02050127 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BDIII19'! gr"nLBERTSON DR WATER HEATERS ONLY PERMIT NO. 02050127
O'1''T SEIANYSKY 970 E . MAIN ST, SUITE 200f6`S71157n'62
PHONE: (415) 566-2209 SANITARY NO. CONTROL NO.
C C ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
C_J L_I
�Qu
S v i LICENSED CONTRACTOR DECLARATION
;i_u Ihereby afirmthat Iamlicensed under provisions ofChapter 9(commencing REPLACE WATER Hl gtffiplion
m F- - with Section 7000) f Division 3 of the Business and PrecisionsCde.rnd my license
a y_ ie in full 7-7
n a nn— q' ,LeYe 7qs7 (4 0 GALLON GAS)
z u¢ Li<cns¢C
LL G N Doc JJ Contmc a'
ARCHIT1,Cf'S DECLARA ION
v I vnJermntl in,plans shall be used or public met
I d C O Licensed Professional •-
c i OWNER-BUILDER DECLARATION
='so I hirer,affnn thus I am<xempt from the Contractors License Law for the
t?¢ following mama(Section 7031.5.Business and Professions Code:Any city or county
E x o which requires a permit to construct.alter,improve,demolish,or repair any sructum
n3= Pnm 't a l.on th ,Meant barmen scrat fl a , d statement ..... .............. ...._._ _ _
dral he I is ftudp n mine nsnlhe 3ofthe manes a W onsChapter 9
Coda) S F[.,FIOOrArea..,•, j Valuation
(commencing, 'e4mtn 'rom) rD' on3onneBmne. pdPor code) �'r;t',f'ra 9' _.
u that he¢exempt thertfrom and the hams for 0th alleg W exemption.Any violation '3 7'5 3 40 2 4•; (] "
-of Section 703 L5 by any applicant for a Permit subjects me applicant a civilprnalry
of no,mare man mAPN Number e hundred dollars S%B. " Occupancy Type
❑Lasowner ofeewk, or my employees with wages a,m<ir<mecompensation. 502 - FINAL PLUMBI ENERGY
will do'the'work.and the structure is not intended or alliance!for sale(Sec.7614. _ GAS
'Business and Professions Corl The Contrnnm',License law docs not apply to an {�p,SpeCIIODS
owner of property who builds or improve,thereon,and who does such work himself 507 — FINAL P 1 Nli
or enough his own employees,provided that suchmpr improvements me not intended or
offend for sa)e.IG howbvcr,the nuildinof-
canopied".
g or improvement is sold within one year
ove for the ase ofb ale.).will have the burden of proving the he did not build or
mprove Rn purpose arxma).
. _ en.
O L az owner of ec Ompe.7 am Business a convening with licensede Contrors to
constrLicense
et the project(Sec.70YL Business and Property
%nob Code:)The improves
the
on's
License Low does not apply to an owner of propmy was builds or sepursuant
tM1ereon, �p
and who contracts for.such.projam with.n commnor(s)licensed porsuam to.mc ...... �
• �i Convacmfs License law. -
❑l amexempt under s«.' ;B a r e for his recon . '.. ..
Owner " Data JUL 1 9 2002
WORKER'S COMPENSATION DECLARATION
I hereby aRrm trader penalty of perjuryon<of the following declarations'
� ❑ 1 have'andwill maintain a Certificate of-Consent,d self-um. for Worker's BUILDING
a, Compensation, as provided fur by Section 37W of the labor Code, for the
performance of the work for which this Permit is issued..
1
havotiol w ill trustm Worker's Compensation Insurance.as riaq 'red by Section
/3700 of the Labor Code for fe performance,of the rk far which this .I,is
issued.My Wor s Compensation Insurance carrier and Policy mi are
..-...... .__..
fes. ,C ._... :c.: .-_ .._.�.
Curr ,.. PoliyN / Y6'Z'4J '� � , .. ,1 1 .. .. ..
.'CERTIFICATION OF W.O'-R•"KE'RS
COMPENSATION INSURANCE
'(Th'v union nccJ not be atmplemJ'f the permit is for one hundred dollars
(S I W)or less.)
Ic nflr tht in
e"min mth workf' which t ' - -
Pe .said I
shall t mpl Y Y pe Y td bcmme hject m he Workers''I-
` Cnmpcns5iton Laws of California Daten�
Applicant
O
NOTICE TOAPPLICANT Ir fl Certificate of Exemptionyou should
Zbecome subject tothe
Workers Compensation pof the Labor Code,you..at
forthwith comply wnhocM1
-
pmv s n to or this permit mull be deemed revoked
20NtSe�UCT10N LENDWG AGENCY --- -'"' "-
a- Iherebywork
which that erre is a construction lending agency for the certomlance
of the work far which this tis issued Sec.309],Civ.C.
QLamle,*,eaName ,_..-.... - .-
= Z orme Addressr.
V C I- rrry m t l n e a n rpren( a f t mann b ' ire rants -.
0 U toren I g to comply he b ry d county ordinances c d state laws luting
W Lorabid g entioneton.andforinsuebnxrepreumnuves of eis<ty to enter upon bill
.W ec above-mentioned pmceonemin inspection and on putposcs.
F..0. es(We)agree
t.ave, and a pica n,keep M1amless the CityofCuceriitio against
h liabilities,judgments,nmx and expenxs which may in any way income against said
V Z
City in consequence of th<gmnun o 'finis.
. '� APPLICANT UNDERSI'A'pD$/f$ WILT COMPL' 'I215
ALLO
SOURCE REGULATIONg'./S : -I"'' O Issued by: ! bate
oporo a of APpllcenUCmrjowor t "' ' "HAZARDOUS ATERIALS DISCLO7Re-rOOfS
till epplican, f ture b Id g o< pa t aterialT e of Roof...as defined bye C pen M ipal Cod Chaps 912 Safely
Type -
CastSection 15532(e), ..Vi
0 Yaxq '. 1 t i
All_roofs.shall be.mspected prior.to any roofing material being installed.
Fit]thea Icam ft bu nolodesire,
pP g P ay Area i <t MManagement
If a roof is installed without first obtaining an'inspection, I agree to remove
emit haurdous air contaminants as defined by th Bay Arca A Quality Management g
Di'°"'" _ all new materials for inspection. Applicant understands and will comply with
n oY all non-point source regulations:,,,
1 h ve used the h Mme mrials 50 mems d 25 Ch Pte 695 of the
California
Wilding
do& curfety Code Seem 25505 t it
and 25534 1 understand that
inhe ba la gab not caremlyhave amnat mt�, yreapo 'nrrornodry ane
m
cup t an gyy<mentz w G n bet t rssua 1 e Ce feat of
Occup cY. y/ .
/( 5Signature_of_Applicant Date_ _
owner onaatnareeaageni .Data All roof coverings to be Class "B" or better
„•, _. ..,�.•. ._._ .. .. •. — OFFICE