02050121 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
B181�41RECSYPRESS CT JUST WATER HEATERS INC PERMIT No. 02050121
° ,sdXtEM HABA 1764 NATIONAL AVE AP6
1frL17LUU2
PHONE: (510) 293-9901 SANITARY NO. CONTROL NO.
t
D z Z ARCHITEC rENGINEER: BUILDING PERMIT INFO
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z On� - BLDG ELECT PLUMB MF.CH
g< �.TW,Lµ,�I,�r r u u u
,ZZa LICENSED CONTRACTOR'S DECLARATION REPLACE WATER RCPW tlOn
Z,_o 1 tion 7 affirm @a 1 vat licensed under provisions nd rfs of Chapmr 9(commencing P
=t is in
nfectiomean)of Division JofrheBusiness andProfesxiontCode,andmylicenm (50 GALLON GAS)
in full force and cficn.
i z a License Class Lic.p
F.ic a o, Dale Contractor
LLO'n ARCHITECT'S DECLARATION
I undcrsmnt my plans shall be used az public records
i i O O Liexamed Professional
m e u .OWNER-BUILDER DECLARATION
I hereby affirm that 1 umexempt from the Contractor's License Law for the
E?a following mason.(Section 7031.5.Business and Professions Code:Any city or county t
E xF p which respond,a permit in construct,alien,improve,demolish,or rcpatr any ancient
w5c prix tot z also quirtthe applicant for such Permit to file signed treatmentea. _ ____
mat be s l cc cd p sis a t to the p o f theContractor I' La (Chapter 9 a S Ft:Floor Area�.
.x Valuation
or mens g with Sect ]ono)of Division i3 of l Business and ProfessionsCode) ( {. ,, ,; �. 6 . i e /.
oh S the to315bttherefromand the basis for theass Ocxt Pt nn.AY violation - 31630059 .`00 " - '• .
-of eon 903 n iv any dred d ll for a Permit xubl«¢the appbcam m e dvil ercnalry
of not mem than five hundred dollars(ssoo) APN Number Occupancy Type
°I.de,owner othe proparty,or my employees with wages as their solecompensatmn, 502 - FINAL PLUMBIN ENERGY
will,do the work,add the structure'is not intended or offered for sale(See ]014, _
'Bullus,and Professions Cddc:The Contractor's License Law docs not apply to an eguired Inspections
owner of pmpany Who builds or improves thereon,and who does such work himself 507 - FINAL PLUMBING
id th gh h own employees, budded that h improvements t bre-intended or
'oticlei late.IL lir .tw Wilding V memn a lh one yearofcompletion,far pur,ec ofodder will have the burden of pmving that he did not build or
Imerrova rot ppmate ar tale.).
❑i of prnpeny,'am axdwtivery contracting with licensed damranara nt [��-q-�--
I�QDaibs+�Ll�® --consonanta project(Sec,]00.1,owner and Profusions code)The convector's
Licensewh Law tact not apply m an owner of a whir who builds ea improves thereon, t
.. _ ,Co cations License
such_projecu with a.convvnogs).Ecemed purse,,to.dm. .
131aexe exempt MAY
' ❑IvmexcmPt undcrSm - `:B&PCfor this mason '!)
- 292002 , . ,
Owner'a. D 1e
BUILDING WORKERS COMPENSATION DECLARATION B U I LDI IV G
\ Fhe bY Rm and. ptIrY f
f juryin,c f t following declarations:
01 have and will maintain Clanifical of Consent 1c;self insure for Worker's
r1 Compensation, as provided for by Section 37W of the labor Code, for the
'performance i f the work fur which this permit is issued.
D 1 have end will maintain Worker's Compensation Ineerince,as respired by,Section
3]00 of the.Labor'Code,for the performance of the work for which this fermit is
issued.'My Worker's Compensation Insurance carrier and Policy number art:
Cam ltl 'r.'. �)tool .;.ON u
C[RrIFlC TION COMPENSATEON(INSURANCE Qk KERS
(TI -s Ghon need not be completed if one permit is for one hundred dollars ' ' - 1.' t)...., -
(9100)orles.)
'I t li th perfo f r n a. -me Ch s Rat't sso d,l
shall ern mploy Laws'pe n m any manes s as m become object to the Work<rs'
o
Compcnsauon Laws of California.Date` ""
..Applicant' .,.: . .. .....
.emu ._ ..__.. __- __....... ., .. ._
NDTICETOAPPLIeANT If ft makingion Candidate fbarExemption,y - Id —
chou y � t
Z Fern s noshy theWriter's C pe p '.'onto be
Labor y 'st "
0 fonhwnh comply with 'such provisions or this permit shall be d dated makes.
'CONSTRUCTION LENDINGlen AGENCY t
1 he lb,for ffn th t the a civiissued
(S on lending e.C.y for thepertortnance' a t-1
W rat I Ili ark for which this pertti r "isxuW(Sec 309) Cie.C) '
Lend ,Name .: ,v'.. .•.• _,n.::. a.. ........ ... _...._.__ _...___..._. _ ...___... . ..._ _
�;Z finder s Aatlres, '
1 certifyee that 1 he sd alapplicationcity
and state that the W information is
correct 1 g t amply hhall.apt nricounty ordinances d r er upon —
C.)
)building cs t Y n d hereby.authorize p u sof "x ofrh city t t i pilon ,&
tat the abo t etl property f h a t purposes, l%G,9W. l��_
-0. ms,juagree s.coon and expeedynses
and keepwho hamlets ilia v, of me ll ag i agmmo
Z) City.'tie;,judgments,costs end of his
which may in any way eccrve against said
City seyucnDERSTthe Biddingod this nnr "
SOURCE RE UNDERSTANDS AND\VILL COMPLY WrfH ALL'NON-POIYI'"`
' SOURCE RF,GUI'.ATIDNS.,.� ; ;: p;'� , Issued by: Dale
Stgi 111 A APPhcanUCanlmnor Re-CODE$
a1, "'�'-' `.HAZARDOUS MATE RIALS DISCLOSURE'"^\" •'
C�defrtWWillb nth Cl can fp
'building phi atm handle haz dour macnal Type of Roof_-. _
a y pen Mu c pal Code Chapter9.12.and the Health d Safety I'. --- "' -
oae Secr on 25S\21a _ '
p ❑Y ONO - `All roofs shall be inspected prior ro any roofing.material being installed.
;,, Will the pplicam f t build ng«the
r.1 devices If a roof is installed without first obtaining an inspection; I agree:to'remove
emit h aardous a c ma is es defned by the Bay Area Air Quality M nayemrnr g
Dirvn ..
°Y No all new materials for inspection._Applicant understands and will comply with
'i °
i
ourceregulations,I ha read the hazed s matcnalall non-point's
alifm Health A,Safety Code.Sections 3srreqmenderC . ot
lythe Wilding does not currently have eitch
5505.25533 and funderstand that
nr
- - - - - -
that it is my responsibility to notify the
Occup, y
'�pant of Ne mmh mn or'noees whicust be inprior to issuance of it Ccrifced of •'
Data
Signature of Applicant Date
owns .n mage y to All roof coverings to be Class"B" or better
OFFICE' - _. __........_. ....- -- _.. _-- ... .- ..