02040097 CITY OF CUPERTINO -
BUILDINGDIVISION PERMIT CONTRACTOR''INFORMATI0N i
` 1:
BUILDING ADDRESS: PERMIT NO.
P12 1-1QQSHANG CT JUST WATER HEATERS INC 02040097
OWNER'S NAME:
APPLICATION SUB DATE
LU CHANG 1764 NATIONAL AVE 04/18/2002 •
PHONE SANITARY NO. CONTROL NO.
(510) 293-9901
ARCHITECr/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LJ C_I L.'1 U
Z LICENSED CONTRACTOR'S DECLARATION Job Description
.t9 I:— r,ax700)oFhniOn3OfenuusinalpandPionsofChepsd..u,dmmlia"a. REPLACE WATER HEATER
with Satiorceandefect. onJof the Business and Profesxions Code.end mylicense
f is in full force and*effect.
a pq5 License Class Lic,sl
3 K rS
Data Contractor (40 GALLON GAS)
u C J ARCHITECT'S DECLARATION
'-E
JJJJ I understand my plashall be used public accounts
rc y in u
O Lucnud Professional
OWNER-BUILDER DECLARATION
—m '•• 1 hereby uRrm that 1 aim Business
from the Commcmrs License Law for Nc
F?G following recon.(Section]0315,Business end Professionx Code:Any city or county
which requires a permit to-orun,ober,improve,demolish.o,rtwir my reinsure
3� -pdw sq iu iuu.ma.atm m{uim It-a
mmfmsmh pemsiuo Ole ui{md wmment.
Net bels lisijued punudnttothe provn7'of the Conumtor.Lfcenu tawlas erg _ S - Ft Floor , , aluation
q
lrommmcipg wiNS_`_'
mtiop 9 ).fDivisim3ofihe Bmimu said Profeesin-Code) �i )�\` � Iti y.,lQ•:.l.f ;l . }:' '
or Nai he is exempt Iheicfrom end the basis for Ne elliged ek apiibb.My viohtion
"d/Seedon 7W ID by myeppllemt for o pared,subjectnhe.pPdhxm as e dvll peneby-
rof tins more than
fore
hundred dollda lS500). limber =e}i:!:T:r DCCUpaOCy Type
❑1 as owner of the property,or my employees with wage as(heir sole compenmtion.
';iydl'do i�work.-indlhe drvnure is not inunifed or'olfeiea'fa-fi c, c'70Gi,-
'Bdilneu.ad'Prdrasimo Code:Tba Comractm;License Law dee,not.,,I,tom 506 - GAS TESrFequired Inspections 1°`'"'"r"
owner of progeny Who builds or improves;thereon,end who does inch work himself t
m dtmu h his own employces.,provided that such impro maenu art now intended or_ ., F,ZNAL PZIUMB I NG
completion,
crude.xIf,howerce he building or improvement is what within one Wild
of
imfo.for the owner-builder will have the burden of proving Net he did not build or '
Improve for purpose of.IeJ. '
O6 as ownerofthe Property.see achumly convecting wid,licensed contractors N tl.l'C:C,FFiJ!
comtmct the project(Sm.7W,Business ane Prefwims Code:)The Contractor's
-: and who
law docs not apply.en mune of popenY who builds w improves Merton.
and wMes License Lam,"
.pojmu.wiN a.conu.cta(gJkensrd.purtmnr.m.Ne- _
muanors L ttnu
❑tem see pt ndcr,SeeB&P C for thsrtamn
t Dne .of the labor CRATION
a
WOR
I KERSCOMPENSATION DECLARnV �®
' 1 hvebY:mrm Merpenalry d �erJ;uY dna of he follovnng dmlarn aim--- MAY ,
/ 7 [• �`.^
^ ❑ I heve`and will�ivinuin'i`Ccnifireie'6f Couren'to self-insure for Worker's 1 tJ ?002
Compemut n u-'prov dad for by-Secti n 3]00 odefor she
performance of the work for which this parous u jx le
/j
/
Q 1 h ve.IM w1ll uuinmm Worktr i Compen.um Inivrnrrce .i required tiy�Section 40/1 O
3]00 of the Labm'Cade (or IM peRmmmtt of Nt wdek fm h ch Nu gamut is Y
isive4 My Wohera Compenuu n Insurance cuner,and Poh ,number 4e:""• "
Cartier EATIh7 ATION OF.ExEMPIION FROM wp g. r' i`' i \ t i j r I I t Ttr�r 1, t } J
'�' t t 1 i�', ,ANON IISIIRANQE, � .c-rc x•1:(rn'+r',...., .• .. I I ,
P $
'° (fhl Section need not he dm'leicd if the permit is fm one huMrW dollars ')" ' ' ."7. L! .s 1"',:],I)q y _yl;;•
'".v JttnJy th tin Ne perforin nee ofhe oh'f hlch Nlspemutrii luu�,I ,N .,,a_ �^r •'„ijt' b'7 5'SL -
sholl not empt Y mY.permn In any'snddnei; u m beaolne iub)ea to drc Wgrkeri `-l• -
ComPenuuon U sof GI 2mis Dne'
.N fCE APPLI A If ober moking thlsC nlfMle pf Exerppuop yqV ahoule .. -
becmetub)echo Ne Warlih O Comyensatmnp Lumni bf rhe labor Cad;y must
foMw N[ mp1Y�,N oh wch p t loin ar N a perm.shall be demes revoked.
lar N t. "CONSTBUGTION, LINOYNG AGENCY I' .
a y I2nae sNuma'-+w Nat N rt n.co swtt on Itnd n sgeneY for ht perfonm'ce F - t e V•` � -
afNe mLf bleb Ni.pe Runs
lhcrcb eR
Z
�
m
. b
I Ganey Net I have .d hn.pplicet on and sum thauhe ebeve of rmmm -
conem 1 egree.to comphy wch all c ry.md county oM ronin end start hws
raising �f
Q• tobuddmgttnructiain ens hertby wNonxerryrtlenutNti.0(Ous my to enter upon
yy;(,� the oboe ntarrulproperryfgim, thnpurpouJ.
L Gt IWingreemeve,mdemndy and keep harmle'a Na woof Cupertinost aid
U Z t u N dgments.Geese end pensee h¢h coq m any q 4ccrue against avid
V y Cl,clry m rontequenfe oP Ne ghnudg of NR permit -
APPLS'1.'h.�YC\'DERSTA�'DSM'UN'fI,(,C0�1PLlt�t 1T1{A1.L�`0\IPOL4T'�' r
sOL42tE REGUL".AY7G`LS ri':': ,� Issued by: Date
Ssgmmic of ApplmyNContee err .t; ir'r DwT,.,
❑Yts ^XAZARDOUSMATERIALSDIScLOSURE Is c" r Re-roofs
1 WIII Neeppheml nefutureandaiamupmt Wore or.herlNe hewdwa needed .'Type Of Roof;_
as
dtfned by the Cupenmo Mun c pal Cade Chap mr9 12 mtl the Hath end Safety - --'—
Code Semen 25532(gnt Jq.rO No....' g,NQgt t r L , ' l law 9 ' s)`.- i) t�( �n)C f !, r_
All.roofs.shall be inspected prior to.any.roofing.material being installed._._,__
x'rs Wdl Ne sppinwntmfurabuilding ser P. I..,quip.ns or as tees which r -
crib hazudoueiirconuMnmveideOnW b)NeB.y'Art.Air QWrtyMan.{ement If a to
is installed'witliout fust obtaining all inspection`,�I agiee tolremove
Dtimrt : .:-
- OY,esr,,;1,,1f,li:; {7❑nai_l,,,f; y „ "'' l,t �.; ;i _ uxn
r__all-n materials. orms ech n APPcantde
startd5 and
will.comply with
all non-point source regulaaons ..-_,._.
,California
{rI he a Lob Ne Safety
Codas metedel rtgmrcmenu n 5 Chapter understand
ilia
it the m.HeaINs SdeYCad4 e.ve as art.thtitis yr op5Je:1ayusiutid that.
UNebblldf he,ty nmme.-hecariently Ohiavh uadt be Mltiemyruponslbf.C,nmif3^,the --- -"'_..__. .. _.___ ._._. ..... ... ......_.... ... _ -_._..
-
ir;` _
acup.nt,of the requireYnenuah&h most be it prior,.Iuumtt of i Ceitiflde.bf -
DCCYPaacy . ? s t � t 4� r .. i•• •. -
_.-Signature.ofApplicant__..........
. . __. .._. .. .._ _Date....._ ..._. ...
ownee ere�non,.n o`tnt All roof coverings to be Class"B"orlieiier
OFFICE ——— ._.,. _ ......... .._. .. _._ ._..__.
__ �., 1:S '-„;.. , � ... .• t ata r, ., ,. _ . t