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CITY OF CUPERTINO
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CONTRACTOR INFORMATION
Run.nwc nrvlsloN PERMIT
BUILDINGADDRFSS:
JUST WATER HEATERS INC
PERMTrNO.
18460 FARMINGHAM WAY
02120074
OWNERS NAME:
1764 NATIONAL AVE
APPLICATION SUB DATE
AMAR GUPTA
12/17/2002
]ONE:
(510)293-9901
SANITARY NO. CONTROL NO.
ARCHM--ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
under provisions of Chapter 9 (commencing
1 hereby offrm that I am licenseddue
Job DeseriB{igg
with Section Bu
the Business and Rolcssinnx Code and my license is
p ��
tl'�9uvki
defecDivixion3of
and
LimneClass derreeL
REPLACE WATER HEATER
License Class Contractor
Date balmsCL
ARCHITECTS DECLARATION
(50 GALLON GAS) FEB 2 8 2003
1 understand my plans shall- used m public records
Licensed Professional
OWNER fr DECLARATION
BUILDING
1 hereby .(firm that I am exempt from the CommnCo License
exempt Low for the
aso
W lnh reason. Cita )nfear Business and i Code: Noy city nr county
c
Which mquircs ec improve. ole
Mo de or repair any
permit m enrotrvet alter, impnnc. Jemnnit
n t
Statement pnnno ,l issuance, also myothe the applicant Inn CoM1 pvler'a blearigned Loo,(Chapt cm
the
mound I, licensed puection
Sq. Ft. Floor Area Valuation
(commencing with Section ]rand of Division 3 of me
AE)pnmmsion 3 Business and
nd Protestations Cook) m,
Any vi Code? or
be al on.
that he is exempt thertfrom and the basis for be alleged exemption. Any violation of
$937
Section 703 IS by any applicant foe a permit xubjecu thea iflicanun a civil penalty of
not more than five hundred douars (ssm).
APN Number
Occupancy Type
37522073.00
0 I, as owner of the property, or my employees with wages as their sole compensation.
will do the work, and the structure is not intended or offered for sale (See. 704,1. Business
and Professions Code: The Contractors License law does not apply tp an owner of
502 — FINAL F�F�Nf Lf Iff e�fQffRGY
properly who builds or improves thereon, and whodoes such work himselfor Nfough his
employees. provided lhatsuch improvements arc not intended of offered forsale.If.
506 — GAS TEST
however, the W ilding or improvement is said within one year of completion, rhe owner
Wilder will have the burden of proving that he did not build or improve for purpose of
507 — FINAL PLUMBING
sala).
0 1, as owner of the property, am exclusively convecting with licensed contractors to
conswn the pmject (Sec. 7044. Business and Professions Code:) The Contractor's Lt -
x Law docs not apply Or an owner of property who Wilds or improves tbemnn, and
who commas for such projects with a convactemb) licensed pursuant dm Contractor'.
License Law.
0 l am exempt under Sec. ,B&PC for reason
Owner Dow
WORKER'S COMPENSATION DECLARATION
I hereby aRmt under penalty of perjury one of the fallowing declarations:
I have end will mainmia a Certificate of Cnnscnt to elf -insure for Worker's Cnmpen-
Satinn, av provided for by Section 3700 of the Labor Cook. for the performance of Ne
work for which Nis permit is issued.
0 Ihave and will maintain Worker's Compensation Insurance, as required by Section
3700 of Ne Libor Code, for the pcRmmancc of the work for which this permit is issued.
My Worker's Compensation Insurance career and Policy number am:
Carrier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This seenimneed not te completed if the permit is for one hundred dollars o HXd
or less.)
1 cent fy that in the performance of the work lin which this Permit is issued, 1 shall not
employ any parson in any manner x as to Wcnmc subject the Workers Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: 11, after making this Cendicane of Exemption, you should
WconaC subject a the Worker's Compensation prov sions of the Labor Code, you must
forthwith comply with sucA provisions or this permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency lit the Performance of
p O
the work leo which this permit is issued 1Sce. 30FI7, Civ. CJ
Lenders Name
'
Lender's Address
I cembe that) have read this application and sum that the above information ix
cortex. I agree to comply with all city and county Ordinances and slate laws relating to
building construction. and hemby amhnfi o rcptexaman,os of this city to enure Olson the
Above-memidgm propertyfor
(We) agree a save, indemnify and keep hafmlevi the City Of Cupertino against
expenses
st
liabilities, judgments, doss andexpensestenxx which may in any way aroma against said City
which may
of the of this permit.
APPLICANT UNDERSTANDS
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE R[GULATIONS.
Re -roofs
Signature of ApplicandCOmmctor Date
IIAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the aPPlicont or future building necupant store or handle haiardnus material
as defined by the Cupeninn Municipal Code. Chapter 9.12, and the Health and Safety
Grde. Schon zs53x')7
❑ Yes 0 NO
All roofs shall be inspected prior to any roofing material being installed.
Will the applicont or future building Occu t px a
equipment rat devices which
If a roof is installed without first obtainingan inspection, I agree to remove
Pe
mei ha'eardnus air comami man as Jerined b the Ba Arca Air
y y Quality Management
all new materials for inspection.
Uistricr!
0 Yes ❑ No
1 have read the hwardous material.smquire dens under Chapter fi 95 of the Califor-
niallealthA Safety Code, Sections 25515.25533 and 25514.1 undersand that ifthe Wilding
does not currently has: a tenant, that it is my respmsibility to nobly the Occupant of the
requirements which must W met prior no iwuanoe of a Cenilic., of Occupancy,
Signature of Applicant Dale
All roof coverings to be Class "B" or better
Owncrmaummi,..dagent Dale