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01060052 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 1173 CRESTLINE DR HOT WATER INC 01060052 OWNER'S NAME: APPLICATION SUB DATE NAST WILLIAM E TRUSTEE & ET AL 2531 GRACELAND AVE 06/08/2001 PHONE: SANITARY NO. CONTROL NO, I\ 650) 298-8494 O OZ ARCHITECT/ENGINEER: BUILDING PERMIT INFO m BLDG ELECT PLUMB MECH fs a i LJ f-1 f-1 L-..I ,�- ,`r„3''• 4.ICENSED CONTRACTOR'S DECLARATION o q 1 hereby affirm that 1 am licensed under,ovskibns of Chapter9(commencing ! Job Description 2.=W with Senion]000)of Division 3 of the Business and Processions Code,and my license! 7 in full force and effect. �o � ucense.Clnsa uc.a Z REPLACE WATER HEATER. a'�3 a u Data Contractor ARCHITECT'S DECLARATION �=O I understand any plans shall be used as publle records p O Licensed Professional { Htis, OWNER-BUILDER DECLARATION in I hereby affirm that I am exempt form the Contractor's License Law for Ihel C?r, following xcation.(Section]0J 1.5,Business end Professions Code:Any city or county:p which requires a permit to conzwn,alter,improve,demolish,or repair any structure d>m prior to itsissuance. L q utheaDPl cam for such nernin to 51c a signed sts'emem. nt,t nq ea Et nttt ma gro sof meCd taro". I yUhr" Sc -I G Cloot Area, p (co gwith sen ]e(gdrD' i.diJonneBaslne naa�,r°asnnaed) !.1;: YJ.Is.��� k t, a'1;.:�'i'f' $5'O�.uLLlon or that he is exam i the¢rtom and Ne bans for the elle jaebxem tion.An D g p" yviPlaion of not Section7031.5road five any undocddollarrui orapcmdt subjects the Applicant acivil pcnvhy Occupancy Type iofnotmnrem.,nE°ehnndreaeonars(a5oo1. 36NIYD!�U '''� i .' P Y ' ❑I,as owner of Ne property,or my employeds with wages as their sole compensation, Business a work;and The simple.The C not intended cra Li en a Law foes no (Setapply tons, 502 - FINAL PL"1sM[iff`*Ags rxvn�iY owner of and Professions Cole:The Contmcmro License Law s such not apply m an - - m through of property Who builds or improves at such improvements and who such wink n i ed or - .or dgdugh nis.wit employees. Wildin Nat such andemisofare not imcnN:J or -'- -,_--_ 5.0.6- -._-GAS.._TES.T_-._.. ..-----_.�___ iifierea m�sale.v;boweyec me wdemg or imvmyement is sola whni�ono rear or completion,me owner-builder will have the burden of proving that he did not build or 507 - FINAL PLUMBING improve for Purpose of sale.), Ed I as in f the progeny xcliness con.sing with]idea seee tractors to , constrain the project(S ]044 Business ad er f. ns Cod )The Commoner's Li La ane f pply t r f property to builds improves s tht the ..and h cit t ns for h p 1 aa.wim a c t t H) <en ed.p am to the. Contractors LicensLaw. - - ❑lani pt nd}5 ., ° B&PCT this remora ✓.I' )� Owner Data r ^ / - - WORKER'S COMPENSATION DECLARATION Thereby uffirm underpenalty ofp rju6 one ofth following dcl tart • ❑ I bave mad wtll maintain a Cedureaie of Conant m ulf-insure for Worker's' D/ Compensation, as provided for by Section 37W of the Labor Code, for the; - performance of the work Tor which this permit is issued; 13 have and will maintain Workers Compensation Insurance,as required by Station boo of the labor code,for the performanee of the work far which this permit is ` iss d MyW"kers C pe at Incur c c rt nd Palt y e tuber are: " v..... Camel S" rt (.i' :d.tL _ -.,«. - _.... _.._................ ...._.._..__...- PEMPTH t 'gl I? }.,..y.•i'.P.. IT��'l ki..S 1.el �I.i,* CERTIFICATION OF E%EMP TION FROM.WORKERS'S-' + ) „: ,a .:. .,,.,-COMP,ENSAnON,INSURANCE ohis seeiion need not be complei d if the permit is for duce hundred deltarx i { s 1. (Simea ass.) , - - ' I intent That in the p f ctance'nf thework for lack thist s'ss ed I - p 'shall not employ any person 7n any mnnner sd vs td become sublcn to Ne Workers' Compensation Taws of California.Dam" I NOTICETOAPPLICANT:Il;obertankingthis simimsof ofexemption,youshould s.. .. QZ tihhwilnuidna,rethe Workers Compenzaiiis provisionsof the Ichor Code,you most O forth Ih c reply with such p s or This permit shall be mandiand resavad. Fr ZI S; ti s ,''CONSTRUCTION LENDING AGENCY I hereby SRrm th u there is a consuv t on lending age cy Smite pezfotmatee 1 o_. ti s aQ ' ork fo which This permit issued JCC1 Lenders Nainc. Lea a Addre I c n ry that I have read di agpli t o and state that the above information is far-t: cormal.1 agree to amallywith Itchy ane county ordinances and state laws relating to baudding conshoiction,add hereby numdrm cpresenmhycs ofth: 'tyttenter upon 'r.0. the abc t n d.P ve tid f„ pea P W. ;. F.. 6i (W) gree to sa dem ipe and ke p harmlessmay in the City sterna peri o ag Inst V V. liabilities,sjudgments,o a ran expenses armhich may any y against said. yueme RST grant 0g d1 th permit t _ 1. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALLNON-POM'' SOURCE REGULATIONS. Issued by: Date ,•�a.: ., 71 Signature -OfAPplicant/Cmumo I . '> , - ": Dare Re-roofs -,, HAZARDOUS MATERIALS DISCLOSURE ' w lim applicant or fumm u" t bat Idm-g ocP no-se+S:r.handle 6�r6mna rommud _- TrYiTPe i qf Roof f defb d byh SeuChapter , SafetyCoe s32 �Y` °N ---._• ----. -.. __ ._.._. .._ .._ ._. All roofs shall-be.mspected prior to any roofing.material.being installed.._ emu Will the applicant or future building occuparame equipment or devices which If a roof is installed without first obtaining an ins ection;Fa ree[ol remove u hazard agement g P g Dstrtct . . , t tle0ncdb the Ba Area It Management all new materials for ins ection. A licant understands_and will comply with s Y Y Quality � � all non-point source regulations:, I have read the ham d us materials requirements under Chapter 6.95 of the Califo..in Health&Safety Code.Section,25505:25533 and 25534,1 understand thou ..if life b IJ' does not orrentiv have a tenant.That it isthe gy m po sb'l ly to notify f ,t Occi a c yuirtm t hmh masa M met uo rsx antt of a Certificate of am of the m' x p for ' Signature,of Applicant _C)•t[e 3wher PI xohnuxedagain Dam',.., All roof coverings to be Class `B•' o[better ..-..OFFICE.'.