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01060139 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 10570 DEODARA DR WATER HEATERS ONLY 01060139 OWNER'S NAME: APPLICATION SUB DATE INCERPI HARVEY I AND ELEANOR 500 AIRPORT BLV 06/25/2001 HONE: SANITARY NO. CONTROL NO. (415) 349-3747 IOu,O O t ARCHITEC TENODMER: BUILDING PERMIT INFO F 2 f BLDG ELECT PLUMB MECH a GJ LL-1 L_J I-1 rad z En_ LICENSED CONTRACTOR'S DECLARATION Job Description O Z—O I hereby affrtm that 1 om aide B under P and Pmfe of Chapter 9 commercials FyF� with Section7000)ad ofect. un3of the Business end Pmfcssions Code and any license REPLACE 40 GAL GAS WATER HEATER. amp; ism full tome and effect. ec sea License Class Lim.e 3 p" Data Canlmcmr ARCHITECT'S DECLARATION u O I understand my plans shall be used as public records �r w p O Licensed Profe.asioml n n es OWNERBUILDERDECLARATION I hereby ellirm mat 1 em exempt fmm the Cmuractio License Law for the C g a following reason.(Section 7031.5,Business and Professions Code:Any city or county Eo which requires a permit to construct.alter mprave,demolish,or repair any x,rele e oc pr 1. . I the_ppl if suchpc to fl g W stammer, .._ ._ thth t Bronsedpurruction In the parati,itio,of the C—anudorsL Law(Clons'9 5 Ft Floor ArLa p (c gwith5 ❑ Division,70(if3fthe Business dPJ .Cod) r } '� : - ,l �iy;so , $.�xs'}IUHLlO❑ or that be s cscmpl therefrn n and the basis for he alleged exempt on.Any violation - Y V V of Section]031.5 by any applicant for a permit subjects the applicant to a civil penalty fin[ of tim am halt five hundred dollars(S500). - 316AMYmVb ':•-.'so >: Occupancy Type i El 1.as owneror, progeny,ramyemployees withwages astheirsalec (Sons.7BI4, J will ne the work:and the ude:ramn is not intended or LicenseofferedLow, oe.ale(v y to our' 5 02 — FINAL PL9WI§T#C GY owner of ono Professions Code:lee Contmcmro , nd w Lowes such nota to elf S owner of progeny Who builds or improves thereon,mpr who encs such work himself t " arthrough h' ply ..provided that such improvements are not immdJed or 506 - GAS TEST offered rm sale.If,howeveF the building t s sold'within one .f - .... ._..___ .... _ _ . ge b Improvement of pro yeldor FINAL PLUMBING improve for the owner builder will have she burden of proving mm he did not bade or - improve for purpose of ale 1. I as per pr the prapeny,WinWill <u sine ely contracting with Coal D contractors r a + t :instar she project(Sec.7(W,Bus and Professions Code:)The vea Contractor Business q License Low does not apply man owner of progeny who builds or seimproves thereon, JJ - Commer e,License for such projects with a.comractorlsl cense)pursuant to the .. .. .. ___.. ..._..... -. .._._ ......_ .L....._.... .. _.... _ __... _ ._.. ._ . Ir and.who contra C 1 m exempt Licence Law. ❑lam csempt under Sec. ,B&PCfar this Owner 'Dam _ WORKER'SCOMPENSATION DECLARATION FINALE® •' 1 hereby affirm under pcnahy of perjury one to following deelamtians: ❑ 1 have and will maintain a Ceriitiealn of Cement to ulf-inmrt for Weaker JUL 10 2001 -- - Compensation, as provided for by Section 3700 of the Iabur Code, for the _ performance of the work for which this permit is issued. ❑I have and wilimaintain Worker s Compeoixlion Insurance,as required by Section BUILDING 37M of she labor Code,for'the performance of the work for which this permit is is' d.My Workers CompersaLlom Insurance carrier and Policy number am: .. ...,. _.._. ...,_._. . ... ........ . ... Courtrai ::r •. „-...; "rPolicy No.:•.... _ CERTIFICATIONS OF EXEMPTION FROM WORKERS'i.. 11 COMPENSATION INSURANCE ., - .... .. _ - Chisi secaan need na be cont IetN if the Permit is for one hundred dollars to 161001 ter Ins.) - .. y _. I ttrp fy thn'n m'pcf any our 'the irkforr whichth amu is used ' i 1: •,, shall n t interhrp,lo,Law, pe if m any manner m ax to become subject to Ne Workeei Compcnsolion Laws of Califomii Date ' .. . . ' ..... .. .. ...._._ .NOTICE TO APP LIC ANI If aftermaking provisions ovisios of tof he Labor ode,you i@ r becameath c.recu the Worker's Compensation pro r.onsll the Labo Code,you muss 00 forth with c ply with ch previsions or th s pc t hall he d Joke) ' �'W "i ° 'CONSTRUCTION ' r emisaEGENCY LNDING A 5... a e � t S-;Q ....Lende!N(herebeffrm lh lam; s� lending agency ued(S t09] Civ.C) f ar the rformanc of Nenfor htis __ .. _.. ....._. . ._ _ .. ._. ..._ .... ...... .. .. ._....... o z I radoras Add ss 1c, I certify that I have mad Nis application and state that the aboveformation is rice,I agree to comply orcin all city and county ordinances and stone laws relating 'Q_V 1.building constronian.and hereby authorim representatives of this city to enter upon the above mentioned property for inspection p rpo. s Fay eagreein save,indemnify and keep hamintat,CfCupertino gain'_ s liabilities judant taI p nee hi y n any ay aaintsaid 2 City n consequence Scooting of m permit.' Issued REGULATIONS. Date SigtmmrcorAppllcantipooductor- . `t "/ •.Date; t Re-roofs 1. HAZARDOUS MATERIALS DISCLOSURE W II ih s pphc t r future building proper,store no article h�aeaadcoto material. Type of Roof - - . .. .. --... .,_.... ..... .... ...:... .._.. . .. ____ as deEped by the Cupertino Man c tint Code Chapter 9,12,and the Health and Safety cod Section 255321 I .,, i . `., .•k s Ell yes ._' ❑N 4. t o. All roofs.shall be inspected.prior,to any.roofing.material.being.installed . ._.. _.., tWill the applicant or butom building occupant use equipment or devices which If a roof is installed'with'outfirst obtaining arc'inspection;'Pagreetotremove em t h' S rJ us air cn t is as defined by the Bay Area Air Qua1'ny Management D r t - , all new materials for,inspection._, Applicant,understands and will comply with, s Disc, . . . .. .. ❑Y .,, I' ,:" all non-point source regulations: I have read the Safety Code. mains 2 regb 25333ta tinder 4.Chapter understand of the ifteCalifornialHeads&Safety Coda Sections that t it is and sponi. understand Inet _ .i(thebuilJldg does nolcurten0yhave atenant,lhht it is my esponiibility to hmi(ythc "- s„ ,L p p y,i p tar nee oft CeniFl<ate of _ - one pal oY.If the re rem t manmtatbe' n to Signature of Applicant Dale _ o aamonacd ago of-. - - .Dao All roof coverings to be Class "B" or better tn , .._. _. .. ... . .... .. ... _. ..._ ._._ _.. ... t OFFICE r