03020089 CITY OF CUPERTINO ' w'<
BUILDING DIVISION PERMIT VCOA RACTORUNI' MTI ,N $
BuILI)INGADDRESS: HOT WATER INC PERMIT NO.
20727 GARDEN CREST CT 03020089
NER'S NAME: 2531 GRACELAND AVE PERMMLSSUEDATR
JIAN LIU 02/21/2003
NE: —8494 SANITARY NO, CONTROL NO.
ARCHITEC AINGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 LICENSED CONTRACTOR'S DECLARATION O O O O
1 W.by air,,.test I aro limmoul under provisions of Chapter 9(commeacing Job Description 9 Q��
with Smile.7")of Division 3 of the Business and Profevime,Cadr.md my license is FONAr7mE' •'
to«ohm Cl ands 3 �G REPLACE WATER HEATER
t
Dam Caesarean r//19 - JUL 's 7 2003
ARCHITECTS DECCARATION
1 undersand my plan..hall W weed as public records
le
k at Licensed Pmfcviontl 1 p 1
oI OWNER-BUILDER DECLARATION BUILDING
<S 1 hereby M.that I em exempt from time,Concamer's License Lew for the _
y G 0 following..air(Section 7031.5.Business and Professions Code:Any city or county
which requires a Permit in comader,start,improve,demolish,or repair any structure
_zy prio,1.is issuance.also requires the applicant for such Permit to rile asigned statement
£ < that be is licensed pmmanuo the provisions of me Contractor's Limn.Low(chapter 9 Sq.Ft.Floor Area Ion
y FC$ (commencing with Section 7000).(Division 3 of the Business and Profeuimin Cmlc)or
3 that It is evinpt memfrom and the trials for the alleged esemMion.Any violation of
Section 7071.5 by any applicant for a permit subjects the applicant to a civil penalty of
an,mate men fin hundred dollars(M). �' Occupancy Type
❑1,ss ownm of me proPmty.oe mY employcca wire wages ss theb sole compermAOon.
willdothework andme.nclumhnotinaM dofofertdforsate(Sm.70",Bu6ness 592
and Profcsomr,Cade:The Convector's Liave Lew does teat apply a an owner of 506 - GAS T air nspecUons
Property who Wlkhruimprons themon.endwhodoessuchwink himself.,through his
own employee,provided that such improvements one amt inaMW moRered form]&B, 507 — FINAL PLUMBING
however.the building or improvement is said within ane year of completion.the owner-
builder will hon she burden of proving mat he did not Wild or Improve for purpose of
meJ.
❑1.as owner of the propcny,am eselusivdy contacting with lianxd eonhactma m
corahwct the project(Ste.70.4.Business cod Professions Code:)The Cant.our's U.
mine law does not apply to an owner of progeny who Wilds or imprans Remain.and
who conch Im.ucM1 lockets with a contractor(,)licensed .at to the Commences
License Lew.
❑Iamcirmitunder Sec. ,B&PCfmdd, son
want Date
WORKERS COMPENSATION DECLARATION
1 hereby slBmt under Penalty of perjury ore of the following declarations:
1 have end will meinain a Crnlficaaaf Coruem toself-Insert for WmtrbCompen-
anten,v proNded for by Section 3700 of the LAhar Code,for the Performance of the
wink far which this permit is issued.
wr I maintain Wmkees Compensation Insurance,ss required by Section
Pip of me labor Cade,for the performance of the wort for which this permit is Weed.
My Wod.e.Com ./down ln,su/gnce cen(v end Polity number am-
'
7r
_�� // /'�"u'�Policy No.: s7 e-7
CERTFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tbham,tlon need not be completed If the Permit s forme hundred dolls.(SIM)
_.._ _ ver lines)
1 ttmifY that in the Performance of the work for which this permit is ivad.I dull not .' -
cmPloyanypersoninanyRennerurssbbccomesubjecUotheWortrriCompcnvtlon .
Appl
Laws of CelifomiA.Date
NOTICE
NOTICETO APPLICANT:If.Co ro@Ing this Certificate of of Exemption,you should
become subject p the Womker's Compensation provisions of ac char plea you must
.JO faMwithamPly with such prnvisinvmthis permit shall Wdccmcd minted.
Z�
CONSTRUCTION LENDING AGENCY
[+ Ihereby affirm that Bert is a construction lending agency for the Performance of
!Ys Y
the wink fm which this Permit I$issued(Ste.3097,Civ,C.)
0 Lentim's Name
a z (coach Address
U Q I amity that 1 hove and this application and sue that the shave Intermission is
it,Hcorrect.1 agree in comply with all city and county ordinances and sum laws minting to
p U Wilding construction,and hereby euth de,mprnsenatins of this city in enter upon me
4g( ahon-mentioned property for inspection pugpses.
gy (We)agree re sive,indemnify and keep harmless due City of Cupertino against
h liabilities.judgments,costs and espeases which may in Any way accrue against aidCity
Uz in consequence of the granting of this Permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WI ALL ON-POINT Issued by: Date
SrCE REGU LATIONSf�
3 1� Re-roofs
Signature of ApplicanUConmscar urs Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle h macem memrid
M defined by Re Cuanino Mmdetru ode.Chapter 9.12,and the Hcelth end Safety
ade.S iY.25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
�Yca o
VIII the applic r rota building oaupant use cquipmal or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit Jr.-adnm air con mine ss carried by the cry Ame Air Quality Management
District? all new materials for inspection.
❑Yes ❑Nu
Ihavereet RehararcUon2eri.255uiadc 534.luChapter iffine Wilding /�
dies nolm Arently Code,Meant, 25t it to 5JJand255J4.I W runt the
up Wilding i / '41does not currently have•mnmL met h ls my resporaihiliry u notify the upant.f the li(y(
nequiremuraw Chrn S pnonuiuuenaors Cenirc. of Oc pencY, Date
C/.i'KA/• 1vel ter �� Signature of pelican[
Owner or authoniust Agent Dae All roof coverings to be Class"B"or better