02020022 CITY OF CUPERTINO
BUILDING DlvtstON PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
19641 DRAKE DR WATER HEATERS ONLY ssuu 02020022
BISCHOF MARIE A TRUSTEE 970 E . MAIN ST, SUITE 20 )02
PHONE: (415) 566-2209 SANITARY NO. CONTROL NO.
' BUILDING PERMIT INFO
O Ill O Oz ARCHITECT/ENGINEER:
�{F BLDG ELECT PLUMB MECH
a 6 r= I--I LJ C-1
LICENSED CONTRACTOR'S DECLARATION
0 6 h o 1 hJob Description
ereby affirm that I am licensed under provisions of Chapter 9(commencing REPLACE WATER HEATER.
F H I_•w 000
,with Section] ) f Division J of the Business and Prolesumi,Code,and my Hearne
a u in full totes an <ffe
z a Licen��_ urs a 7 7 (5 0 GALLON GAS)
3 LL h Darr; Commcmr
ARCHITECT'S DECLARATION
saC m - I understand my plans shall be used as public records
6 d p O ued Lic<iProfesvonal
o ]� OWNER-BUILDER DECLARATION
1 hereby aRrm that I am eaempt from
the Contractor's License Law for the
.F Y< following mason,(Section 7011.5.Business and Professions Code:Any city or county, -
,Fd o which requires a permit to construct,ulmr,improve,demolish,m rtPar,any smacwm
n 3 mc' In
armi's islarrice.-Imquires the applicant f s hmna peno file signedstatement -_„- --
that he irfiesinedpu 4 t to dip Provisions of the controadoesLcenseLow(Chapter9 ti, Sq. Ft. Floor Area ti e ' Valuation
¢ nlig "ms tin0000)of Division Sof theBusiness and Prpfgss,nscnde) t'`i�ii,� l,:S t t orAr.11';_v°f,lCaS�d"'+ ' i
u ,hat he is exerepf rhiefiom and the basis for the alliged exempttoh Any violation
-vf Section]OJ I:5 by any applinm for a permit subjm�me upplicam to a civil pennlry OQ
of not more than Five hundred dollars(S500). APNNumber t.';..:;,,.: Occupancy Type
Ol,ssowneroftheprepeny,mory employees with wages as their sole compensation, 502 _ FINAL PLUMBIN ENERGY_
' - w
will do me ork and-'he'strucn re is not intended or offered for sale(Sec.]Pit,- --- --- -" - - -
Business and[implosions Cade Th=Cmumcror's Laren.law ones not apply to as 506 - GAS TES'Ikequired Inspections,."
owner of property Who bolds or improve,diammi and who d«s such work himself 507 - FINAL PLUMBING
o through h ploy p -d d that such improvements t intended or 1
offered for sale.If,iscosse,the bidding - - e year of ... ._ -_..._- ._-._..._. ....-_,._ ------
completion,
_.
or improvements Id th' ..
p pie h own b Id will have the buNen of proving that hedid nm build or -
improveforpurpose ofsale.). I� 811
..._.. ......_ —__--__ _. 1.-
01 of property.am exclusively ro contracting with licensed comwracto to F E B: 2 6 2002
construct thep j t(Sec ](o a Business d Professions Cad=)imp
Contractor's '
L se Law does not apply to as owner with
.,emay who),lids or reproves thereon, `
�. and,wLmms forsuch.projecw.with a.cammnor(z).licensed.pursuam 1.the- ...___....._. _.
Contractors I-chat Law ...._._ _._p-.. _...._-.... .... ., ._.._ -_._.
❑I pr nderS L r ';B&PC for this mason I } -' ' BUILDING
Owner '''Date '
.WORKER'S COMPENSATION DECLARATION
ihereby affirm under penahy of perjury 6ne of the following declarations:
• '
01 hale mid wiil'maintain a Cenificam of Consem io self-irrure for Worker's
.( Compematlaie-as-provided for by Section 3700 of the labor Cool the
�p(erborro n ie rif the work for which this permit is issued..
`CUI have and will main6i6 Worker's Compensation Invide as mquired by Section
l W of the Labor Code.'f theprifd a«e of the work fo which this permit is
n d My 'rkk 's pe sou n Tno ane and P I y her rs:
C mergf_� (/ �CYoI Y No.-
i; CER IFICA'rIONOF.EKEMPr10N ARD.WORKfiRS " - { ,
COMPENSATION IUSORANCEr }" ___,__._____._...... _
i
"(Th s se t oii need not be concdrtcd if the son,is for one handled dollars �� • ''t t.' ]
(S 100)or Iwa). '
i ,
net
n fy Kaki the n i l, 6for harm
h thisperms issued.1 -
'sb 11 t employ any pc n airy tan r w as to hccoiim b):a m the Workers i.-•,.
Co pe non Laws of C I f -,Date
:Apel t
NOTICE TO APPLICANT II after makingth C nl lc ot Esemplion.'yoshould - - -'— --- - - _ -
Z bem m M1lettieis t h Cpcuuuirmpro ns of the Lathan Cul you i
rth -
zO foth limply with such p at o m pe e t shall bed d v,kcd
f}yCONSTRUCTION
oh IEAGENCY
I h rcbY Rnn ih tc nm , I'hofrwhch this s issud(S309].CC)ending agency forthe p.e.rfim urc'e
v.
- - "-"
Z Le eers Acme:..
U .
I it fy that I have ad this application and state that the buse infiannation is
Ca F correct l a.mac ca comply th all city and county ordinances and state laws relating
�.V to building o i fon tlhereby
, Thor p rt a of this ;ryt enter upon
the b tdp penyf aph(H )ag to a mJ fy dkeep rules;th Vp
Cty ofC pen' oaganst
fq
lialailitims,mignicaus,costsd expenses
which ay in any way accrue aglin.t said
U Z .City inconsequence of the RromingofI u, - r
APPLICANTONDERSTANDS VJIJ,V IMPLTH ALL NON`
SOURCE REGULATIONS (/ I / Issued by: Date
-4 Signature of Appl,cannContramor
r, HAZARDOUS\ATERIALS DISCLOSURE RB roofs
Will be iridiens,on f t m building« po t ,me«Handl homid.a.,ret nal ..Type of Roof. .....
as defined by,theC p n Municipal Cod Chapter 9.12. d theHealth d Safely
)
' Cm 5❑eY n2553?1114 of Z.f,�Y CSP 1Vl..t1 D '-
' � a ,All roofs shall be.mspected pnor,to.any roofmg,material being Installed „
t Wll the ppl'uamo f t nn,Iq; g p eq p t d e� n n If a roof is installed-without first obtaining an Inspection''Iagree'to remove
Dir t e Air Quality Management
R, ❑Y r all_new materials for inspection Applicant understands and will comply with
enrha N s contaminantsadf defined ByAr
t. ;t , :+.. "�� ' ,.''i.. '' `. '- all non-point source regulahohs ; : __,-._ .. _. -- .
I ha.e read th hazardous mama I. regmrcmea s under Chapter fi 95 of be
California Halm&Safny Code:sections 25505:25537 and 25576,i understand that
if the building it.,not currently haveumnam:mat itumY msponsibiiirymnotify,he
occ pant of the mqui i ms whmh must 0.met odor m,,source of a Ca,i rat of -
". Q uP P ,
4 �L Signature of Applicant S Date
_. ...
owner n monitored"gen; rata:— All roof coverings to be Class "B or better
. t _ _....•._ .__ .' OFFICE-. .-_. .