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03120069 CITY OF CUPERTINO BUILDING DIVISION PERMIT *MaR IN 'O N AT-ION ' BUILDING ADDRESS: PERMITNO. f HOT WATER INC 03120069 OWNER'S NAME: PERMIT ISSUE DATE LTN 25-11 GRACELAND AVE 1ARCHITECTIENGIN NE:SANJA SANITARY OL NO. EBR: BUILDING PERMIT INFO BLDG ELECT PLUMBMECH ] 0 0 0 0 yOi] LICENSEDCONI'RACIOR'SDECLARATION Job Description 1 Wroby aflbm Nal I am Ikenwd uMer pmvisionsof Chapmr 9(commencing n X26 mthSmdon7000)af Divisi0.3 ofthc Businru and Professiuos Code,entl mylicuucB 666 in full force and � j. Licenaua — Lon.A �- n(Z REPLACE WATER HEATER alli Oaw cW osmir uv titj ARCHITECTS DECLARATION 1 unM std©plany.Wl�ysW u public mcmds 3 wyJ� Licensed Pmf ns tC �� 4.0J OWNER-BUILDER DECLARATION T 0 @@ 1Mmh,nam M.(Section n 1 em exempt from tW Contractors License Law for mW OC followingrisen&.emith7 onto Bmimssand Professions Oda:Any city or county $ which its issuance. •Permit re eonwucl alar,W for such h Permit er t t ri e a sig any sttmwm txi thathe its ivuudinumu requires the, ovisio so for soh Petor's filca Law(ed ahapter t Q fe unmeaningwdpsWontrotheproVivisNmfthe aftheBsinem LIWnaeLJimusCapIR9 Sq.Ft.Floor Area Valuatio ^ (hommcnc unmeaning section 70nddo Division?theseBed exemption. dProfessions Cade)at � thn W V eumpt therefrom and Use bub far we alleged eumpton.Any Wotadon of Section 7031.5 by My applicant fm a permit aubJecte the applicant to a civil Penally of 3 0 Occupancy Type not mom than Eve hundred dollars($500). 1,u ansa of the property,m my employees with wages u their ane comPehaadon, will do the work.end mhaawmum is not intended moffend forsake(See.7044,Busimuss and Prefesswns Code:The Conoocwre Liceme Lew dam not apply wen owner of Required Inspections property who builds orimprowa tumors,and whodoessmh work hism, Uhpmjll 14 ownemployees.provided thusuch lmprowmema mount inwiwmar on fir We lf. ,(�howew,the Wilding or improvement is sold within ane year of ample .the OwwrrvV �/ tWilder will law the WNer of proving that he did not Wild or Wprof purpose o )' ^,sok.). 1❑h u owner of W pmpeny.am exclusively contracting withlicensetracwmmmosuuct the project(Sec.7044,Business and Professions Code)Thetnnora LIJ ' moose Law does nm apply to an owner of property wa Wilds or impm tMtaan ^^^who contracts(or such pajama with a contracmrts)licensed punt- CbmradtaY! ED Licaose Law. I ern exempt under Sec ,B R P C for this msam Owner Dow WORKER'S COMPENSATION DECLARATION 1 hereby a(Oan under penalty of perjury am of the following dmlantions: Linwood and will malnuin a CeNOcaw of Consentwuif-imum fmworkdaCompcn- ratlon,an provided for by Section 3700 of the labor Code.fm the Performance Of the work for which this permit Is issued. ❑1 haw and will maintain Worker's Compensation Iran==,as requited by Section 3700 of the Lear Code.for the performsoec of the work for which this permit is burned. My Worker pm ensetimbismancemnimand Polirynumb�f Grricr. vN� Polity No.: > l0 CE TIFIC O OF SATION70N FROM WORKER COMPENSATION INSURANCE (Thi auction wed not W completed if the permit Isforone hundred dollam(Slip) or less.) 1 canify that in the performance of the work fm which this Permit Is issued,I shall not employ any person in soy manmr so at to become subject to the Workcri Compensation Laws Of CalifOmia.Dow Applicant NOTICE TO APPLICANT:If.after making this Certificate of Exemption.you should become subject to the Workers Compensation provisions Of the labor Cmc.You must Q forthwith comply with such provisions m this permit shall W dcemm invoked. z N CONSTRUCTION LENDING AGENCY (~ I toothy Affirm that Vert is a construction lending agency for the performance of y'7 to work for which this permit h banned(Sec.3097,Civ.C.) aQ Lender's Name Z Lenders Add. me w u V O 1 cenify that I haw mad this application and futhat the&Winformation 0.0 cement.I agree in comply with call city and county ordinances and saw laws mluing w 0 Wilding construction,and hereby authorise reprommadws of this city in enter upon the (27 save.mentiomd property for impend.pulp=& (We)agree to saw,indemnify and keep humless the City of Cupertino egsiost / y liabilities,Judgmeno,costa and expenses which may in my wryaceme agunalaaid City U Z in conaugmnco Of the granting of this permim. .. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE BrffNS. �GLP (?,(IL�O� Re-roofs Signature Of ApplicamXonttactm Duero HAZARDOUS MATERIALS DISCLOSURE Type of Roof WIII the applicant or future Wilding oecupont store or handl.huawom material as deMol by tW Cupertino Municipal Cods,Chapter 9.12.and the Health and Safety Cad..Sectian255320)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes R Will the applicant Or home Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove It Nosou.air conuminanu an,dermad by the Bay Ame Air Quality Management all new materials for inspection. District? ❑Yes I have mW the hvaNr 6.lsmquimmenuundc,CMpwt6.93oftheCalifor- niaHml"SafetyCalc Sccdns25305,25533ad25S34.lundcmand maifthe Wilding does not currently how a wnanm that It u my rupomihillty to notify the Occupant of the mquimmnna 'ch bean pdatwiavmen cera emirate oflcp Signature of Applicant Date 6G GQ 4? ��ZI 03 All roof coverings to be Class"B"or better Owner orwthorivwd agent a�¢ CITY OF CUPERTINO csv G g WATER HEATER CUPERTINO PERMIT APPLICATION FORM APN # 2 013 Date 2— 101 O?:> Building Address:) 035 Owner's Name: Phone#: ass - 73'/0 Contnk:torO f w Phone: License#: Contact: Phone: Cupertino Business License#: / Building Permit Info: Bldg ❑ Elect ❑ Plumb Ili Mech ❑ Job Description: Aopjo6Z , . 1 titer. Residential Commercial ❑ G Cost of Project: CO5 • Strapped ❑ On Platform ❑ Bonded ❑ New Location ElRe lacement Qt •f A is le Fee m Fee Description Fee Group BPWHEATER Water Heater/Vent BUILDING PPERMITFEE Plumbing Permit Issuance PLUMBING BENERGY Energy BUILDING BUSLIC Business License BUILDING 0 3 Z E. 61