02070136 CITY OF CUPERTINO • -
BUILDING DIVISION PC,RMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO
22428 CUPERTINO RD HOT WATER INC 02070136
OwWdb ET CRAIG 2531 GRACELAND AVE APPLICATIV17 2T/2002
IONS:
(650) 298-8494 SANITARY NO. CONTROL NO.
O O ARCHITEC(ENGINEER: BUILDING PERMIT INFO
rc U BLDG ELECT PLUMB MECH
s« u
;Sm 2 LICENSED CO,NTRACfOR'S DECLARATION
IS Iherebyafirm,halamlicenaedind......i,smsofChapter9(commencing REPLACE WATER T ptlon
pmt-tOy xith 5cmion]I]OOI of Division lof the Business end Professions Cd and my license
x is in fall lane
A, se 3
a Linn ` Lic.a
O a O Dae Conwcmr
0, _WAft TECT'S DECLARA0
I understand my plans shall be used as public records
s p O Licensed ProteW.a.)
a e OWNER-BUILDER DECLARATION LLI hereby affirm that 1 am exempt from the Contractor's License Law for the
!'a< following reamn.(Section 70.1 L5,Business and Professions Code:Any city or county $500
As F cewhich requires a permit to contract,aper,improve,demolish,or repair any structure
ca -prim to is quire th
lssuanee.also require applicant m file or such permit le a signed statement
that h<iilimhsedpuisuanito iluptbsisiomofS eCmn tori Licens Uw(Chager9 `
` ..
or that be ing s exit t theion9000)n the Division the
Business aMi.d.Anyvi Code) 1/, t .,!i, I q:;,,, .(,\�i1'1 �, Valuation
of that be is 31.5 bi tany applicant
and the bass for the alleged exemption.Any violation '
'of moSection
more
]031.3 iv any applicant fora permit subjects the applicant m n civil Penalty
,or na male titan five nadrca dollars($soo). 5 O.$PA�N ecupancy Type
❑Las owrmr of@e property.ur my employms with wages as their sole compensaiun, 506 — GAS TEST
will'dd the work:'and the.amcureis-not intended or'offered'for sale'(Sec-7000:' _
'Business and Professions Code:The Contncmr's Licence Law docs not apply to an actions '
owner of proper Who builds at improves thereon,and who docs such work himself
or Shmuggh his own employees,provided that such impro,ement,are not intended or
offered or sal 1l.however.the building
ge p f proving
cold within one build of - -
th a of
will have he burden f
Completion. w proving that he did not build or
improve for purpose of sale.).
Prtrye Y Y ions Code:)
The ctrecmrsm .,�.,,. .
_ .as owocro the n am exclusively comrxSin _ ;,.i ft,
construe the does
n (Sm.90oan Business and Professions ilde:l Thc Contractor's " '' '
License Law docs noirapplysuch
toanowner with
proper who builds A improves themon,due -
`-
-and,who.contrimrsucc s.for such pmlect,..witM1 a-conuanorts).licensd pursuant to the
.. :..2 01 Am .A Limnse law. ---
o I am exempt under She.. . B&PC for thus.."go .�.® ,. .
Ovine Dam
WORKERS COMPENSATION DECLARATION ItIS„ •j �QOrs
(hereby Rrm and penalty f perjury,one of.She following dlamtions:' L
d�' I h.vA and will maintain A Cenilicate of Consent to self-insure for Worker's
•. Compcnsnlon. vs-provided for by Section 3]00 of the-Lebor CIA, for the BUILDING
performance of the work fa which Nis permit is Issued.
Ave aM will on-'-in Woekers Compeniationlnsumnce,as required by Seetian
3700 of the Cnbm Code,foe the performance of the work for which this permit is
s ed My W kern Compensation Insurance terrier And
,Policy bar art
Curs \ «�_
to Nak7,Y�j�y
"{t CERTIFlCA IONOFEXEMPI'ION FRORKERS - pl .,,S. st.'r. vl;
:- COMPENSATION INSURANCE `:•.�. ._,._. ........
. .._._...._-
-
ISI00)(Iessua bn died not be complmeE if the permit is for ane hundred dollars �' 'f - i i(-;-S f J '-_I•: -�-� -
• "'I Certify that in the rerft o f the work f which'his 1'.t..-issued.) "'" """"""""""' "-' --' -
,hall"n t employ any personn any manner o as to become subject to the Wurkcn -
Compensation Laws or California.Date
Applicant. _ >. .:: . .
NGTICETOAPPLICANTIf itermakngthsCsficae bort nyoushould -;,�v '
became -subjectWolk is Compe anon pro .ons the
Lof the Lebo Code, u must
Z 0 fonhw th< plj- 'the with such praymons or this Permit shall be deemed ked.
CONSTRIICGON LENDING AGENCY' •- r
a of ' I hereby affirm this Share rats issuer s lending agency for the performance „
W Ik der s NaLhi Work me which this pe t 'sued(Sec 3097Cm C.)' '"
�,-Z landcrs Address s _ -
C.J.,0 .,1 certify that I have rear this application and nam that the above information is -'
face!E.t correct.1 Agree to comply with all.city and county,ordinances and state laws relating
(� to building connraction.and hereby'nutboriae represenmdveA of this city to enter upon
�.:w Ore above-immioned proper for mspemion purposes._
t'CIL. (We)agree to vve,mdemnify and keep harmlass the Ciiy of Cupertino against
'rnliabilities,judgment,,costs and expenses which may,in any way accrue against said
V.z City in consequence of the granting of this mmull.`, -
APPLICANT..
SOURCE REcULsinorbs! AND FILL COMPLY WITH ALI:NI]N'POA'T I //�
Issued by: JDateHAZARDOUSMATERIALSDISCLOSURERB'IOOf$
WllNe app)l nt or Mute bu lding occupant none o had) ha"At-Onetuial Type of Roofas defined by th C polo.M ipal Cde.Cla 9 12 nd the H hh end Safetyt. ,
Cde:Sect o 25532(an- , ' '• - •r '
:OY 1Fr No .. t \ fa •' a Ic 3 i (1.'�.) , .. )•. • ' .. 1
/� All roofs shall be mspected.pnor.to any roofing.material being installed.,.._
SN;Will
OYe No occupy t use equipment c Which t -
w II mapplicant
ppl co t a mm beim dg If a roof is installed without first obtaining an"Ins ecnon` I agree tdremove
Management g E1
y r Quality Manag all_new materials for inspection Applicant understands and will comply with
aau sur coapt A, ab efi db the.t ArtaAr
Califo I h Healthd he
ety ar seaiana,i r o f i all non-point source regulations_, I : - `
g
1 have bead thin hazard s mamnals iequ Ansi under Ch prey h 95 of Ne
503 25533 and 25530 I u dersmnd that
fthe building dnacurrentlyhveatenantthatt is my responibl iy to mCify Ne
Oc ufxlnt of me raq itement,Which must Bemet p to issuance of Cert ficate of ✓NA 6 yGf"Z3•� v'-✓ - �� yi -
y -
1z. Signature of Applicant - -- - - --- -__ . . Date _
° Cr or authounueda2 a^t ;. Date `� All roof coverings to be Class "B"or'better
„
..OFFICE ---