02090131 CI BUILDING CUPERTINO ON
PERMIT CONTRACTOR INFORMATION:
BUI DING DDRFSS: PERMITNO.
1�77� W ESTATES DR JUST WATER HEATERS INC 020,x901131
06111M JOSEPH AND RITA M 1764 NATIONAL AVE APPLIcAT O19N/ 19/2002
PHONE: (510) 293'-9901 SANITARY NO. . CONTROL NO.
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
m- BLDG ELECT' PLUMB MECH
y a LJ I---t 1=_1 L>
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LICENSED CONfRACrOR'SDECLARATION Job Des ❑ I ��®
Q z_ I hereby amrm that 1 am licensed under provisions of chapter 9(Commencing REPLACE WATER HEATER
with section 7000)of Division 3 of Business and Professions coda and my license
ads 3 is in full Ora and effect. (4 0 GALLON GAS)
C, FEB 14 2003
z 6 License Class Lic.
Oyu Date Contmcr
W e:0.1 m
ARCHITECT'S DECLARATION
t2 to 1 undersand my plans shall be used as public o cnNs
BUILDING
y i p O Licensed Professional
cLL OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
t?afollowing reason.(Section 7031.5.Business and Professions Code:Any city or county
M x O which requims a permit to construct.alter,improve,demolish,or repair any structure
Ce
an prior to its issuance.also requires the applicant for such Permit to file a signed summent
that fo plapsw xintuarmto the pro ismas of Contractor's License Law Chapter S Ft� Fr-Ar Valuation
(c mon ng with scut 7IXI()of Div ision J of Business and Professions Code) f , i yl - kq: f l I,.5,,e j a a.'1_'{j(,' f
or that he is exempt therefrom and me basis for the alleged exemption.Any vWmimi 36922033 . 00
of section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty- Occupancy Type
Penalty-
!of latitudinal not am In..6w, dollars 5500). APN Number ",:,: '.0
❑T.as owner of the Fropeny,orray employesswith wages astheir solecompensation. 502 - FINAL PLUMBIN ENERGY
-will do the work,-and the slrlretlure is not intended or'offered'for sale(Sec.7dW." - -- ---- -
Hairiness and Professions code:The Comacmrs License Law does not apply man 506 - GAS TEST Required Inspections''-`i' p
aw
ncr of pmpcny Who builds or improves thereon,and who docs:veli xvrk himself
507 — FINAL PLUMBING
orened gh foh':own employhoweveces,proiidedm is h improvements rt ,intended or
completion.
Beall for sale If:however the ll ild n - ,i 'i n sold w thin and ear of -------
g or vrovemen y
impasse
for me owner-builder will nave me burden of proving that he cid rte,hued or
improve for purpose of salel
. _. _ _ _ ._ _.-.-_._ .._..._-. _-- _-
Qexclusively
I ss Owner of property,am c t t g w with licensed com rauars to -
construct the Pot(Sec 704.Business nd Professions Cade)The Contractor's
License Law does not apply to an owner of property who Wilds or improves thereon, '-
C _.and who.commcts.for.such projects.witha.contractons).licensed.pursuam to he.
Comraaors License Ww.
^
❑I am exempt unJeriSec- 't " ;B'&P C for this reason
i ....,yn ...... .. .,�....
O Dat . ..
� WORKER S COMPENSATION DECLARATION
_• I hCmbY offlon code,1.Pen Ity f pe 1.jury o f m mOs.
following de<Iaon
❑ 1 have'and will anaomn e Ceni6eme en
of const m self insure for Worker's
Compensation, m provided-for by Section 37M of be Lahr Code, far the
'performance'af the work for which this permit is issued_0,
❑1 have and'will'ma t worker's Co pe fiorr 1 uran 'required by S' tion
37M afire labor Code fir the perfoonsince of,he work for which this permit is
.slued My WorkersC pe. ion Insurance carrier and Policy number are: "-
1, .. _ ,•. .tee.. .:._...., - .,-.....•.........................
Ga r 6 11 :I. t.' .) I' eP , y N ' C. r T tt ... ..
. I1 _CERTIFICATION OF.E%EMPTION FROM,WORKERSt- ' .,1�_ a rs .._ ns }1� IYM}�!v 1 � { Tl,Job iia :', i
COMPENSATION INSURANCE-.(-' a^
a -- .._ _ __ _..__ _. ...._— ._ ..._.. _
rn: -----------
.OF . ..._..,.., .....
(Th '. Inn neeJ tot by mmplcn•J Tthc permit is one hundred Dollars �
Blllll)`r less.( - .n ..,wr .' ,,.r •. .'
Icmlythttmmperfilna
,bell no,employ any R n) na n hsa s b)ect to the Wnrkeh 1 .. v---i.'I '" •�..�••
Ct pci nlawssfCelt Dam `
s..,
.NOTICE TO APPLICANT If tr< makingtht C tl t 'of Exemption.Y hula
Zforth th n l m h this -_ o
O becomlh<rebY tB'rm moNSTR malmat
LENDING
A ec f th
objectnfth L bor Cdd
pY p pc rot lilt i<tl occurred kJ
*CONSTRUCTION isa on LENp1N0 AGENCY
W > firm
ofm kr etch n x r sissued(s 30W.lending ttK�
d_0 bend Nm - .- _ _: _�. _..". __. _ ..... .. ........ .. .-_. ..... ...._.,_..._. _..._..__._..._ ._
=-,Z find r Add e<. `' •. r _ _..
. V re 'his
Icenrfy matIhave read this application and sin¢thin the above immonationis '
.cooed.I agree to complyswith all city and county,ordinances and sate laws relating
' V no building cunstmn.
aloand hereby authorim repremantive.0 ofthi.s city to enter upon
W the above nsemiuoed progeny for inspection purposes.
p. L lw 1 greet save,t demmfy and keep In 1. the Cly ofCupertino against
r'V1 liabilities,j dg a Is,cost.'and penses which y n any . Y Boinst said
V Z City consequentt of the grant n f N -
APPLICANTUNDERS
TANpS'AJbWILLPCOaIPLY WITHALL'N'OV-FOL\T I$$Uedby, Date
SOURCE REGULATIONS.; •�.,e I
Sgnmure fApplcsm/Com mr ) 'Dte 1 Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the pillcat mm bisIdo,.6 pant sin handl n ted' mama 1 Type of Roof
s refined by th Coleman M n pal Code Chapter9A2; d th H ,Ira d Surety' - -- - - —t-
1-6
-
Cade5n n853 p r i`sr t) r' lti S. Ys 1'•' t
tOY ( I Iii Nv. !t� v t
All roofs shall be inspected poor-to any roofing.material being installed. _
• '�- w°m ppr_, f` "'la,g p eqn t a--s.,n n If a roof is installed without first obtaining ati'ifispecuon I agree to remove
70 t h arJ r cora ant .d toed by m B y Area A Q I ty M agent t
District? all new materials for inspection. Applicant understands and will comply with_,
allot on-point source regulations.
I have mail tic lfirigzrdmis meienale requ rements under'Chapt 6.95;of the '
California Health&Safety
P, cceCode.Seitimss 25505.25533 mid 25534 u'ndemand nim
If,thabulld1nhdoe not cuready have a o t that it myrep 'b'IrymrotifY the
'ifc Wm gath<ti mut rti
poor to ids of 5 cenifiCaa of, '
occup.1y.
Signature of Applicant Date
_ ... . -. .
f ' Owner err aumoruN a t - _- "- -- - -
: Date All roof coverings to be Class `B"or better
r
t
.. .__. -.:_ .. _... . - .. __ .OFFICE
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