01100058 CITY OF CUPERTINO
BUI.DINGDIVISION PERMIT CONTRACTOR'INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7558 HEATHERW OD DR JUST WATER HEATERS INC 01100058
OWNER'S NAME: APPLICATION SUB DATE
BUCKEL JOHN J AND ELIZABETH R 1764 NATIONAL AVE 10/10/2001
PHONE: (510) 293-9901 SANITARY NO. CONTROL NO.
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WOO ARCHITEC`VENGINEER: BUILDING PERMIT INFO
H BLDG ELECT PLUMB MECH
�i� C7 O O L7
H 3LICENSED CONTRACfOR'S DECLARATION lob Descrition
Z y 1 hereby affvm that 1 um licensed under provisions of Chapter 9(commencing P
yt withSation]OOOjofDivision7oRheBuninessandProfcxsiomCnde,andmylicame REPLACE WATER HEATER
,m is in fall masse and effect.' (4 O GALLON GAS WATER HEATER)
s o g V License Class Lic.k
GG Dae Conuacwt
u O r" ARCHITEC'S DECLARATION
S 1 understand my Alam shall banned as public amends
r6f
i O Licensed Professional
Oat I am exempt WER
DECLARATION
1 mora .Bina the,1 am,Bean,from the Contractor's o :Any c taw for the
t 0,Mewinguiresa(Section]03 L5,onstruBusines+and Professions Cook:Any city structure o which requires n permit re merman,aper,improve,demolish,or reply any nrvment
-pr t t sw cpur q the oMpinO da such Permit's Lice se Law
,ha,h u 1'ttmed puts dm t Na prdvumns of the Contractor's Ltttme law(Chep¢,9
S )OW)ofDivsooRheBnd rf_tPhft Fe voP�'v e�It fAifC)1' t
ua[ion
onsco,a)isexempt dicimm enc the basis for the etieddemp,i�.ryviolaon
oa .fivny , onorS) wbjaadhe epplicanno.60
1 penalty of Second mrehee red dusoM
,F Occupancy P Y TyPe
❑1,n owner of Ne property,or my employees with wages as their sole compensation, t
will dnlhe work,and,he swcwre is no,intended or offered for sale(Sm.7036,
Business and Professions Code:The Connector's License law don not apply or an 506 - GAS TESrlRequired Inspections
owner of property Who builds or improves thereon,and who does such work himself I
or through his awn l m,ausr,she budding
that such improvements arc not ore a.or 507 - .F I NAL PLUMBING..
Offered for sale.If,ho builde he building or urden o ntem n sold within one Yem of
completion,the owner-builder will have the burden of proving that he did not build m
improve for puryou of sale.).
owner._. ep
❑Lm owner of the p(Sm.7,am excBusiness a contracting with da:)ed rhe C odesctors'.construct the does
(Sec. to Business end any he b Code;)The Canmdor's
License law does not apply ro en owner of p comma who builds s improver Merton,
and who.canaacts for such projects with a commissions)licensed pursuant to the9
Conaanoex Li..Low, Q q Q •f
t]Iameaempt undersee. " ' B&PC forthismason )'OCT.'2:1 :'.2�01
_ _ 0.,.,er. • Date ,t• .
WORKER'S COMPENSATION DECLARATION
t''t I bemby affirm under penalty of perjury one of the following declarations: BUILDING
a 1 have and will maintain a Capffim a of Consent m ulGinsure for Worker's
Compensation as provided for by Section 3700 of the labor Code, for Ne
perfoodantt of the work•for which this permit h'issued.
Cl I have and will maintain Worker's Compensation Insurance,as required by Smion
3700 of the Wboi Code,far the perforrrvmce of,he'work for which Ws pamtit is
issued.My,Wohcr's Compemmiop^lnsommc�arier end Policy number aya:M,«„ -
Coni �_��Pol'c Na::
, W`i t L •r, 1'•a CPRt V ki IT.Is. sill tl}�1`sT,
!CERTIFICATION OF .W
,EXEMPTION PROMORKERS'�, i
,•,,. OCMPENSATION INSURANCE '. .,�..
. .,. ., __ .. .----- _._._..
•(Thu section need nm be completed if the permit is for one hundred dollars —
(LO(rmless)
I certify Shu in the performaoee of me work for which this peau,ii issued,1 _ _ _. ._f't•Y ' • _ _..
.hall not employ any person in any momen u as to beton¢aubjem m the.WVmlan' '
Compensation law:of California.Data"
Applicata , . I _. .. .,.
NOTICE TO APPLICANT Work rh flat Compsc ashen r vision o of Labor Code,you
Q Qbecomesubject to the Warkcrr Compcnmt n Provisions hot] the Labor Code,you must
forth th comply with such pmvatona or this pertnu shall be dearnad revoked. �
.l CONSTRUCTION LENDING AGENCYt'
I herebyeffirm tart thea ix a commucdon landing agency for the perfamanse• J
ai spa of the work for which this permit is ix1mdt(Sac.309],Civ.C.)
C6 Lender's Name`_ ..
.... . .. . . ._-M..,
rti.�
Z Is , as ..aAddrt
U F ,.1 reg ee tam 1 hely real this application my nae Sem the above laws r Dian is
W y[� conen.l agree m comply with all city and county ordinances and stem laws mining �) `1( aft
C.U' m Wilding construction,and tieieby 6mhorinc anixientatives of this city to enter upon /'L(/f
t-W the abovememionad pommy for inspection purposes.,,
QW (Wei same to Ism indemnify end keep harmless the City of Cupertino against
Get%Vf liabilities,judgments,costs and expenses which,may in any way a mme against said
City in consequence of the limning of this permit:,
_ APPLICANT UNDERSTANDS AND WRLCOMPLY WITH ALCNON-POLYP w;
SOURCE REGUIssued by: Date
_ LATIONS.',:'. 's�P t
Signature of APplirnnJContnaor " "- ': K Dam' Re-roofs
HAZARDOUS MATERIALS DISCLOSURE '
Wffl ft epplicam a f t bu(ding=uMt:,are er hurdle haietdaus maaael •.Type of Roof- - .. - - -- - - -- — ---- -
esdefined by the Cupcn M nciNd Code Ch pt r 9,12.and the Health and Safety
cede eves?s572(a) rapNp:. tv" Cj . � "I
:`1
I e•
__.All roofs shall be inspected prior.to.any.roofing,materialbeing.installed... ._.
Will the applimm or future building decupent use equipmemu or devices which If a roof is installed without first obtaining an iiispeetion;-hagree toiremove
,out bazazdous it moumninants as defined by the Bay Amo Air Quality Management
Dhu;m]. ' all new materials for inspection. Applicant understands.and will comply with..
' ❑Yes; Otho: ., .t :;fat all non-point source regulations:_
1 have lead she hataxims materials requirements under Chapter 6.95 of Ne
California Health&Safety Cod Secdans 25505,25533 and 25534..1 undersand Net _
film building does not cu-oIIY breve a man,that it is my MN,onsibibty to notify the - -- -
p - q - must he met prior a issuance of a Cenificate of
oma a t 0e re y're ts which __ Signature of Applicant Date
owny.oraame-n.yengent ,• De,e All roof coverings to be Class "B"or better '
• - . , ._ -OFFICE -
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