01090014 CITY OF CUPERTINO
BUILDING DIVISIONPIERMEB CONTRACTOR'INFORMATION
BUILDING ADDRESS: PERMIT NO.
10127 COLBY AV JUST WATER HEATERS INC 01090014
OWNER'S NAME' - APPLICATION SUB DATE
SHANGSHENG TUNG 1764 NATIONAL AVE 09/05/2001
PHONE: (510) 293-9901 SANITARYNO. CONTROL NO.
'
y O z0 ARCHITECT/ENGINEER' BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i fu
H Z LICENSED CONTRACTOR'S DECLARATION Job Description
I hembyafermmat lam r�eenr<d under pro.;,cons or enaprer9(reformatting WATER HEATER.
HiQ with Section]000)of Division 3 of the Business and Professions Code,and my license
m i is in run foe and effect. (4 0 GALLON GAS)
rc
a a a License Class Lic.W -
O ou Date Contractor
ARCHITECT'S DECLARATION
V4 4 I understood my plans shall be used as public tecoods
dp Licensed Professional
co IOWNER-BUILDER DECLARATION
uxi'-�,, Thereby affirm tha Icon exempt form the Coatorron s License Law for the. _ -
F 'following mason.(Section 7031.5,Business and Professions Code:Any city or county -
Owhich requires a permit m emsewarn alter,improve,demolish,or repair any structure
pr t is rn al.q Teq es the applicant I...ch Permit t le a s fined smmmem - - - - - - -- - -
thatho<I =eapum tl mPr tmr,afinecnntmem',License-xv(Can 9 1 w Sq 'Ft'F1oorArea Valuation'
(commencing with Secton7")of Division 3 of the Busnesg and Professions Cal) '_(y- } yt.
m that he is exempt tberefrdni and the basis for the alleged exemption.Any violation 31 62pn4? nn
--of Sec ion 7031-.5 by any applicant for a permit subjects the applicant r a civil penalty 1
-nf na name men five hundred d.11.m 1s500). APN NumberOccupancy Type
❑1,as owner of the property,finny employees with wages us their sole compensation,
-will da the.. r k and the structure s not intended r off r d far I'(So,.'7(U4
'Business and Professions Code:The Cntract .
Lce,eL d m
t apply 506 — GAS TESrRequiredInspections - -
wmer rf property Who builds ,T impr w there,n and who does such work himself 5 0 7 — FINAL PLUMBING_ '
or through his own employees,provided that such improvements are not intended or t
,.or
red for sale If,however,the buildingn rovement is sold within one -- f' - - - -- -- -_- - - - - -the
p year i . .'.. ....
c
d prove Ca the owner-builder will have the burden rf proving that he did oat build or
imp f puryose ( I ).
°Ias ow,oe, (the P(S city < los son tract gwith l d t_-. ���AL�D ,
consumer n ct thedoes
n(5 ]IH4 Business and er Professions Code)Tb Contractor's ,
License Law does apply 1.v man owner of a nor t who builds orimproves
pim mi thereon,
. .i roil who comruns.forsuch.projects w m a comrennr(s),I licensed pursuan to the.;-._ _. .... .. ... _.... ....... .. .. . . ._..-_ ,_. .. .- ... ...._- .- ... _.. ... .. -
Cu t t .License L -- .... .•
❑I pt ntln5 s, A&PCfar miss reason SEP 1',212001"!''"I
f Owren DaraLl - _
WORKER'S COMPENSATION DECLARATION
Ihreby offirint under penalty of peryrya ofthe following declarations: BUILDING
p ° 1 have and aill maintain a Cmifieam of Consent m self-insure for Worker's
A. Compenselon;'as provided for by Section 37W of the Labor Code, for the
'performance of the work for which this permit is issued.
01 havaand will ma t W kers Co pe i'n lnsuran o`required by Section
3]00 oP the Eubrr'Cndq for the pafoomence of the work,for which this permit is
issued.My Worker's Compensation Insurance.carriernd Policynumber are:
CemerP<I yNo �.. ii. iF
t CERTIf�ICATION OF EXEMPTION FROM WORKERS ' -' - - - `I '+ 4-• "
,� fon s Benton need nu bePEomAletedN INSURANCE'_—
CO
lin p if the permit is for ossa hundred dnllary "' �`t` - "
(SI00)or less) -
1 pen t thePerformtt m
a f the work ' h th permit . issued,I
sh 11 peremploy m m any p any man io bacone aub)ed m the Wore kers
Cmimmurdior Law,s f California.Date '
Applicant
1NOTICE TOAPPLICANT If after mukmg cors Can nese fE prion,ynushnuld
be b) ttd it such
k' C'mpero t p tall be
Luh r d,yo must
Q O forth m ply,with <h p m o th pace-t shall be dee n d re,
ked.
c,''CONSTRUCTION LENDING AGENCY
a ' I M1 reby'mfArm that then'...ant ion lend ng mg cy f r the performance
0.`Q. of the kf which th pe, t',i.isued U a,,,3097Civ.C),.. •_,;,._. _ .: _. .. ,. _... .. ... .. _ ...... ... . . .. . . .. ._. . ...
�.Z Landar,Addoos .�.. . .
I certify that 1 have read this application and state that the above information is
0+ emore.'I agree m comply with all city and county,cournacw and cote laws relating'
0 f) to building consumption,and hereby immunize represematives of this cityto enter upon
>,.W the h e o ped Property form,ce,min P to s _
E.-Aum (W)ing.to a e mdemmfy and to pSain the 6yfCupertino against
h
liabilitiesdg encs c st and a pu n e 'inch mayinany y <ue against said
V .zi "C ty n q ce fiheg nfng fm pacer1. 1. M,/'A'1yeee S -
'APPLICANTUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT" Issued by: N bate
SOURCE REGULATIONS 'o
Signature PV�
fA canUCr ontracto , • ' e 'Date' Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will ihd appq=am orod Wilding occupant t or he1 h b-' material :Type of Roo£.
:. . „ .
as d °edY by the Cupertino Municipal Code Chapter
:9,2, d the Health and Safety code,-Section2ss3x) : I . .
T°"
t
ial,being.installed _All roofsshal] be,ins e ted.priorto.any.roofingmater
Will the applicantort re building occupantuseeq pet or devices Which; If a roof is installed without first obtaining an'inspecticn;I"agree;to remove
art hazard contaminants defined d by the Bay Area Air Quality M dgement
D ton .. '. _ all new materials for inspection Applicant understands and will comply,with. _
-
❑v ❑y 1'' allnon-point source regulations_,
` I have read'd, hrzdrdr.s iia n Is regv oemems nder,uChapter 695 f the'
Cal Tomia Health&Sandy Cde:Seniors 25505.25533 and 25534_6
On""
..
understandthat
ifthebtocsnt hbmaltis my responsibilitytothe
..
ly
overlain,oftheeq rem t,which must hetP o is (aCoifiLm r
ou
PaY ,.....i-gnature o Applicant
a
te
o rampreagent Date All roof coverings to be ClasssBsorb
etter
:.
..
OFFICE. .__ _ .. ,. ...... .. .-._ ... . . _._ .. ....
t