03010168 CITY OF CUPERTINO > A
BUILDING DIVISION PERMIT CONTRACTOR INFORMATI,ON:0
BUILDINGADDRESS: HOT WATER INC PERMIT NO.
10151 DEEPROSE
OWNER'S NAME: 2531 GRACELAND AVE APPLICATION SUB DATE
MICHAEL BIRDSALL 01/28/2003
IONS (650) 298-8494 SANITARY NO. CONTROL NO.
ARCHI7 ECTIENGINGER: BUILDING PERMIT INFO
BLDG -ELECT PLUMB MFit
0 0
�00 LICENSED CONTRACTOR'S DECLARATION
1du Job Description
I hereby affirm that 1 em licensed under provisions of Chapter 9(commencing p
with Seeonn7 Xgof Divisian3nf me U!��iM.ev and Profession Code.and mylicense iv
F,<M„ imm�rrTderc«IG JJ j REPLACE WATER H
b 2 Limove Lic.X
?yF Da C....... Gr
i;QQ ARCHITECTS D�`'f.^�.�N.���T]RAn1N
r, I untlemland my Plans¢hall be umdispdhhe records )
3LLu
u.C Licensed Pmfeuirnal
OWNER-BUILDER fr DLCe Continuous
onti ON
y 1 heresy affirm that I 1 exempt from the Casimir License Law for me
6O O following masa.(Section]OJIq Bmiecm and improve,
de noli Carlo:,orAny city or manly
a�$� which requires a t,idso ac comuum,alcor,impmw,h perinsh, fi repair any morem
Z> that hor nslimmed pursuant
nttacqoths thcvision ut ofMc tach Pcrminaicerix aw(Cammcm ti
C—< that an wit pursuant more of Division(the Commcmr'and Professions
Code)
Sq. Ft.Floor Area tion. I I
$ that(commencingINeempthhereion rom and of basis forn 3 M the Melted
ess xempt on.Any
lation of
Nat he V exempt therefrom and the buts for Ne alleged eumpdon.Any violatlon of �
Section 7031.5 by any applicator for a Permit subjects the applicant o a civil penalty of 3 Occupancy
not mole than five hundred dollars($50(f.
❑Lu eworkOnd Me aeny,ar mycmntendedwire wage Mtale(hole mmpmvatic.
will do Me ands. he Conaisnots intendedcatenateddolor sale(Sec.town owner
pro erty he Ina Cade:TM1C CssdowerY License ..does 001 apply lf oto rrough of 506 - GAS TE gqulre nspec Ions
ow nervy who huilds ar improves merman,end who area such was simmer'edthrough his
however.Me u,ping or improch vement
is id wtsamm intended 0th owner, 507 — FINAL PLUMBING
builder me building or improwmem is hold a within one year of completion,the owner
builder will have Ik burden of proving that he Oitl not Mtiltl or improve for purpose of
aa1C.).
❑1,as owner of the properly,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Profession¢Code:)The Convectors Li.
cents law does not apply to an rumor of progeny who builds or improves mercer,and.
who camncu for such projects with a comracmr(s)Invested pursuant to the Canoaclor's
License Law.
❑1 am exempt under Sec. .B&P C for this reason
Owner Dow
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the following declarations:
I haw and will marimba CenlficemofConxat in selLineum far Worker's Compere
ration,as provided for by Section 3701 of the Labor Code,for the performance of me
work for which this permit is armed.
❑I haw and will maintain Workers Compensation Insurance,u required by Section
3711(1 of mk c I�hnodc,fur m c pertarm cc of the wart for which this permit is icvucd.
37 of ,, penis Insurance mer and Policy nu wh r
Canicr. u Pnlic n _
RTIPICATC OF EKEMPI'10 MWORKERS'
COMPENSATION INS RANGE
(This section need not M completed UAW permit is force wedmddollan(Blab
or ecu.)
1 certify that in the performance of the work for which this permit is issued.I shall not
employ any perum in any manner m as to become subject to the Worteri Crmpematirn
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.after making this Cenifem,of Exemption,yea should
h,mrsm subject m the Wo kc,'a CamPenmtiea pr ieinns of the LaN,Code,you must
QO forthwith comply with such provisions or this permit shall be deemed mveked,
tiCONSTRUCTION LENDING AGENCY
[r I hereby affirm Out there is a mnsuuctinn lending agency for the performance of
tY+7the.,it for which this Permit in issued(Sec.3097.Civ.C.)
W4Q Lcndel Namc
G Lender'.
z Address
a
V P 1 cenee that 1 have read this y and coup and sum that me above information g is .+.
0 U cumin.1 agree ct comply with all city and county ordinances and city
t laws raining e
QU shave menmwnioamd herby authonprepecunutiwsof mistily then¢(upon me
W
have (We)areoned to rtysave for inspection
mnifyi an keephs.
(We)agrccto save,indemnifyendhecD hay in
IM Cityof
against
against
y p�j liabilities,judgments,courts and expenses which may in any way accmc against said City (s/i%rl(/
in
of the granting of
bis permit.
V APPLICANTeUNDERSTANDS tAND WILL COMPLY WITH ALL NO POI Issued by: Date �a
SOUR REGULATIONS.
Re-roofs
Sign urcof ApplicurVCamncmr arc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant or future building Occup oral slow or handle huallous material
as defined by the Cupertino Mun'ipal Code,Chapter 9.12,and the Health and Safmy
Code,Section 25532(.)'? All roofs shall be inspected prior to any roofing material being installed.
❑Yes Na
Will the applicant or future building occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
i raxamnaaaircenmmiranlymdcfncdbymeBayArcaAirQualityManagcmcm all new materials for inspection.
District? we/]
❑Yrs No
I have mad the harardnusmamrialsmquimmemsundcr Chspmr6.95of me allfnr.
nits He afcty Ctdc,S¢tinns255D5,255JJ end 25574.1 ndcrsland mal i(thc uiltling
rocs t cu a haw a tenant,mat it is my maponsihitity 1 otify occup 1 of me
n wmehmust Wmet priartoimumccefaCenirca t Oc pm�,.D-S Signature of Applicant Date
Own ",aushnrizcd agcm / LSD le All roof coverings to be Class"B" or better