02030107a
CI
BUILDING DPEROrvNO
PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMrf NO,
21481 ELM CT
JUST WATER HEATERS INC
02030107
OWNER'S NAME:
APPLICATION SUB DATE
MAHROUYAN REZA AND AZAR
1764 NATIONAL AVE
03/21/2002
PHONE
(510)293-9901
SANITARY N0. CONTROL N0.
ARCHITECDENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
L�
LIC
SED
l hoeby affrm�at I amO cued and Rr provisions of Chapterg (comment ag
Job Description
u withSeaion]0001o(Divisinn3aflheBusinasandProfasionsCode.andmyl;cense
REPLACE WATER HEATER.
I Is In full forte and effect.
License Cl... sets a
(4 0 GALLON, GAS)
Dale Commmor
ARCHITECT'S DECLARATION
I understand my plans shall he used as public records
5 Licensed Pm:fe„meul
I OWNER BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License law for the
r following reason. tSection 70313. Business and Pmressions Code: Any city or county
which requires a permit to conmr keL alter, improve, demolish, or repair any structure
a - prior to its issuance. also requires the applicant for such permit to file a signed statement
S FI. Floor Area
f i,4(1'S;
_
Valuation
- (commencing
the he Bmsbr, License Law (ChapterCoce)
' i Divins sion
core l dip' _u rt on thS of
Icomm c 8 with Section ]000) fD' sion3oftheBu3mespeMP,ofeuonsCode)
or that he rs exempt therefrom and the basis for the alleged exemptiod. Any violation
1, I� 3,q f1 -}.k\ 5,16-;�yit�-q J. -
of Section 7031.5 by mry applicant for a permit subjects the applicanno a civil penalty
of not more than me hundred dollar, (5500).
A umer
:-i--.,-,,.-, Occupancy Type
01, as owner of the pri or my employees with wages as their sole compensation.502
_
'will 'do the work: and the structure is not imended-or offered for for sale'(Sec. 7044,
506 - GAS TESRequired Inspections " '' x'11 r"°
B.,ind,a add Profeadm, Cade: The Connector, Lletme Law does ani apply to an
n rte
w , afpropeny who band, or improve, theraan, and who does work himselr
.. or through his own employees. pmWded that such improvements are nm intended or
507 - FINAL PLUMBING
ffered for sale, If, howeber. the buildin __ _ ._ _
to ,. building -or improvement is sold within one year of
_ .__ _. __.__ __. __ __
completion, the owner -builder will have the burden of proving that he did at build or
•"
improve for pepose of,me.).
-----.. _. ..
of.he.p_(S. e_a.m__ . _-..--ra-c_dne_w.it. h I.. . cont_a-cto-rsm
- --.-------- -
-'
constructthe eo (Sec. 7 Businessand ProfessionsCoal The Conwmor.
""''
License does not apply to an owner property who builds m thereon,
-' •• .t. 'tt -I
_❑Ltrwn'er
and
and who comsuch projects with is romamor(s) licensed, pursuant w.the
Licpoe Law.
❑ 1 am exempt under Sic, r ' "' .'B& ' P C for this reason
_..-_-_.-..---
___
------- .._._.. ._._
®
Owner'
WORKER'S COMPENSATION DECLARATION
`
��� O 4
I hereby am Rrunder pcnaltyof perjury ox ofthe following declarations:
LOQ[
❑ 1 have and will maintain a Certificate of C ... culo self -insure for Worker's
Compensation, as provided for by Senion-3700 of the Labor Coda for the
BUILDING
pe
performance of the work for which this permit is issued.
111 bare and will maintain Worker's Compen:mionIncarnate, as required by Section
r 0
37M of the Labor Code, foe performance of the work for'which this permit is
'
sued. My Worker's Compensation Insurance canier.wd Polity number. ere:-'
Y I YN
t 1-CCRTIFICATIOION OFOF EX EK;cEMFI'ION FROM,WORKERS) "'
t� Y } • j ',r ' F -:'
_.•-.. - ..I_....., COMPENSATION INSURANCE'".
(This union neem not odtom IeeE if
P permit is for one hundred dollars-
a' ); .. t, %•;.I .. --.`-...
(g111H)or less.)
,': '
,.•. Icert th pe a ce hh -to which t zm d 1
":-:. ...._.._: .,_ _. ._, _.. -. _• ,•:- +_ __ -_-
�•
tothat-in
in
ml t employ any parson y er u' t become 63ea t the Work rs
u
- � t- - i ti '
C
Compcnsauon Laws of California Dere,
..Apel. .t ..
.NOTICEAPP LICANTr ore k gth Cnl<t fL bore hmuld
.. .._ ._.. _.__" .. _ _.. __. ._. ... _. .....
subject the ionthis previsions of the Labor Cale you must
,
becomeco
' •" "'
such to iskims r
forthwith comply with such provisions or this pemtit ,hall he deemed revoked.
y
._ .. .__ __
r;' CONSTRUCTION er,isaLENDIIJOAGENCY'-
1 h reor which Ih I e e ;s croswet n lend ng agency r the performance
._.... ......_ _ .. _ ..... _. .....__. ... .... _ I .. .
.�
of the work for which this permius rssued (S' 7097 Civ. C.) • -
s
In
r -
Lender's Addresx
.
. 1 certify that I have read this application and state that the above information is
comet 1 agreet comply with all city and county ordinances and state Laws relating
the - ton do nr nflic. v hives of lh'sctY memerupnn
the
/1
on t
.1vong th dp.pe nyf .pectin pep
(We)agreemsave, dcmndy and keep harmless the City of Cupertino against
liabilities. judgmenu. ensu and expenses which may in any way accrue against said
City m wh
consequence of the gcwm p of this pe.
T'POINT
D1— 1 WILL COMPLY WfHALL NON
SOURCE REGULATIONS! 1 '
Issued by:
Date
Sig nature of Applicam/Convamor
x .. '..•..'.� .'....r.' 's:•';4. .Date
HAZARDOUS MATBRIALSDISCLOS UE " -`
Re -roofs
WII Ne relant a future w Isore g occupant store ,nand) eald- I
_ .-Type of Roof...,
,defnr4 Cupertino MunicipalC dee. Chapter 9.12 and the Health and Safety
- "'•-'s=-: -- - - .-
Code.Loth
ale S t n 25532f 1' l O No' n t 'i st ♦ i
❑Yes li
t t it, r I.% T. 1. ] - f k . ; I i' 1
� : I•
7 "
i {:
All roofs shall be inspected,
wu heat r'�Ion bmld'n' e
Pp buildingoccupant use eqa p t a -awn an
eml bozo dons c td ems as der ed b) Ne Bey A < At Q al iy Manag mcnt
nor to an roofing
- - p .p - - y.ma[enal being installed.
If a roof is installed'without first obtaining an inspection;=l'agree't0 remove
g
D"'"" -
°N
_ all new materials for inspection Applicant understands and will comply with
k�Y< { '
all non -point source regulations - -' .P_Y. - --
" I h read the'M1 za d os' tenals gmremcros undc Chapter. 6.95 ofthet
`•
Cnlifo a Hi n th &Safay Code, Sections 25505: 25533 and 25534. 1 understand that
if the.building dims not ccpamtlr have a Lemont that it is my responsibility to notify the'
occupam of the regmrem ¢ h h must be t p or m issuwc
occupancy.:f a Cenirl a e of
_
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner or authorW agcm - •- p ¢,