02080061 PTY OFCUPERTINO
"'.,BUILDING tirvISION, - .PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS:. _ PERMIT NO.
10191 HILLCREST RD. JUST WATER HEATERS INC 020��uu80T061
Gw'.rug"e'SHERMAN L AND VIVIAN M 1764 NATIONAL AVE APPLICA08/ T iA/��2002
PHONE: SANITARY NO. CONTROL NO.
(510) 293-9901
ni0 OZ ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Z �.Z LICENSED CONTRACTORS DECLARATION . . - ]Ob Description
oz o Ih byaArmth.tI rcnsedaa p visions of Chapter 9(commencing REPLACE'-WATER HEAT
H :j iN Sec,oan)cfD Sof N<Bu. dProfssions Codc and myl cense ����®
y.< Luc f ll force end elle,
0 m a License Class Lic.tr
U Data Contractor
ARCHnLCuDECLARATION JAN 03 2003yap-3 ^I undemand my plans shall be used
d as public records
Sr�f
ai p Licensed Professional
'OWNER-BUILDER DECLARATION {��
I hereby affirm that 1 am exempt from,he Contractor's License Law for,he BUILDIgAQ
following recon.(Section 7031.5.Business and Professions Cade:Any city of county 4
F O which rotation a Permit to construct. I¢ p demolish,or repair any svu i re
3.m -:Prior an t ri,sun oxicam,the applicant fh permit ro file.signed statement
that he IS men kdpu netroN.ion 'ass rte c trac,wc andPricense llewrowC r9 ,0„` 3*1F31AC10r6 �a ..r:tt 1 Valuation
(ro c g ,h Sectionoa)B) ID' J of the Business imd Pm.Any vi Cal.) S s I.s t>:-a•., ruts •.rl11 }vs
or that he is exempt anyefromand'or barfor die allegedeumpaon.Any violation -
ofSormoethan iv anyanexi ariforap.rmi,subject the applicantmaCivil prnalry
nfnntma manr.ewna aaours(ssak 502AP-NVtltlftL PLUMBINO ENERGYOccupancy Type
❑h as owner orNe Prop.ny:ar myemployee.with wages as their sole compensation, 506 — GAS 'TEST
-win do the work,and the somemrc is not intended(itofferedfor sale(Sec.71146; 507 - FINAL P
Business ata Proftssiont Colic:The Commerce's License Law does not apply to an FTeXFnspeetions: ^ '
owner of reopen Who build.nr improves,hereon,tad who it.such work himself
or throughhis own employees.provided Out such improvements are rim intended or '.
-offered for sale"If-however.the builain - is-sold
g or improvement within one year of
completion,rtor tb.owner-builder will have the hoiden of proving that he did nm build or
improve fm.puryou aLsalc.).
-O 1,a�wner of the . . _ .'_. .. -. — _ - ._- _._.._._ - .._.___. _.....__.. _ _ _". ........_......
property unm exclusielyc t , g iN lie .sed contractors to
onstmet the project(Sec.7046.Business and Professions Cade)The Contractor's 1
License Law docs not apply to anowner of property who builds or improves thereon,
.:.i ,.and,who ,onocos.for,such,projects,with.a.contractor(s).licentedpursuant to me
Conuactort License taw.. _._.. _...._...._..._.".-
❑lamexempt order Sec.' ,B&P C for this reason - (:� I, •,i
Owner Dal. -
WORKEWS COMPENSATION DECLARATION
1 hereby uniform under penalty of perjury one of Or following declarations
`le-• O 1 have and will'm5inthin a Ccnifcae of Consent,o self-inure for Worker's
Compensation, as provided for by Section 3700 of ,he Labor Code, for the
performance of,he work for which,his permit is issued.
❑1 have and will maintain Wmker'a Cma,matumi lruuancc.as requbed by Section
3700 of the Labor Cods,for the performance of the work for which Nis permit is
:ud MyW k 'C pci nl . run c< and Policy number ares;" '
Cs'noil Policy No.. b
CERTIFlCATION OF EXEMPTION FROM WORKERS', ' s b ks i a )?
- -.COMPENSATION INSURANCE - -
' (Th.. n nneed nmwcam lc¢d if the ,r „_•r )-_.__, ..._.,. ..._-_..,.._.
(S 1001 or less.) P permp os Por ane hundrtd dollars _ J.1
..sits in
_ .. .. .. ._ __" .... ,.. ,..r.... . e. .�.
Ic of ,hut in th �.�_. .. ......_ ,.___.. ._
Y pert f the work for lone N e, it- sued 1
shall not lion L any person n any manner so as m bmnme sublet In the Work<ri - •" •. 1.. 'f�'I
Comicant on Laws of Califomiu.Date -
_ .Applicant .••_ .
NOTICE TOctto the WD If.orker's
Compensation
Nis Cisionse of Exemption.
,you mind -
Z become subjccno Ne Workefs Comb.nsauan provisionsof the tabor Code,you must '
C
Q fnnbwiN 2ambly with suchproviviam m Nis permit shall be deemed rcvnkN.
CONSTRUCTION LEND INGAGENCY
�.� I lictsby Uffirm
that them is a construction issuca(Sm. Icndmg agency for Performance
y
ofk'f wlocb p eros 3097,Civ.C) "0 Lenh ge Nme
r7(Z Leader',Addrc.. •-', r � /T� ... .- _ _ _....._.... . .
(L I lin e l h h-11 city
and e J late ance, d information s
Ll
0f" core t 1 cons in with all coy and county erdmaoasoand slot,laws relining
.V towddmgn'.14a dPropert hemi nspecoonpin,varec, Ives of this city to corer upon
til Ne aho(WO agree 16 property for inspection purposes.
d es,judgmets save:andepensesk which
,an City or Cupertino against
DO City in co)cquernr,cosy trod expense.whnh may in any wayIazcrue against said
U Z City in CUND of the UNDERSTANDS
this permit.
APPLICANT UREREUNDERSTANDSAVD .'LlCO w '&WITNALLNOR-POINT Issued bye Date
- SOURCE REGULATIONS.. "�,
9gnamrt of ApplmanVComracmr - - ,Date Re-roofs
-'1 .HAZARDOUS MATERIALS DISCLOS URE -
Willde`opplkmt or future waging account store mhandle ha;amonabastanal Type of Roof .
as defined by the Cupertino Municipal Code Chapter 912 and the Health and Safety - =-"T"= "-' — -:+ - -•
Cade S u n2553 (al Oh .. 1P 1 f S � `•s 11 1 7�y t +..i ? 1;,} s r
oils " ..All-roofs-shall be Inspected prior to any.roofing material being installed.
Win N pprc..,orfut e building occ p , -,a Imp device,which If a roof is installed without first obtaining an ins 'ectiori' I a rce'to remove
emitIt zard contaminants .defined by the Bay AnaA Quality Management g p - g
District?
Dycx ON° all new materials for inspection. Applicant understands and will comply with-
- all non-point source regulations. -
1 b 'rend flic hato-olbal m¢rials,..gmremems onac Chapter 6.95 of the '
Crilfarma Hath&Salty Code.Sections 25505,25533 and 25534 bundersmnd th rt
I
f the wilding does nn,carnality have animal,Nat itis-my responsibiI ano,ifY die, -
oceupmii of the mquiremems which mmsu
,be met pd.,to isance of a cenuris e of -
• _' Occupancy. .. � -
Signature of Applicant Dale
owner or aatbOrned agent Data t All roof coverings to be Class "B"Or'better ,
' -- - OFFICE '-`