02010104 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21114 GREENLEAF DR JUST WATER HEATERS INC 02010104
OWNER'S NAME: APPLIC TION SUB DATE
TAKANO TAIKO 1764 NATIONAL AVE 0128/2002
PHONE: (510) 293-9901 SANITARY NO. - CONTROL NO.
00 ARCHITECGENGINEER: BUILDING PERMIT INFO
U^� BLDG ELECT PLUMB MECH
<E4 E= LJ LJ C_7
" LICENSED CONTRACTOR'S DECLARATION
0 5 re Job Description
O z 1 hereby aRw Net 1 am licensed sins provisions of ns Code,and
mme+wing P
FHF with Stttion]OIMI)ofDivision 3m(NeBusiness and ProfessionsCode,andmyliccnse REPLACE WATER HEATER.
is in full(lace ala eeen.
��� Lieenae fans, Lie.« (5 0 GALLON GAS)
KO i U Dam Contractor
3 u. ARCHITECT'S DECLARATION
C 0 5 1 understand my plans shall ho used es public tecmds
O O Licensed Pmfns,onal
o OWNER-BUILDER DECLARATION
to 1 hereby uffiw but I am exempt from the Convenor's License Law for the
E?< following reason.(Section 7071.5,Business and Professions Code:Any city or county,
N
u°'139❑ which requires a pewit to construct,alter,improve,demolish,or repair any structurepiano its issuance,also requires the applicant for such permit to file a signed statement. _ .._.- -
that hetiSlicensed Puritans tothe provisions ofthe Conoacm(s License Law(Chapter 9 f S Ft.,y❑❑ylo rArear> Valuation
(commeneing,with Section 7000)of Division 3of,h.Busious end Pftrepsions Code) Y,\rsi�, 1 r ^x'q.• 1.aA'. Q°i.,.y,It���„-tcijl,`'� '
or that he is exempt therefrom and the basis for the ellagid eiemp tat.Any violation !
-of section-7031.5 by any applicant for a pewit subjects the applicant to a civil penalty. 1 Occupancy Type
of not more than five hundred dollars($500). Ap umber P R' '
❑1,as owner of the propeny,or my employees with wages us their sole compensation,
w H doth -w rkr'end the swaure Is out intended oa of and-for'sale Scc:7d,Ft,-
Business and property
Who
Code The Contractor's,License
and w law does not apply to an 3 03 - ROUGH MH F1hiSl>dd CdAlJacnons
,
. :b
owner of hhiso Who budds or improves thereon,and who dues such work intended
or
o e through h' own howl y p 'd d that such pro,is sols ore not,mended m 3 04 ROUGH ELECTRICAL
Ntercdf -I:Ifho - -thell Iver imp-- mvingtathedidnotWiaiof 505 - FINAL ELECTRICALn:IT..'• r.. f. •r:
----------
completion,the owner bmld<r will have the W Nen of pmnng thin he did not Wild or
improve far pmpoee of axle.)' 507 - FINAL PLUMBING
_ ._ . -
❑la.owner of the property teasels ely comm gwnhlanxd cmntrumnm SOS '= FINAli MECHANICAL '"" ';;' e". :R,•I'.'.=r,
to not 'et the project(See 76 Business end P f sial.Cade)The Conuacon'a t S. F
License Law does not apply to an owner of property who builds or improves thereon, '-` '' - '
e.c, ;
It.
. p WORKER'SProjects
COMPENSATION DECLARATION
C farina m the _r
s _"_. .."..._ _.._...._
and who ca tracts fL such lite ecs.w Ih cmnwnor s licensed. urs _
Contrvcto License law, -
❑la em r Me Stt �' this ma
line D m
1 hereby air,.trader penalty of perjisy one sf thehe
following declarations:
- ❑�1 have end will maintain i'Cenificaie of Corsican to'as"'mam for Wmvcr's
Compensation, A. provide for by Section 37M of the Labor for
far he
performance of the work for\ i-IPermit is i
which this Peit issued. .
T. L.
01 have and will'ma main Worker's Compensation Insurance;as required by ghnion
- 3700'of the Labor Code,for the performance Arita work for which this paint is
issued,My Workeri Catniscrudion insurance camer,and Policy number are:
C1� . policy No a
N 1,OLRTIFICATIONOFEXEMI710NFROMSWQRKERS's C.
Nh N iisAl�. nt �T'� c.h,,Pya,t it¢;xt t:L;
-,, "COMPENSATION INSURANCE,
' • " "p c,T `permit is far one hundred dollars:,. •_�-._- .. _ _,,..,-...-... ______._.._._...„,,,,�,......,-
-iTh
+sseetiuhneeJ not be cum toed if the �P :"dl:%:✓ 1 -,.
(SIIXI)nr less.)
,
c rt fy th t'in the'performance of the Work for which this permit is issued,l
ih II n t empl y any ficr,.Aany rhminer A.as m hecmm object to the Wdras •`
Co icnt.o lI.I (California.' 'Doie
-Appl
NOTICE TO APPLICANT 7r ftemnpkm_g th Certificate ofExemption, u
should
beta umpothe tankersminpronmsmine ttlyou tensecQ z forthwnh'colwith prosmi..,or this pwn hall bedteed--oked.Z C - ._. , ..
__ .. _..
._--- .. _ __ .. . .._..___....._ _ ... - .._._...__._ .__ _ __._ _ _ _ _
I' ' - '' CONSTRUCTION LENDING AGENCY
, r
a�' i' 1 hereby a1Lmt that there1.a const c1 lending Asian,to,the p nfuntan'h •r.;L
Ott
ark for which this Forms is issued(Sec 3097,Civ.C.)
�+ .... t _ ____________ _
.. t. .. tr.�:. .._-Twit.:._.. _....A'.._ .a,.:. ":._�.:. ."... _ "._.... ...__.. .. ., ..
L:Q, Lenders Name—'- ----------- -
. r^7"Z L-erder',Addorax
V 0 .1 certify that l have read this application and state th rhe above information is
chsrem•'I agree to comply with all city and county ordinances and,state laws miating
2$D:V rebuilding our suution,and hereby atohoriterepresentatives dfihiicity to-enterupon p%n/,,/�t,(`//t//1 �/P.
F W Ne edne-mentimncd property for inspection purpoxs. „ _ ,_, —,7x
'/I`' '�- V �
.6, (W)agree tee c nd nify and keep harml s the City of C penins against
_ -R] liabilities j dlinci costs d expenses Which may in any ., me Against said
`V Z Cay a nmgTo'a of the granting of thispermit'
APPLICANT UNDERSTANDS AND WILL COMPLY,WITH ACLNON-POLY("' �`
- ' SOURCEREGULATIONs , , " Issued by: Date
Signamrc of ApplicaMCommcmr e. . r. :"base'- Re-roofs /
' HAZARDOUS MATERIALS DISCLOSURE x -
jy W I th jq+l¢ t r(rase W d ng scup m rt+e ca h idle haxallou. matewl Type of.Roof.
as dd' dby theC pamnM plCcNe Ch pt 912. nJ,h Halth and Surety I - " "" •"" `•'"'
Crtle ah.S Ft(i'y11 , I r
s A r•. )i>, twa. t .�.
_ Allrogfs shall e ins pected,prim,m any roofing,material_being installed..-
Aran
nstalled
'Ar ,With__ppl mart i altsWngoccupantuseegmpmemordev¢As Which If a roof is ifistalled'without first obtaining an'inspectioii;1 agree tolremove
em t h Nos o nam na is u defined by lilt Bay Area A Qual ry Attention
°in01 all new materials for inspection. Applicant and will comply with
❑Yes a❑Nn q P .k .... .._ ._PP - .....
all non-point regulahons
I,ha a revel the huardous'mmenals re mremenn.under Cha mr.6.95 of the
H meta Health'&Safety Code.Senilis 25505.25577 and 255]4 1 understand that
ifthebuddingdnesnmBuncntlyhaveusti,c.Ihmitismy responsitiiliry,til nidi(y the
mcdpant of the requircmemi which muni be met odor tb issuance of a Ceniacose'of
a pan- " Si nature of A Ticar Date
Owner mgmhmsted agent " ,,• -.,Da,., All roof coverings to be Class B or abetter '
.OFFICE_. ._.. .. .__