00090105CITY OF CUPERTINO
CONTRACTOR INFORMATION:
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BUILDING DIVISION� PERMIT
BUILDING ADDRESS:
PERMIT NO.
OWNER'S NAME:
zRIST WATER !'EATER
A .1 •TION SU
PHONE: J.U. JUHliltulil INVESTMEN-
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SANITARY NO,
z ARCHITI=IENGINEER:
BUILDING PERMIT INFO
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BLI%'i ELECT PLUMB MECH
i LICENSED CONN 'RACfOR'SDECLARATION
Job Description
1 hereby .form thin Ian, licensed under provisions of Chapter 9 (commencing
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with Semonn 70NO of Division 3 Ilhc Business rte Rasions Cn le, andmy license
is in full Foresail eff 1p_ 7
G
< Lfc. n 5
J Liceme Class _
_ Date_�r cammenr_
WATER HEATER
1�� - CHITIiCI"S OECLARA'I 4111
g I J be I - —
undo sw r plum shall used m public recmdst
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`� Liccmal Prmlesxlnnal
OWNER-BUILDER RATION
1 hereby affirm rcarmafods he Law Tar the
1 inn eBusin from the Cations
following recon.(Semon ] Cor ,Anse
< on Business and Professions Co de Anycity mmouthy
�
❑ onstr
which ragltir..npermit tocnnxime !mac improve,de mollsh, fietiogany
theappl.,mout mere ,
is
Sq. Ft. Floor Area
Va IOn
da Contractors License
dust be liensed,rodual the the
itpursuant io the pm Liceme Lawons
(commanding with Section 7f0 the Bumors Cvr9
(commncing Division 3 of the s and P Cale)
.
or teal he is and
rad do,i Iddis
beanie li,nhe alleged
alleged rr. An i
lad,
Any viPenalty
31.5 b pli or ,kcard to
of normo ]than fivelrs(S50rmit subjemsthc upPlicum ;oacivil Penalty
ydred dollars
ar not more man Bxe hundred canon (snook
APN Number
OCcupan
❑ Las owner ml the pmpvdy, or,ay cmployeex win, wag" m moor sole smnpmamin r,
will do the work, and the swctme is not intended or offered far sale (Sec. IlW'
Business Cask: and Professions C: The Contractor's License Law docs not apply to an
C+, `R'(; U red I❑SPCCIIOBS '
,inner mf propcny Who h iilds or improves Ihcmnn, and who does such work himself
or to ad, his awn umployera. IF lad that such impmvenmms arc naliram,ded or
offered for sale, If, however, the building or in,taverarm ix sold within one year of
502 — FINAL PLUMBING ENERGY
campleiom the nwner-huilder will have the broaden of proving that he did not build or
improve for perp Oe ar sola.).
- 506 — GAS TEST
01, as owner or the propery,amexclusively contracting with licensed daniracmnit)
507 — FINAL PLUMBING
construct the project (Sec. 70dD, Business and Professions Code:) The Contractor's
License Law does not apply to an owner of property whit builds or improves thereon,
and swho contracts for wch projects with a orona,ta W licensed pmsuanl he the
Contractors License law.
❑ I am exempt under See. , B A P C halos reason
,
Owner Dale
WORKER'S COMPENSATION DECLARATION
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I hroreby affirm under pcongy Ot'ptop, one of the following dd,ladhiom,
❑ I have and will maintain a Cenifcale of Content ra sel6imtre for Worker's
Compensation, as provided for hy'Seerion 3700 of she Labor C,de, for ;he
perfommnca of the work Bt which bi, pennil is robed.
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❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, far the performance of me work for which this permit is
issued.M,�yyyWn'r"ka,,r,"C'�,m""lwnsaron lnxumnco cam!7 �ond Poliry� nher ufo:
0 IUII(/
Caricn,C_Cr M�Pwicytlogxc0
CERTIFICATION F EXEMPTION FROM WORKERS'
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COMPENSATION INSURANCE
(This section need nm be completed if the permit is for one hundred dollars
I$ IWsor less)
1 codify that in the performance of the work for which this permit is isued, 1
,hall not employ any person to any manner so as m become subject to the WddacY
CampensaBad L uv, of Culdamia. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject o the Workers Compensation provision ofthe WEror Cale, you must
forthwith comply with such provisions or this pem,il shall he decmod revoked,
CONSTRUCTION LENDING AGENCY -
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I hemby to firmchat them is a construction lending agency for the performance
or the work for which;his pennil Ix issued sco, 9097, Civ. C.)
i_vada', Name
Lender's Address
1 cert lfy that 1 have read this roppl ism ion and state that the above inf ai n tion Is
,
mel. I agree to comply with all chy and county ordinances and stem laws relating
I to building construction. and hereby amhadze mpreummives of this city to enter upon
the abme-mentioned prapany for inspection purposes.
(We)au.It, o,c. I ndemni fy and keep harmless the Ci yof Cuper;i no almost
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1 liabilities, jndgnents, rid is and a Imams which may in any way acerae against said
City in consequence am gra til ; mf; 's Permit.
APPLICANT UNDERS SNI ILL COMPLY WITH ALL ryOry BDIN[J
'J
Issued by: —1 Date n rid
Sigw rot — Dam
Re-roofs
AYARDOPS MATE!ALS DISCLOSURE!
Will the a,fi,aat nr mord nailding s enpam nam or It ale hpmnlaroe neurnal
Type of Roof
as defined by rhe Capcnino Municipal Cale, Chup1er9,)2, end the Health road Safety
Code. Section 25532N)?
0 YesON.
All roofs shall be inspected prior to any roofing material being installed.
Writhe plidard ,, ficame buddir,ra,upon use id,riparrent or de,ted, which
If a roof is installed without first obtaining an inspection, I agree to remove
mit hazardous air contaminants as defined by she Bay Area Air Quality Management
ixricn
all new materials for inspection. Applicant understands and will comply with
❑Yin ONa
all non-point source regulations.
have read the hazardous materials ad,do ran;s under Chapter 6.95 of the
California Healer.@ Safety Code, Serious 255115. 25533 and 25534. 1 understand that
If the oildog does nm cmoarly have aboa ,dol it is myraspmmibdity lodroy the
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occupant of the requirements which most be met Prior to issuance of o Cenifica¢ of
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Occupancy'
Signature of Applicant Date
All roof coverings to be Class "B" or better'
Owner or authorized urged Dae
UhhIG6