00090103CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
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BDILDINGADDRESS:
A085 HYANNIRPORT DR
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JUST WAIER HEATER
PERMIT NO.
INC 11111,7111`1901 L717,'
OWNER'S NAME
APPLICATIONSUR DATE a
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[ONE: -
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SAN[ ARY NO. CONTROL NO.
ry
Z ANCHITECDIiNGINEF.N:
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BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
al
z LICENSED CONTRACT'OR'S DECLARATION
1 heresy affirm Thal [ am licensed under provisions of Chapter (commencing
.lob Descrl tion
p
ii with Section ]N)0) lot Uiv ylna j of the Businowma''r fissions Code, loamy license
' in Section N)0) ef& !b
i:ieense cm »� L
Date -�
WATER HEATER
—aCI�� Cnmmrmr
ANCHIT[Cnse DECLARA
1 uneerxbmd my plans shall lensed as pnhlic rcrords
cord,
xLicensed i'mfecaunal
OWNER—BUILDER DECLARATION
1 Washy
that I oto exenmpt from the Cnntraanr's License Law for myt0lov
a�
j
maso . Sect
and oa,, dl,ar lin Coe,! Any oily orcoit untyJ�
which requires a permit
which ire rcmna (Salon ]031.5, construct, aper, improve, demolish, lar
repair may sbement
re uiresfile,
Polar to s l ismavice, also requires the applicantonfor such rotor' m file s signed statement
-(coterncingAdPursuant mmeptoDivisin3ofthf the em„orxuecn�Law
(commencing Sn,iotional
'
Sq. Ft. Floor Area
704110) of Division roflhe Business sionsCde)
Cade)
xorne fin Any
Any violation
,,robot he isexempt1.5 iany
and the mora for thj alleged exempnt
.tion
of Salon ]IU S by any a,fi Ii,r a permit mhjcco the apPllamo to n civil penalty
to l
'
dirld dm,
nr nal intimidator foie nanared souls (asoo).
� APN Number Occupancy ype '
❑has ownerof,hcnd the
inytt.00dexageclood rsoleic(Se
T
do the snrrk, and the structureIx nal 7.
11 lar ,Berea fns, tole ISec.
-L71 0
ode: The Contractor',1. an.
amnoroxanerrlyWhobend,:TheCrmrmreo,andwLawapexnmorkhmam
Required Inspections '
cats rws such wad himself
caner ofh his coy Who builds or improves t at such improve,
or borough his . If, eabdayhoweveccs. povidin than such vement mems am no, intended necar or
,lured for sale. If, however, the building or improvement a sold wiohin nuc year of
Sat — FINAL PLUMBING ENERGY
elamplcdaor ft,owner.hwmer will otos till hams,.a' prlaamg non hears ton n'Jm m
pros
intrrov, for Pnrrnm of sule). ' -,
506 � — GAS TEST '
❑I.mn~nerefthe propeny.amexclusively mmmeingwith rtecnsedeormaonm
507 — FINAL PLUMBING
construct the project (See. ](III, Business and Professions Godes The Contractor's
License Luw anus not apply m on fore of It piny who builds or imp nrvu .ninon,
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and who contracts for such projects wall a contractors) licensed pursuant to the
Cnmmcum"Licenm Lw.
❑ I tun exempt under Sec. , 11 & P C for this reason
Owner Date
WORKER'S COMP17NSATION DECLARAnON
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I hereby affmt under Penalty of perjury one of the following declarations:
Min
I have and will a a Cenilicm, ,f Clausen' ,o 1,11-huum far Warkar'v
Comrrnmrcc n, or la( be faM1nr Code, for the
for for by Sections
ark
rkrrnrmanee nr me work far which his permit .a ismea.
issued,
have and will maintain Worker's Co n arrnminn insurance, its required by Section
3700 of the Labor Code, Iia the perfonnuter, of the work for which hors Penni, is
Ivamd, M(y't1�'y1rkerr's'Compensation carrier and Policy are
fInnsurance
ygnumber
((
Carrier: `keVW!i TIi U1 T,E,,J) I k3i Z(V•
CERTIFICATION OF EXEMPT[ON IBOM WORKERS'
COMPENSATION INSURANCE
Mil section need nm W completed if the permil is fur one hundred dollars
(5100) or less.)
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I eerily that in the peroarmia 'a'I ,he wok I'or which this permit is Issued 1
shall not employ any cersun In s�n yeglryr, �uhj¢t to the Workers'
Call not empl Laxso ttl tU
Applicant-
NOPICETOAI'PLICANT:I,ermak'mgt cnt
Cenifcote of Hxption, you 'El.—Idhccsnnesuhjttnothe
Wnrkcrs Coincenm,inn rvixiuns nfthe l,nhor Gxlc, ydu most
forthwith comply wiN such provisions (it his permit shall IIm deemed revoker,
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CONSTRUCTION LENDING AGENCY
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1 hereby affnn thou (here Is m,unatuctinn lending ogency fnrthe part mnm,l
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oldie work for which this Pcrnit Is issued (Sul. 3097, Civ, C.)
I<nder:s Name
Lender's AJdra
1 ceniry that i have mind ,hls upplicadon and state that the Wow, inrarnradun is
recti 1 agree lin comply with all city ..it county ordinances and s,am laws mind,
whuiWing constructioaend herehyamLorira representatives of his city to emerup,a
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'he shove-mentioned p.K.y for mo,volion purposes.
( WO agree ,o save, indemnify sad keep harmless the City of Cmamino against
Iinhilitie.. jndgnmms, mets ;me expenses which ally in any way accrue ag;miro said
City in consequence UNDERSTANDS
grantingDWI permit.APPLI
NT DS AND WILL COMPLY WITH ALL NON POINT
SOURCE
SOURCE REGULATIONS.
REGULATIONS.
C—.
ISsned by: Date
Sigamurc of Applicant/ onlmctor[)ale
Re-roofs
HAZARDOUS MATERIALS DISCLOSURE?
Will ihe.,plicant nr fuwre building occupant loom or handle hazaMus momdal
Type of Roof'
as refined by the Cupeninn Muninpul Code, Chapter 9. 12, and the Health and Safety
Code, Section 2.5532(x)]
WYe"
All roofs shall be inspected prior to any roofing material being installed.
Will me air co act nrrots a lutlemg aeueaHayAint use egmpr utility or ana which
mit hazamom air contaminants a. dcfnnl by the Hay Area Air Quality Management
If a roof is installed without first obtainingan inspection, I agree to remove
p g
i"t"at"
❑yes a
all new materials for inspection, Applicant _ understands and will comply with
p y
all.non-point source regulations. -
1 have read the hazardous andelod, requirement, under Chapter 6.95 of ohe
do&Safety ioreant,th253]7aner,lear 1unrentand ohm
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if
if buildingmly have
mo'ion"o, yhaventcnant, that ri Ls n oili notify the
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enicailof bore
cupam of the requirmnent, w ell muxt be ate, rrinr to, is ounce of a Ccnlliaen of
issuance Cc
Occu c)
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q `rIw
1
Signature of Applicant Date
All roof coverings to be Class "B" or better
Dwnn nr asmnrl as n =
OFFICE