME: 1764 NATIONAL AVE APPLICATION SUB DATE
ah CHEN WEI-LIN D ET AL 01/23/2003
IFLONE: (510) 293-9901 SANITARY NO. CONTROL NO.
ARCHIfEL7,ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
0 0 0 0
�00 LICENSED CONTRACTOR'S DECLARATION .IOt)DCSCIDescription
m Ys p 1 Mmby affirm that I am licensed under privations of Chapter 9(commencing I p
�� wire Section 7011y of Division Sof dm Busineu an Professions Cfde.and myliccligi,
mmnmmranderec'. REPPrAGE TER HEATER
Zpp_ License Clan Lica I- �y
c i t;, Dam Unntranm ' — (46' GALLiON' DO-1
EC6 ARCIIIT[CTS DEC ATIOI
C"a UU 1 understand my plans shall he used as pts 1 c records
Hw
rLLO Licensed Profuswidel
OWNER-BUILDER DECLA
eqd ser 00 1 hereby affirm that 1 1. exempt from Ne Cssions rs e:Any
Law for the
w_20 followwhiching Rqui.reason.Section t 703 1.5, r.altar,
s andmpr Professionsh,or Any city oreuard,
d $ which,its sires n permit m,also re nmswn.aloe improve,demolish Permit i file
e pair any urr and
=�0 pdonnitscense pursuant
ursuarc in theres the
evisio cam for such Panni,Ncse signedsurround
Nmhe rmcmdgwit pursuannothe previsions(if the Cumranssnd ProlawsCode)9 Sq.Ft.Floor Area Valuation
oar (c01 he
xemptb Sermons ad of basis for
of the Business and fAnyvi Code)of 61174
a. that he is exempt @crefrum and the buffs for IM alleged exemption.Any violation of Y
Section 7031.5 by Any applicent for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more dun Eve hundred dollars($501). 36924035 . 00
❑I,urwner oflM progeny,or my employees with waguu these cote compeuadon,
will do the work.and the stmctum is not Intended oreffered fnfbale(Sec.]0114,Business gg,�� ll�� �g
and Profusion'Code:The commander License law does not apply to an owner of 502 - FINAL )?L 1 N�e 1: RGY
property who builds or improves thereon,and who does such work himself or through his
own employers,provided that such improvements are not intended or offered for sale.If. 506 — GAS TEST
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving Nat he did not build or improve for purpose of 507 - FINAL PLUMBING
sale J.
1,as owner of the property,am exclusively contracting with licensed conmemm m
construct the project(Sec.7134,1,Busineu and Prufeuiuu Code:)The Contractor's Li-
cense law does not apply to an owner of Property who builds or improve themon,and
who contracts for such projects with a con ucmas)licensed mutant 10 the Contractors
License Law.
❑ 1 am exempt under Sec. B&P C for this reason
Owner DeO
Wm under WORKERSCOMPENSATIONDECLARATION
1 hembY Affirm under penalty of perjury one of the following daluniom: 111
I have and will maintain a Cenificam of Conant to self imum for Worker'sCompen-
su ion,as provided for by Section 3700 of the L&M,Code,fm the performance of Ne
work for which this permit is issued.
1 have and will m rutin Workers Compensation Insurance,as required by Section
3701 Of Ne Labor Code,for Ne perfmmance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number am:
Cartier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not becomplemd if the Permit is minor hundred dollars($1 00)
or Icm.)
I certify that in the performance of the work for which this permit is issued,l shall not
employ any parsnn in any manner m as to become subject to the Workers Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of she Labor Code,you must
OO fn lhwith comply with such provisions or this permit shall N formed mvnkcd,
CONSTRUCTION LENDING AGENCY
[—i ONO Ifor by which firm
Nm there isoro (See. 0x)7.Cin.agency for the performance of
Newark far which Nis Permit is issued(See.Jly)].Civ.CJ �-
Q Lenticr'a Name /Y
� z Zanders Address / 'n•/
U I certify that 1 have read this application and sum that the above information is
E✓ correct.l agree to comply with all city and county ordinances and sum laws relating to
0 building construction,and hereby mahonne repmsenutives of this city to enter upon the
W shove-mentioned properly for inspection purposes.
(We)agree to ore,indemnify and keep harmless the City of Caperton against
r V) liabilities,judgments.costs and expenses which may in any way acerur against mid City
in
of the granting of
his
U y
APPLICANT OUNDERSTANDS tAND Permit.
COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicaDam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the a Ciicam rr future Muni building te.Chapter
store9.1 Or handle h eaNnus material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Ilcehh and Safely
1n,
ode,Section 25532(a)'! All roofs shall be inspected prior to any roofing material being installed.
❑Yes ❑No
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
I
mOotedous air condominiums u defined by the Bay Arca Air Quality Martimeam all new materials for inspection.
District!❑Yes ON.
I have read the W ardous mamrialsmildremcnts tinder Chapter fi 95 of tic Califor-
ia I malth&Safety Code,Sections25505,25533 and 25534.1 undersund thatifthe building
oes not currently have a mason,that it is my resp risibility m notify(be Occupant of the
requirements which must N met prior 10 Assurance of s Cendieme Of 0.cupancy.
. Signature Of Applicant Dale
Owner or tothodvad sgom Date All roof coverings to be Class "B"or better