02060195 CUPE
CITYBUILDI G DIIVIISIOrvNOPERMIT CONTRACTOR INFORMATION:
RYI'gNc),bDDT:ESTATES DR JUST WATER HEATERS INC PERMIT n060195
fffl U"WINAN 1764 NATIONAL AVE APPLICAOO ,NyLa28AJE2002
(510) 293-9901
1 PHONE: SANITARY NO.. O CONTROL NO.
O c ARCHITECTIF.NGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MF.CH
S v i LICENSED CONTRACTOR'S DECLARATION ri IIOn
i z= I hereby affirm that I am licensed under pmvisians of Chapter 9(commencing REPLACE WATER H>! $ FFt�ptI
.-' with Section Tl(adefect, onJof the Bminess and ProfessionsCode.and my license (50 GALLON GAS) �Du Vld`U Is.IS•®
-t in full form unJ effect.
:Oyu Lice a(,Inas Lie Y
7 3 a.F Uamn S DECLARATION i0 ARCHITECT'S UECLARATIOS NOV a 2002
1 undcmand mplans
y shall he used as public recount
iv i=
i i O O
Licensed Prnlcuiuntil
ce o LL OWNER-BUILDER m fila, RATION
1 hereby affirm that I am exempt stem Niu Cosions Co License Law far the BUILDING G
ria Ihloh regmassa Stalled t IDnsru Business and improve,
demolish,
Any citymcounty tl Itl
F G xitich requires a permit in construct,ober,impim'c dcnmlisn,or repair tiny structure 6 5 O
y3- prior m its issuance.also requires the applicant lot such V - _ _-
9 fP Permit 'g signed
that he licensed purrnt to the provisions of the Contrustor's License La (cnapter9 -1, S . Ft:,FloorArea{i g e .,.4 Valuation
(commencing 'th Standen]000) f Eb soon 3 of the Business d P ore:i .Cade) (�,'- I 9 t
ser m I he is empt therchorm.sed the bars for the alleged exemption.Any violation 3 6 92'2 0.01'•'.'0 0 ' ... ..
of Section 7031.5 by any applicant fm a pemit subjects the applicant ao a civil pcnahy Number
of not more than five hundred dollars(a500), ApN Occupancy Type
❑I,asOwner othe propeoY.(it m,employres with as ages astheir sole mmpenamion, 502 — FINAL PLUMBIN ENERGY
will dm the work.and be strumare'is not Intended or offered ser sine(see:7044, -
'Business and Professions Cole:The Contmeor's License Law docs not apply to an spections
owner of progeny Who builds or improves thereon,and who does such work himself 507 - FINAL PL ��
or through his own employees.provided that such improvements arc not intended or
offered for sale.If,however,the building or improvement is sold within onef
Impletion,the owneole ilder will have Ne burden of at m did not buiild or
improve for mrrywse of saleJ. proving N
_ ❑6asown er of the p(Sueny,am vclun sand Professions
n%s Coac:)The mmcron to -
icewa the does
projectlace, to a,Busowner o pro eny who
Codeq The ve,tractor s
themon,
License Law docs nut apply to an owner of progeny who builds or improves t to the '
Cm wh Linens for uuch.projens with a comm<mrts)licensed pursuant rs the ..
C 1..sir s License law.. -
- _ ❑1 am exempt under Sec. '-.,B&P C for this.,on
Owner - Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penahy of pse avy one of the following Jeclrmomas
O I have and will maintain a Comficare of Consent m self-insure for Worker's
Compensation, as provided for by Section 3700 of the Lahr Code, for the
Performance of the work for which this Isomer is issued.
❑1 have and will maintain Worker's Compensation Insurance,a%required by Section
3700 of the Labor Code,for Ne performance of the work for which this permit is
sued.My Workers Compensation Insurance ebmer and Policy number arc:
Polic7 CERTIFICATION OF EXEMPTION FRO _ • n.
M;WORKERS's t t` s t..
a as ..
, COMPENSATION INSURANCE "
(Th. pion need bis be rompletetl Tthe permit is for ane hundred dollars -
1s100)orlcs) '
I ccnify That in rM1e performance of the .,it for xhich this permit is issued,l - " - '" --'-' " " ' •-
.,hall net am to n in an (.'the
p y vny,perso y manner xo as to become subject Workers'Applicant
un Laxs of Califnmis.Dutc
NOTI his
NOTICETjoinmu ,Worke's afmrmakmg Nis Ccsioroo oe Labor Code,sonhmuld -
becomeh comply
the Workers Conrgemati is provisions of the Labor Cale,you must
Q forthwith caniply'with such pravisinm or this permit shall he deemeJ rmaked,
Z
.�. - CONSTRUCTION LENDING AGENCY" --- '"I hfor
affirm this there is a construction
lending agency, rm
for the perfoance
W bf he work farr which this permit is issued(Secy 3099;Civ.C.)
y,o Lcndcr's Name.'.:- e . .., .. . ...
_.Z l.endera Address
V 1 certify that I have read this application and state that the above information is
�'Lit t",t i'dmeL 1 aeons to ebony ,a dhe all coy tine ,rePr ordinances and state Iowa relining
V the Aivoc-mndioned construction, for i 'speedmuthrnpuposenraives of this city mercer upon
x.'96 the oho(We)agree edpmpcnyforimpddkep hmpmle,_.
t.. Z) (We)agree t save:i and edfy and keep homy in he Cityor true a mragainst
`n Z liabilities,judgments,costs and i n of the which may in any way accrue agninr said
C.'.1 Z City in consequence of the granting D this permit.. T
'-' APPLICANT UNDERSTAND$'AND WILL COMPLY WITH ALL SON-POINT 1
SOURCE REGULATIONS: + Issued by: Dale
Signature of Appbcant/Cmumel r " ' -' Date
HAZARDOUS MATERIALS DISCLOSURE Re-roofs
Will do ppl fans or forms Wilding om pat same or handle bamdMes msec al Type of Roof
as dtl fired by th5 Cupertino M pal Cod te Chap9.12 nd the Health and Safety
yp oo
All roofs shall be inspected prior to any roofing material being Installed. _ _
will thendous applicant ntim,ature Melding by the ayAt use cqupm Qualityrd or
Management
If a roof is Installed without first obtaining an ins ection, I agree to remove
emit hazardous air comamin tsmd fined by the Bay Arca Air Quality Management g p
°i""`" c all new materials for inspection. Applicant understands and will comply with
❑Yes.-'t ❑No "' .... - -
- '. all non-point source Fegulations.
I M1Health the hazardous material'req.25533 a under Chapter emb of the
California Health'&of cur Cade.Sections am.fi 25533 and sponse 1 understand that
if ane building doesnotmnts wly naveast So tem is is myresponsibility notify the
Ob up ars of Ne requirements which must h mea poor to issuance of s Certificated
Occupancy. .
" - Signature of Applicant Date
6•. ' Owncrmimhorzed agent -
Date . All roof coverings to be Class "B" or better
a.: .. . ... _ .. .. _. OFFICE -- - .