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01070028 CITY OF CUPERTINO EImLUING DIVISION, . ' • -PERMIT CONTRACTOR INFORMATION: - :BUILDING ADDRESS:. : PERMIT NO. — — . 10652 GARDENA CT JUST' WATER' HEATERS INC 01070028 oN �sT. . . .. .. ,.._,- '.r . r,.c '. .. _. APPLICATION S D NE�I liARRY / ATE . . ...... ...... — 1764 NATIONAL AVE 10 2001 PHONE: - (510) 293-9901 SANITARY NO. CONTROL NO. 7Wj ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Desch tion o heeby a�m that I am licensed under provisions of Chapnr 9(commencing REPLACE GAS WATER HEAP)ER. ioof vssicenseis in full forte and effect. LicenseCims Lic.Y k Date Contractor F u p�+ '+ - . ARCHITECT'S DECLARATION I understand my plans shall be used as public records y<f a ii o is Lensed Pmfesstowl _ =n OWNER BUILDER DECLARATION - y I hereby affirm that I am exempt from the Contoodor's License Low for the f !=z a following reason.(g coon]031 5 Bus nc nd Pr f. Code Any ry ounty - rma to consuuel.eld m ro - d 1'h,or re +t to h o onwhich remits, Pc P Parstructure - .. .. - $680 : ' - - w3 ,.pri t ire caul orc9 the applicant ofor Contractoruch permit s is signedChapeent. thot]t shenxd purelint to the pro sons.3 Contractor L' Le ons C erg (eo m mg wvh S<t ]000,) f D'vis'on 3 of the Eusiness and Professions Cade) ^ ! 1 ' 3 _ V'6-V/�C.6qa S +"h}i 'h j Valuation If of he is ex'enipi th tefor and the bass for the dlegdd exembnon.Any violation °" of Set 9031.Stinny onliwnt for a permit subjects the applicant to a civil penalty - - _ or of etnanfee wnareaaou 1($50H. LEI PLUMBIN - ENERGYOccupancyType X01 w ne of the property,or my employes thwages a-their sole compen5 r n: ! " 506 = GAS TEST -'will tl the vrrkmd the stionlare is not intended or-offered for sale(Sec sadProfessionsCode: ComfortLicense La d n t an f507FINAL.. PJit rkBlfs ec[ ions '. -.ovine f property Who builds orm h eo d seen work hielf ' or through his own employeesprovided tl at inch'improvements am nt intended or offered for sidIf,how the building - - - __ __. .... _ ... B P met la th one Y f mf theowner-builder 'illi [h Lard fpo ' gtM1 thedd not build - improvePurpose fml ). ❑1as a wo e r oRh e pre n7a esI elyc t mmg 2hI need fr, t vin - n th p le t IS ]014 B and Profession,ss o C de)Th Cnmac t License Law does not apply t no h y p , ad who contracts( such ujctst ommnar6s1.1' nsed.punuant.m the C. tis LccnseLa ❑ - - ...-. -: ... 1t mPtuntler Sec ' "`' " "'''-,',B&PCfonhis revson ,• "• ,..;•,;, Date WORKER'S COMPENSATION DECLARATION Phereby affirm under petmlty of perJury one of the following declarations: 1 ^O I have'und will maintain a Conilirl4c of Consent lm'mlf-insure far Worker's S ` Compensation, as provided far-by Section J]00'of-the Labor Cale, for the - ` - - performance of the work for which this permit is issued.., 111 h d will riatudiihn.Workers Camiuiryoioa Insuran- required by Section ' 3700 f the Labor Cod f theperf rman f the ark'f which this perm r i.- - issued.MyWorkers Compensation Insurance comer and Pole ii - - - - Cerner ._i.t "Polar -CERTIFICATION OF,EXEMPTION FROM.WORKERS(' -' '-1."4� .i:i 1 f. ' f4Fd. s_ COMPENSATION INSURANCE 1111i sedition'ne d not be completed if the Permit is far one hundred dollars - » t 1 I ttfY thato the pop c fa workfwh hthspe tis vs a 1 shrill t mel Y'a'"Is-- any nae n o t be come-object to the WorAers' "' -' - -- -- - •-ti. : Comp neat nn'Laws of Cut ifom ia.Date'- ...) APPlicdm_ NOTICETOAPPLICANT If,of..mkgth.C rtific t of,-xemFlt - yen shyuld - z bec me, bled m the W k r-C pe. t pm ' s of the Labor Code you oust O forthwith comply with such provisions or this permit shall be deemed revoked ' N.'~" v+;, .Ili by affrm th NSTarstconst of the'work for viii ch tM1 t le dnga n f th .- - - - � CONSTRUCTION LENDING AGENCY " IYj', 6e Y Pe fomi'nc< ssuW(S 309] C.C.t ..Lend s Name..-... _._. -_. ... ..._. . ._ _. _ ... .. _. .-. .. .. ..... ... .. ;D Lender's Address - - Uz • co. I cemify that have read th -application d state that the bove onfiernaraid,:s E.. rtet f e t o plY th all c tY and county dicta c ❑ ret I . f luting D,C) tob la ng t to adh by authorizerepresentatives of this city to nth, pen the alms,rainioned pro,orty for p C an rp es F.,.O. 1a e t indemnify. 1,lace,phma theway fC P n' ganef 'rn Ctheadline,indictmentsrose, a pe c li may m any y -rue.,amt,aid U-^ Clry As.ey NDERfth grin KDWILL ret APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL'NON-POtNT : SOURCE REGULATIONS:. 4 Issued by: Date Signature of Alplmant/Contrxctor, .Date: Re-COOTS - Cot HAZARDOUS MATERIALS DISCLOSURE I •'deW II to aper vm f t building ac p nt do orhandlen m 's mat -1 _ Type-of Roof .. f d by the C Pertto M n leIC°d Chapter912,and theHealth d Safety. Code,Section 255) (nl , No 'I it AIL roofs shallbe inspected prior to.any roofing material being installed. `t11 Will he applicant t i future building' p t ee equ pine t d 'mc wit' h Ifo root 1$ ]ns[alled without first obtainin an inspection;'Irartree'to remove th d ore utca-aefned by over HayArea ItyNI evitt,e m g p e °isi f1 all new materials.for.inspec[ion..,Applicant,understands and will comply,with . °w °N° all non point source regulations -� a have read the ha,moli terou's monourement,order Chapter 6.95 of th C I if a He lin&Safety C d Sections 25505 2553) d 25534 I nderst d Nm o'co,iam Idngdoe' tc nentlyh a tuthan my rep bltyt tit'th - - `-' - - - - oc cupthe requ remenw which moo be be met prior m iwuunce of a Cenifeme of Occupancy.:. . '. !, _.. .. .... _ . .Signature of Applicant _ - - . Date own« t o�xea ugen . Date„., All roof coverings to be Class B"or better OFFICE..