01010018 µCITY OF CUPERTINO ' • +' ° °<."'"
uLutNc ntytstory PERMIT. CONTRACTOR INFORMATION:
m
BUILDING A DDRESS. ' - ! ' i. PERMI T'NO.
19147 COZETTE 'LANE JUST WATER HEATERS INC 01.010018
OWNER'S NAME: .. APPLICATION SUB DATE
CAROLNORZO' 1764 ' •NATI4/200
'ONAL AVE 01/01
PHONE: ' - - - - SANITARY NO. « 'CONTROL NO.
(51o)293-990.1
M m Z ARCHI GIC37ENGINEER: - ' BUILDING PERMIT INFO
,BLDG ELECT PLUMB 'MECH
LICENSED CONTRACTOR'S DECLARATION
Job
,,4 OZy nt y affirm m6t I ant hceasN nnanr ploldlonal ofChapter v omcng Deeiiptont r•.
- -
-
H9��
with Section 700o1dD' -. m3ol'the Businessland Plalmllons Codeond aryl arose
�Y full force eefr tREPLACE 50 GALLON +GAS WATER HEATER
a'�a ee se Class ` - L u
° 3 W y Dom - Contractor
_ ARCHILICI"S DI CI ARMION -
i eve 1understand. yplan,'hall M1c used a,p hl orris'
pLifernard Professional
S OWNER-BUILDER DECLARATION - M1,•
17i 1
heieby affirei that I am exempt 1 (lie C t t Licen,Law far the
C 6 fool g (Seellan 7031 5 Business and Pefle,am,CodCodo A y vit'rin county
.F�SFG
which requires a permit m :t t Iter,improve,demolish, L Y stracture • ,
'ata_ pran win9 ,th ppl tl hl)crinIt tl .'6 dmt eiI
mato I Iinternal m p Id C t l r L (Chapter 9 - Sq. Ft. Floor.Area Valuation'
ba n ' b with section 70010) fD'' 3 ft II .' 11 f:a:ns Code)
1 O
or that he - - pt therefrom and the -
ha I the allegedexemption.AY violation $13EO
.fSection 71315 by an,applicantfor tfe t. Mete the uP1I uuucr,d Noah, r
or t �rehim iven I-dl,uaoa(s5a). - APNNumber- r. Occupancy Type - -
_ o l�. tonne pn p 'tr ,v.�t6pi y v;n w s=da.m . I endpenaannn, - 37507N20. 00 '-
will do the k d the Wunmr,is not-amnided or ofiroad f (See.7044
Bu dProf—ions Code The Contractor's License Low draw not unityt 'a_ `r-, Required Inspections -
fp p my Whohard, p tu d o don k.h' If. . n'
ort ghhisownemploye,.x,coveredfelllen mpr ,e t, are nn menlediar S0'?_ — FINAL PLUMBING 'ENERGY ,
offered for sale.If,however,the hallhlny nr itnpnwemem is.old within one year of
Y, plf m wnnrbTa ilea.dmeburden nfp,.,i,,that hedid,attadddr 506 BAS ,TEST,. . ,
`ml s
r, eel -I ) 5017 —FINAL PLUMBING , . .
•❑1.as ovsnarof the property,an exelusively oautbacting with licensed contractors to r^
a,n,wct the ptulwl(Sec 70W4'Buei ter and Professon,Calc)The Commeror's' -
Llcense Law docs nm apply toanownerol'prt perry who builds or improves Ihamon," �.
and who can bels for such p jean with a courts, rLd licensed pununnI to the -
n Contractor's L Xeric I.uw. _
plan,eay:apt:mdarSw. -• ,Bffi P Clhr this reaxan
OwnerDate FINALED 4 W ,
ORKER'S COYIPF.NSATIDN DECLARATION •, ' _ ,
itheaA,y ff...rude,pereally ofp jY ,e rtnn f ll glee t • "• r t' JAN 0 2 2001
pen sad will Analmain aCorti l to orC tt .Ifof Walker*,
_
Cf pe 1 I by.S t ta f x the LanCada, far the BUILDING
pedffrom tai n, a, na,vtwh'
far eh this p n t a, add,
❑1 base mW will muinmin Worker's Compomavun Inxuruncc,ae rcyuimd M1y Stereo
3700 of the Labor Code"for the ped for,mr ce of the work I which this period is -
wd.-My Workers Compensation lrmvrnue carreraad Policy number are.
Carr t Policy No` ,•• w ' n
CERTIFICATION Of EXEMPTION FROM WORKERS' -
COMPENSATION INSURANCE
"(This section need not he completed if the foamil is for one hundred dallurs' -
fS 100)nr less.) -
•I certify that in the pedorea nee of the work far which This penrtit In issued.I
shall nal employ any person in any manner ,,m la become yobject to the Week... , --
-Compensation Lawsof California.Dlnc .a,
Applicant
NOTICE TO APPLICANT If after makin,,hi,C,nifl,ald WEs,armanni.yao:marld '
Z fort t nl tt theta k C Pratio.p Ieh Code y u. t
. QQ Q fonwn
nw th comply h h pr vii ons or this perms xhall be
d nod avokad. , - .{,•.� , `
F CONSTRUCTION LENDING AGENCY •d e
a ' I hereby affirm that the, construction lending agi e,f rlo e perfonflume
W of the
lw kf hi
for p it is Issued(Sac.3097 Civ.C)
Lend Name
z Londer',Addee,
1 everyttllread Li pplat -d state thatth b frtht'onis n - r
Ga
varem I agree m inndY with all city and yN
an ' ' a .l andled refining „t •' -
- to bidding construction,and herby arthri7e representatives offinis city to toleration - t
ty W the above mentioned rob,it,forne,wnp p • .
..F At 1 (W)agree t save,indemnity and keep oo le theCly inCupn against
rat tA liah rf :1 dg eall 'I'll'an I expe,ses ashith may in,nY way:aama aidin t said s t+
C). City ase trthesDSAtlicRarnit. e - s.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b Date
SOURCE REGULATIONS. at Y•
Signature of ApplicanVContrnmor y- Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the appucam or future budding eccapail store arnandle no aMans material Type of.Roof • _
,'.w ns deCoby the Cupertino Mmtici P:J Gide.Chapter 9.12,anA the Heahh anJ Safety
-
Code Seei on 95532(x)"
°vex. p No - .All roofs shall be inspected prior to any roofing material being installed.
-
Will[lie aplhca t or ruturic n 'la' s DiCalvell use nynp t e -canwhichna -,If a roof is installed without-first obtaining an.inspection,I agree to remove
emtl d - r onrninenn a,defred li,d Buy Am,Air Quality Manago •n +
st t all new materials for inspection. Applicant understands and will comply with
❑tris ;'_ ON. -all non-point source regulations.t
I have read he hidifmoti,notEnal, q ' t."and' Cdcov,C95 of the
61 r,mia Health&Samtj ,C r Saaiou 25505 um t
25533 and 5534.1 ,dersd that
it the building does not currentlyh a tereare,t that yep "b'llyt tfythe -
. .t occupant ofthren'r1 as which mustheprrm issuance ora Ceoate o
°aapan`y
• Signature of Applicant ., ` Date - ..
owneroganmarvwagent Date I All roof coverings to be Class "B"•or better
OFFICE is