01010101 C17Y OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BVILDING ADDRESS: PliRMIT NO.
19991 LL CT. JUST WATER HEATERS INC 01010101
OWNER'S NAME l, . APPLICATION SUB DXIH
1764 NATIONAL AVE 01/3/2001
PHONE: SANITARY NO. CONTROL NO.
(510) 293-9901.
�ro0 zo ARCHITECT/ENGINEER: BUILDING PERMIT INFO
m C BLDG ELECT PLUMB , MECH
zal�i«
Z Hz LICENSELCONI'RACfOR'SDECLARATION Job DescriptionO a 4 G thereby slam that I am IicenseJ under provisions of Chnptar 9(commencing
av�Cµs with Seclinn'1t100)nf DivlsinnJ of lhu llusincvs and Professions Cnde,onJ my license
N y fis in full farce and effect.
ca�a Lmerm cross I.;p.M REPLACE 75 GALLON WATER HEATER
3 i- Dete Canlmctor
t� ARCHITPUI"S DECLARATION
$P
l50 1 undersmnd my pians shall be used m Puhlo,rmmd, -
a z p O Licensed professional OWNER-BUILDER DECLARATION
1 hereby aRrm that 1 a exempt from the Commetor's Licce Low for the
C a thllowing Indun.(Seat.... 1 S
i903en
Bo,loevs and Probo,imis Code Any city...manly
f S o which requires a penal to construct.after,improve,demolish,or mpau any structure -
iPnnnoir.v indance,aBn requites the applicant for such Pemil ro filcasignN natemem '
tnathe;.Epm.eawrsnantratnepct,.nn,nanrmacamrucmrsLipmsLaw(chapter9 Sq. Ft. Floor Area Valuation
by any applicant for
(commencing wlth Section 70kd o1'Division 3 of the Business rand Prnfessians Code)
,,,,but he is a,mnpt mea�rmat:ta,]the basis rat the alleged exemption.Any violation $1638
of Section WD 1.5 n Pemit subjectsthe applicant a civil Penalty APN Number - Occupancy Type
01,ac owner(11 rite property,or my employees win,wages its their sale mmPconmion, UIVI
will do the work,and the structure is not intended or offered for sale(See 704J, 'Required Inspections
Business and Professions Core:The Comical License Low m m does napply an
w of propcnmq
y Who hudd%or improves thenand who Jens such work himself
or me
through his nom employees.provided that such improvements am not intended , 502 — FINAL PLUMBING ENERGY
ntfemJ for n'lde If,however,the building of improventenm is sold wtrain one year of
„n,led...., heawner.baildar,wilnmveme hunknuf proving —
idrm
Mm hedr build 506 GAS TEST
improve Tor purpose nf,ala.r
O L as owner of the prior",am excham
;vely comeang with licensed competitors to 507 — FINRL PLUMBING
ism et the proved(ape.IDW,oRoutines,rrorand Pnd'as.,ions CnJo:)Thr improves
thereon, 5
1 arose Law docs not apply c man owner of apmlvnyIonto why builds or improves thio the
and who enmmen for such projects with a coatmcmq.,)licenced pursuant n,the
ECr ll matorsld ae Law.
❑I um exempt undder Sec � ,If.@ P C for this reason
Owner Dude /
WORKER'S COMPENSAnON DECLARATION
I heathy affirm under penalty of ryrjury one of the following Jeclarvtinns: n�
p 1 hate and will mtinnin a Ceailicme nl Consent e,self-insure far Wnrker'x
Courts,...far. as pn,vided for by Section 37M of the Labor Code, for the
perfomanee of the work for which this Permit is issued.
01 have and will mai main Worker's Compen,nlon Insuranm,ns requited by Section
3701 of the Labor Code,for the perA inure,of the work for which this permit is '
sued My Worker's Compensation Insurance carrier and Policy number ate: -
Carrier. Policy No.: '
CERTIFICATION OF 1 XE.MPTION FROM WORKERS'
COMPENSATION INSUIIANC17
(Thi,section need not be completed if the Permit is for one hundred dollar
1SIINq or less.) -
I certify that;n the perromance afihe,wort far which this pcomi,is e,sum.I
shall not employ any person in any nurner sn as t0 become subject to the Workers'
Compensation Laws of Colifomia.Date
Applicant
NO]ICH 10 APPLICANT.IL after making this Certificate of lixemptint.you should -
bemme subjectto the Workers Compensation provision,of the IzWr Cnde,you most
0 forthwith comply with such provisions or this permit shall be deemed revoked.
7 CONST RUG I ION LENDI NO AGI'.NCY ,
71 herchy affirm chat there is a constmcrion lending agency lin the Performance.
.1 the and;it,,which this pemit is issued(Sec 3197,Civ.C.) -
(� Lender's Name
u. Z I,rdios Address
V I really that l have mad this application and state that the above information is
correct.1 agree to comply with all city and county ordinances and state laws telu ding
4.1 to holding construction,unA herchy mahorue reprcaemmivesnf this city to anter upset -
cry the abate manicured pmpcny for im,efion purp...us.
E.r A. (We)agree to ave,indemnity and keep hranmless the City of Cupmnion against .
IA bahiline,,judgments,cusp and expenses which may in any way emrue against said
City in consequence of the granting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
SOURCE REGULATIONS. Issued by: Date '
Signeluroaf AppheanurC:mtmmar Dare Re-roofs
HAZARDOUS MATERIALS DISCLO.ORE
Will the applicant nr furore h,Ildinga,.vpam,mrc or handle hvurdim,material Type of Roof
a defined by roe CaTcu no Municipal Cn I,Chapter 9.12,and the He d h and Sroa,
Code,Section 25532(u)'l
0Yet, 0N All roofs shall be inspected prior to any roofing material being installed.
Will the aP,I"ra, ,r mare bmishngocrupal ase wnipment r,r de'vim.which If it roof is installed without first obtaining an inspection, I agree to remove
. . noir hamalom air a....I In ins.isdetined by time Bay Amu Air Quality Management
District', all new materials for inspection. Applicant understands and will comply with
Dyes 0N all non-point source regulations.
1 have read the hazardous numerals remlrcntents trader Claupmr 69 of the
CMifornia I Inith&Selet,Cade,Secaina,25505,25533 and 25594.I understand that
if the building docs nal currently have u tenant,that it is my responsibility to notify the
occupam of rhe regarcmen6 which must be amt Prior m mouton,of a Cenificate of
Cre tion, ' Signature of Applicant Date
Ownermaathnnmdagsmr Date All roof coverings to be Class "B" or better
OFFICE