02120058 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
�o:.,
BUB.DiNGADDRESS: JUST WATER HEATERS INC PERMFrNO.
7601 ERIN WY 02120058
OWNER'S NAME: 1764 NATIONAL AVE APPLICATIONSUBDATE
AM HARRISON ARTHUR L AND DONENE M 12/13/2002
IFZONE: (510) 293-9901 SANITARY NO, CONTROL NO.
ARCHITEC lENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
.0, LICENSED CONTRACTOR'S DECLARATION C7 O O O
K C 1 heresy allirm that 1 am licensed unJer provisions of Chapmr Y(enmmencing JOb PPgg'S'a�C�flfaTafly1tl
w, wishll once and
Division 3nf dm Businccm anJ Pro(easinns Code.and mylicenu is �li I1V.[t
,.J� imm�eClass effect. REPLACE WATER HEATER 000 tltl �rrr ( l
p�z Demme Class Co «
Z"� Dale ennDECL (50 GALLON GAS)
ARCIII'IS(TS DECLARATION JAN. 0 .2 2003
3wUlundcrmand my plans xM1allbeuscJ as public records
LLog LicensedPenfeaainnal BUILDING
OWNER BUILDER DECLARATION
,,:5
Y I greasy affirm that 1 1, exempt from the Contractors :Any c Law for the
oO Billowingreasonuit,,a (credo,703L5.I, let, and Pmfcuions Cook:Any city mummy
which myusux a punted ttm requires the aper.Impnrvu,demolish nr repair ed .mtement
=i„ pnnnoi¢iensed p,alsnthe pro inion of toe such Cormarmil trice s Law(stammrm
8sG (commie cingwidpunuanl70th)ofDistoaofNCCommness License Law(Chapter Sq. Ft. Floor Area Valuation
(commencing exempts Scniunllandth Division3oflM Business and Professions Code)or
y — Natio is 31.5 b Iany applicant
p li and the Per for the alleged exemption.Any violation of $422
Secnot mom than
aundredinnars(SS Permit subjects Ne applicant macivil penalty of APN Number
not more than five hundred dnnaea(SSW). 3 5 92 0 O 15 . 0 0 Occupancy Type
0 Lampe
s owner of the properly,or my employees with wages as their mile consation,
will do the work,and the structure is not intended or offered for sale(See.7044,Business ,,QQyy®®µ4D,1�� {�saaaSp �.t p�,�
and Professions Code:The Comaclors License Law does not apply to an owner of 502 — FINAL k'LYJI°I1V lS e L'7VIiKGY
Property who builds or improves thereon,and who das such work himulf or through h6
Man employees,provided that such imphavemenls ere not intended oro@rcd for sale.If. 506 — GAS TEST
however,the building or improvement is sold within one year of completion,Ne owner-
binlder will have the burden of proving that he did not build or improve for purpose of 507 — FINAL PLUMBING
sale.).
0 I,as owner of the pmp)ny,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li
Commit taw does not apply to an owner of progeny who guilds or improves Neleon.and
who contracts for such projects with a contractions)licensed pursuant)the Contractor's
License Law.
C l am exempt under Sec. ,B&PC for reason
Owner Dale
WORKERS COMPENSATION DECLARATION
1 hereby afhlen under penalty of perjury one of the fallowing declarations:
0 I have and will maintain a Certificate of Consent to scl6insure for Worker's Compere
satinet as provided for by Section 3701 of the labor Code,for the performance of the
work for which this permit is issued.
0 1 have and will maintain Worker's Compensation Insurance.as required by Section
37(X)of dm labor Code,for Nit performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are
Canter: Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ThLmumion steed not becompleted if the 1-11 is fell'.hundred dollars(SIM)
or loss.)
1 exnify that in the performance of the work for which this permit is i.auad,l shall not
employ any pecma in any manner so has to Become subject to the Workeri Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject m the Worker's Compensation provisions of the labs Code.you must
OO forthwith comply with such provision or this permit shall W deemed rivaled.
zuj CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency Iia the pclormance(if
x be work for which Nis permit is issued(See 3097,CO.Q
1 0 unJcr'1 Name
Z
Leaders.IAddress
J � 1 certify Nal 1 have read this application and smile that the above inlivmation is
i U building l agree to comply with all city and roomy uNlnancOf and state enter
r upon t e
U BuiWmgconswnino,and hereby of NisCity menmrupon the
above-Ore)agree
progeny for inspection dump ha.
ti y (s judgments.
ud gme to casts Inde expensfy es which
kap harmless the City m Cogent said ity
y inimetties.ence of the craning eapenusmitch may in any way aaruc against said City
Jy in conugancc of the graining of this Permit.
APPLICAti SOURCE NT REGULATIONS.ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
Signamrc of Apphcanl/Contraanr Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 4.12,and the Health and Safety
,deLCede.S)nLlo 2553Na)'1
❑Yrs ON. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building acupam esu equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
ems havallous air contaminants
as d)fined by the Bay Arca Ail Quality Management all new materials for inspection.
Doone"
CYea 0No
I have mad the hanrdoes materials"mumer underChapmr6.95oftheCalifor-
mallcain&Safety Crile.Section 25505.25533 and 2556.l ulalmsmnd that
if dm Wilding
Jce not currently Marx a tenant Nat almost my h sprom ado to nMfy IM tn'cupant of the
requirements which mum W met prior to issuance of a CemOche of Occupancy.
Signature of Applicant Date
owner orarthoriecdarim. D„r All roof coverings to be Class "B”or better