02100132 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTWINFORMATION
BmL1i ga0h8tsN FOOTHILL BLVD JUST WATER HEATERS INC PERMITN®21000132
OWrIJiKS(SVE:JOHNSON INVESTMENT CROU 1764 NATIONAL AVE APPLICATt9BC"IfpyDsY2002
IONI:: (-5-1—OT-293-9901 SANITARY NO.// 7 CONTROL NO,
ARC1fITLCT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECU
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woo LICENSED CONTRACTOR'S DECLARATION p
.-P I hereby affirm Thal I am licensed under prwiaionu of chapter Y(commencing REPLACE WATER IARTgkplion
with Section 7CkBol Division 3 ofine Business and Professions Cade.and my license is II6 1C.t(
in full fora and effect (10 0 GALLON GAS)
�z License Class Llex
0z;-
-o Dale Contractor
ARCHITECT ARCHITECT'S DECLARATION
yI understand my plans shalt be used as puhee records
OyU
usiipy LiccnwJ l'rnfcvinnal
3 OWNER-BUILDER DECLARATION
�ta P 1 hereby affirm that Thal I am exempt from de Conuactnr's License Law for the
se
O following reason.(Section 7031.5 Business and Pfnfesxinns Code:Any city or county
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I
m which requires a permit U)construct,alter,improve,demolish,or repair any structure 3 8 41
us prior to its issuance.also requires live applicant of such permit to file a signed statement
�o mar he is licensed pursuant hr the provisions of the Contracto0sLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation
pp
(commencing with Section Mar)of Division 3 ml the Business and Prnfcasiwnns Code)or
that be is exempt therefrom and the basis for the alleged exemption.Any violation of 32615125 . 00
Section 7031.5 by airy applicant for a permit Whjecls the applictin,a civil penally of APN Number
not more than fn hundred dollars(S5O0). 502 - FINAL PLUMBI G ENERGOccupancyType
0 1.az owref of the property,or my employees will wages az their role compmuaion.
will do the work,and the supclom is not intended or offered for sale(Sec.7844,Business 586 &AS TEaT
Q®µ�pq�{���¢a,�
and Pmfessions Code:The Contractor's License Law does not apply les an owner of 507 - FINAL f MJC1S'fIWcctions
property who builds or improves mercon,and who does such work himselfor brought his
own employees,provided that such improvemenu arc not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving Nat he did not build Lir improve for purpose of
Galt.). Y N NB!� .tk-T gym-g3
1.as owner of the See71property,em exclusively ineancontracting with licensed contractors m
conam a d project(Sec.oast Business and Professions Code:i The Connector's std
whoclawdoesnotapplyjean owner ofproperty who
ce buildsorimproves Oberman.and j � ^OO�
who La contracts such projects with acnnvacmr(x)liccnxd pursuant the Contracmr's NOV1Y L
License Law.
0 l am exempt under Sec. ,B&P C for miu n
Owner Dare BUILDING
WORKER'S COMPENSATION DECLARATION
I hefeby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Cerificata of Consent to self insum for Worker's Compen-
aatioo,u provided for by Section 37IB of the labor Cee,for Nrformce
Ne peanof the
work for which this permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,u required by Section
I'M of the Labor Cale.for doe performane,of she work for which Nis permit is issued.
My Worker's Compensation Insurance carrier and Policy number arc:
Code, Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Criissectiom need nm becompleted i(de permit is forme hundred dollars(51(0)
of less.)
1 certify that in the Performance of the work((it which this permit is issued.1 shall not
employ any person in any manner m as m become subject o the Workers'Compensation
Lawsof California.Dale
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should
become subject 10 the Worker's Compensation provisions of the Labra Code,you must
OO forthwith comply with such provi.vions or this permit shall be deemed revoked.
z' y
CONSTRUCTION LENDING AG
[-. I hereby affirm that mere is a construction lending agency lot the perlirmance(it
(.ti me week for which this permit is issued(Sec.31)Y).Civ.C.).)
Clenders Name
7 z Lenders Address
U O 1 certify teal I have read Nis application and store that de shove information is
Ly F^ correct.l agree mcomply with all city and county ordinances and scam laws refining to
DU building construction,and hereby authnrire representatives of this city to crier Upon the
ahnvn-mentioned judgm property for inspection purposes.
F 6. (We)agree to save,indemnify and kap harmless the City of Cupertino against
N inconsequnce of the
costs bating expenses which may in anyway acme against said City
U z incnnseyucncc nl the graining of Nis permit.
'-' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by: Date
SOURCE REGULATIONS.
Signature of ApplicardCondractor Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE handl Type of Roof
Will rheeCucxmor future building occupant scoreor handle Braids aGmaterial
az defined by the Cupertino Municipal Coe,Chapter Y.12,and the Iicaim and Safety
"MLCode.Seninn 25532hr?
❑Yes 0N All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant or future Wilding occupant use If a roof is installed without first obtaining an inspection, I agree to remove
pp g p a Air Qu of devices which $ p
Districts us air contaminants asJclincdbythe Bay ArcaAirpualiryManagement all new materials for inspection.
Disvlc@
0Yer C)No
I have read the havaNrus materials requiremene,under Chapter 6.95 of the Cali for-
not 11ea1th&Safety Code.Sadons 259)5.25533 and 25534.1 understand Thal if the building
docs ma currently hare a moot,mat it is my rearymsmildy m madly the occupant of the
red,mmoscreswhich must hemet prior tocousneenfaCerificatenlDecrier, Signature of Applicant Date
Owner Lir mhoutml agent Dale All roof coverings to be Class "B"or better