02070168 CITY OF CUPERTINO
3dUILIDIM;DIVISION PERMIT CONTRACTOR INFORMATION:
'BUILDING ADDRESS. :}, "' PERMIT NO.
,852+:tHYDE AV WATER HEATERS ONLY 02070168
OWNER'S NAME: APPLICATION SUB DATE
.-LUCAS' MAXINE' L 970 E . MAIN ST, SUITE 200 07/25/2002
PHONC•: SANITARY NO. CONTROL NO.
(415) 566-2209
q m zO ARCHITECT/ENGINEER: BUILDING PERMIT INFO
4C FF BLDG ELECT PLUMB MECH
i 6 ' '• LI C_I I U
8Z' c,;9.t' • i',,, LICENSED CONTRACTOR'S DECLARATION Job Description
j,z- , ,L I hereby'aff nn them I sets licensed under pnrvisians of Chuner 9� (ememeacing-
N . s000
lwith Senion] )af DiviaionJofthe Business vnd Processions Cafe.and my licca. REPLACE WATER HEATER
; I
�'m f'_ sin full foganb7fun./ 1
a a -Licen lid V Lict?l .x
pminor
.Fi, e:i, ', . : ARCHITECT'S DECLARA O
,Qj ��,iiI I Lndeniand my plans shall he used as puhic reconls
16 p'D L Umnmd Probe.oral'
.r, OWNER-BUILDER DECLARATION
in 4,;!"t`,n I'mocby affirm rhaW am eseidpt from the Conlraoin's License Law for the -
Z q ,following masa Permit
1n common Boaltc,. andimprove,
de profession,li h.or Any tiny or county $700
S O which q pend t t commoner,ante Proa demolish m file.signed r any amcture
0.3 dojipreisto li _ ace.dw 9 the b,h of such manscananseLawstatement - . .. _. _... __ . _._n _ —_____ _—
rhornmencanudpurianuNep ivi ftheC1 arsraenttlsiomisCrer9 ����ys4��s,7t0OC{��QB Valuation
I
or
nog, Nto ](glans(he vi 3 fah BsneuanQPiri.Any
Csde) :1"yVd3.;.lJV
nr rhu he Is31;5exemptthercfe,humJ the basis for the subjects
thd'eKnnlemn Any]peaelon
oI Sot.a than b e hundred d.1e f..($50 mit suhjecu the upplicam m e civil pennity-
af,n ma than,RY.hanemeeallar:fs5w). 502APN1;rrL PLUMBIN ENERGYOccupancyType
'D 1,as owner of the property,or my employees with wages as their sole compensation.
will do the work,'and the stmnule is not'ilncndee'or'ahead for late'(Scc:7044;' ' -
^Budness ad P.fczsinns Code:The Cornmeal's License Law docs not apply.an 507 - FINAL Piayss7aarv, 61lbspections t-
owner N propeny Who builds or improves the.on,and who does such work himself
or thmugh his own employees.provided that such improvements arc not iniended or
-or
formic.IL however.the building or impiovemenP is sold-within-one it-.,of _ __ __._....._..
ciumpletimi.the owner builder will have the W Nen of poeving thea he did nm build or
"improve for purpose of uleJ:
L71 s own.ir of the p spent'on xclus(ely cont...ig with licensed contractors to �'1 tea® t r
co stoat the project(Sec 704,1Business and Professions Code)Th Y �'1 Contractor's 0
License Law does not apply to on owner of property who Wilds or Improves thereon.
�I.who,co rus.f r. ts,wth a comrouortsl lcensed.punu,m .ehe _...... . ._._.__._��� sew �._Cyoo� ....._ ___-. .. _...... ...______ ._. .__..... _ _
and who,commas.for such p n3ec G L
Co n t d L cense Law,l v "P
..s.p, seas J.'
a BdePCfonhis rc
wner `' ' :- 'Date ".'I'..
-WORKERS COMPENSATION DECLARATION_ BUILDING
r s 1 h reby (firm under pen Icy of p 3 ry. ne f the follow ng doelamt ons:
❑ 1 latim and' ill.mo nrain 4 Cenificam of Consent to self asum for Worker's
Compcwtion, a,provided-fo by Section 3]00 of the Labor Code. fnrlhe
performance of 0e'work to which this permit is issued., ,
! l e d II dui 1 In W k C mp n uu n Insumnc ui q d by Sen on
Y i 3M10 f the Latmor Code,'for the pe f m nc f the work for which this permu is
s ed My W kegs Crati,evantion
Cemr 1 Hinsurance cater and Policy nubee
3 `
..._.
Policy
,..._y. .. —
1
.�` y 1 ,v.,, RTIPlCAT10NOP ' EMPIINSURANCE ' tE"S 1,
�iVac(Thrssenlon need not cam 1, , INSURANCE ' _ .,i.,., - _-1..... .. .... ... .. .... _...__.._..
COMPPNSAT ,
' p ledif the permit is for one hundred dollars
ISI00)o;IcuJ,
sof the ,.;k f hsh s iso d,
11 pehli il ,;1,,:
I Genf Ihrmlh prim
sfinll m e pl y any pen n n any diads. s' eo become sudden e @ 'Workers'
Conpclnadan laws of Ceb(amm Uaed
NOTICE TO APPLICANT'.Work If,after making Compens.atwo is Certificate the
Labor o d you,you uld
' fimorue sith ma l the such p..kimis m this iohall eti LabrCo.ked. must ` r
mply with such p or this pc t hall be JcemeJ oked.
CONSTRUCTION is.cON LENDING AGENCY'
forth rah co
w.r
1 hembe affrm eh nth ons n o lerld g agency(or dIe perfoirna'ce t I
A I ccnJ that h lhrs perms l issued 15 c 30)7 Ci C 1
t.
Or,
N work,for h
Land r i Nem
�' z , Lend AJd
mil ce I have d this application d t.mace,a d late
u
conem bore.to comply with all city and county men ordinances angnmm taws enter
upon
Q't) the the ingronswed prepndhemby-,'horn Purposes.
urposenmeiv<s ofthis city tomer upon
the ho nee t e property f i pen p rpI -
Pi" 'IWe)ugre 1 sae mdem ft' nd ke ph sthe'C iy1fC"pd o'sgvinst
rr W'Z: liabilities.judgments.c sea d pe tes which y y ay m g inst said
V City n sry thee ahfie gra e g f cher permit. _'
ppI ICA.NTUNDERSTAND "ILL COMP /WITH ALL )N-P INT '' f
`3DURCE KEOUBATIONS r '��j-$�IZ. Issu
APed by: Date
Y,p4,Si,acture of Applchm/Ccm.—r ,,. f, "'jr, Date Re-COOP$
(HAZARDOUS MATERIALS DISCLOSURE
Wll d. ppllcane or f. bolding atvpam store handle b" On maenal. Type of Roof _. ...__ _.. _ __
as defined by the Cu en on Municipal Cod Chapter 9A20 and the Health and Safety •^ --- __ .. .. _ .. _ _
CoE< Seelo 12553?<QI ) t ._3 l A f , ,s f"
'
DY<a „': 4 t _ t F All.roofs shi ll.be inspected.poor to,any_roofing material being installed.
•{,1 Wlltheeppthoil orfu.m Wilding occupant useequipmentorde iceswhlah If a roof is installed without first obtaining an'inspection; Pagree to'remove
to ct Y s Rned by the Bay Area A Qual t,M agement p pp
f'bazardo,a mnumlama ace _ all new materials,for inspection. Applicant understands elm
' (stands and will comply,withall on poi source'regulauons
1 h ve read Ne hazardous ma¢ri51s mqu mmenrs uruler Chap¢r.0.95 of them
California Health'&Safely Cade;Sections 25505,25533 and 25534:1 undemand that
tI ., 7Z5Qofy she
rite ui of the notion r met which must an ma no to a'a.he
{ Ocdoes nm currcnd have ant then from rt bll 1 no
building Y Y P° Y
P 9 P s ant Cemfof
p �'. Signature of Applicant Date _
Owns o uNonzeJ dt — ) ID.1C All roof coverings to be Class B"or better
OFFICE