01070030 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
11410 GARDEN TERRACE DR JUST WATER HEATERS INC 01070s0y30
DV6W A10I-YIN M AND CHU KATE 1764 'NATIONAL AVE A07G/100/ 2001
t PHONE: (510) 293-9901 SANITARY NO. CONTROL NO.
0,-6
0Z ARCHITECTIENGINEER: BUILDING PERMIT INFO
<U BLDG ELECT PLUMB MECH
<i GI r= IJ CJ
LICENSED CONTRACT'OR'S DECLARATION
5„? Job Description
Sectionhemla, that REPLACE ELECT. WATER HEATER.
p�F_w is in full ho eu 0).fDivision 3 onhe ensure:sand Professions code,and my license
m S j is in full forte and effect.
z NNa Liccnsc Class SIGN
K O eclat Dare Conn.,,.,w 3 u u t; ARCHITECT'S DECLARATION
F� O¢� 1 underswntl my plans shall be used as public r¢ords
6 p Licensed Professional 7
OWNERBUILDER DECLARATION
w I hereby affirm that I am exempt from the Commoner's s L' La for the 1 Y�0 following reason (Section 7031.5,Business d Pr fie.i m Code A y ',, county $1 0
which m,a res a permit t Consumer,t erlilt approve.demolish p y dominate
Print-it , cera also req ' th eppl' tf n ch petmu file.st,rodlicampartthat he cams witormardh
tdthe p ivisinftheContractors Le . Law
masC(Chapter 9 tW� �,�P.',1�,y. a Valuation
or mmnc a th Se lenom and the basinooRhelegd es IUP fAny vi C°del Q, 1 ,1's'7 r3-T.g -C Z.C, anal i Tf'''
or that he is exempt therefrom and the basis for the alleged uemant to any violation
of not
703 n v any applicant for a permit subjects the applicant to a civil penalty
502APNI��IL PLUMBIN ENERGYOccupancyType
❑h as owner hewalk;and property. my employees intendedth orwages fe edfar compensation, 506 GAS TEST
will ne hewalk;lsters ode:The is no, s tl e offered for snot(Sec. toa n - 507 - FINAL PlJ(�I>pi&MsPections',
Business property Who
Cale:The ori the is License Law does not apply to an
owner of property Who builds or improves thereon,and who does such work himself i
or hisfa his own l ply provided tom such erient improvements are not intended or t
'sale IEh in bidding us sold within one ear of
offered f gorurden of pro y
completion,provthe owner ba Iden will have the burden of proving 0a be did not M dd or f '
improve for purpose of sale.). �
41 of the p peny a.exioas lyComputing with licensed ontnwt r a + Y' ,
_ License the oejcet(Sec TBaa,Busies and Professions Codd:)The improves
Contractor s _
License Law does not apply to an owner with
pinata who builds ar.prous r thereon, -
i
_aced who comrsns far such praJects wth ac°mmnogs).ticenseJ.pursuam m.the. .......... ..._....._. . - _... ... - ..... _ _. . . 7 .. _. _._.—__ _-___.._.. _._. _._. ..____.
Col a.
Contractor's it under
Law..,., 1
❑lam exempt under5 i.t �,B&PC,6nhis mason ..
OssncrqDate l ,
'WORKER'S COMPENSATION DECLARATION
Phereby affirm underpenal,y of pr,my one of the following declarations:-
_ ❑ I have and willmaintain a CeniGcdie of C°nietn to selhiasure for Worker's
Compensation,asprovidedfor by Section 37W oftheLabor Code, for the
performance of the work for which this permit is issued.
°I had,and will maintain Workers Compensation Insurance,as requires by Section
3700 of the Labor Code,for the performance of tM1e,work Car which this permit is
issu d MyW kis Com peiso tion'In mer and P I y be,amt
s: Camerrs
CIN OMPENSAehey NN5URn, ., s , Yr , .,n6 .. - -_.... ... ...........
CERTIrICAT10NOFEXEMMON FROM WORKERS',.” C •. s is.i.l .' s a.,l.vj.
of secilnn need ndt be complet d if the permit is for one hundred dollars is
(SI W)or lean.)
I c rr FY th ny tM1 pert din ce F th! k f OM1 a th' pe t s kern' _ 's•
C u not employ any permn m any manner co as m;become tablet[hi Worked ,
Compeacution Laws of California.Date; ,
.Applicant .n .__..-
NUI ICL TO APo the Work ryf.afteNor mak nio this Certificatesof f Exern o al,y hould t
become subject y the Worker s vii ions or ti is provisions of the Labor Code,you must
Q O forthwith comply with such provisions or this permit snail be deemed revoked
CONSTRUCTION LENDING AGENCY
1
h by. F that there - -t t lending YfthPerfor_
n ce
of h k I which tM1 permit ss.d(S c 1097 Ci,C
-Led cNu _ '
,
o
Z Lend eall Address - ..
I certify that 1 have read this application J tam that are above information is
V � ycity
and
nt s
correct.I agree to comply with all city and county ordinances and vac Imvs relating
O.V tab Id g t"u sadh by' th p t i es Of fl City to ter upon
rW theb
Ay l r p t pp T .
0. (we)."' t a J rify and k hamleathe a fC pe
t aga
Vi liabilities,judgments,costs d pence which may, any%sy me against said
^ City nfin,g t g°f thisa tat '
PPLICANTUNDERSTANDS �L�`-p✓,k/`f`//y v,pI`
vy
AND WILL COMPLY WITH ALL NON-POINT`
SOURCE REGULATIONS Issued by: Date
SIB at f Applic'{aZARDOUS1Mn ...7. ' Dater Re-roofs
TFRIALS DISCLOSURE
Will theapplicant or future drifting a pntstmc of handle tradition,it I Type of-Roof,
as defined by the Cup Imo M n cippl Code Ch pt 9.12, lid(he Health ad Safety
s x 4 ` ,'
❑Y. ❑vns roofs shall be.inspected prior io..any.roofing material,being installed. .......
_..._.
w u.th ppl' t or farm building mcu,ma use eq ipment or de rocs hien: If a roof is installed without first obtaining an inspection;'I agreerto remove
ei th d ,r cot a t as defined by the Bay Area Air Quality Management:
D t t ng all non-poinr all new t sou for inspection. Applicant understands and will comply with
❑Yes " „-°Na . - - -
rte regulations,- s 1 ,
1 have lead'he Incautious materials iequiremcnti under Chance,6.95 of the
Califomia Health At Safety Cnde.Sc,,ions 25505.25533 and 25534.l undemmnd that= _
' _ifthe building does not Currently have a tenant.train is my responsibility m notify the -
Ocp y i Of a Cenifcam of
,°c p lit nM1r�rr < tents wmrn'act b t t s Signature of Applicant Date
qu m p,or
.. ... _- -_ .. .. ...
Owner or.ipm0(1)Ld agent; Date All roof coverings to be Class "B" or better.
OFFICE _ ..