02070135 CITY OF CUPERTINO '
BUILDING DIVISION PERMIT r CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO
10445 IMPERIAL AV HOT WATER INC 02070135
Va"YM-FEN H AND SITYUE B 2531 GRACELAND AVE APPLICAIJO.N$!T/72002
PHONE: U
(650) 298-8494 SANITARY NO.
L.5
CONTROL NO.
OOp ARCHITECT/ENGINEER: BUILDINGPERMITINFO
Is tai U BLDG ELECT PLUMB MECH
a y I L i 7-1 L.,J U '
N i LICENSED CONTRACTOR'S DECLARATION ����hh�e
Ihereby affironn.t In.licensed mdcrprmisiomofCm,ue,9(commeneing REPLACE WATER HEA'1'Ekription
with Section 70001sT Division Sof the Busmicssand Is tensions Cade.andmy Bcensc -
;yE•7 Lie full forte an e(`kr_ 7/ �
:O i u Linn_Class Li,
.a Cp
3 v oma S ontractor 2tZ.,Jid..
DELI-A
e O d ARCHIT 'S DECLARAT ION ��
1 u deemed . plum shall h used as public records
Zt
OUsnsetl Protessinnul OWNERERDECLARATION /913
ot I hereby dfinm Nat 1 am esempt from the Cmm ctor s Linn_Low far Ne $5 0 0 111 ` 11
z_ following reason.(Section 703ity1.5,Business and Professions Cade:Any car county S I1
o x hich requires a pi,mait to construct,alter,improve,demolish,or repair any structure
i3� Pnot Is s, 1m q„r, he pPl'cam forsuchpennnmfleevgTredoo.menn ..... _ ..._.........__. ....
Naheb Teens dp Is a ilo iheprotl time the he Btgtars and pr Lnsirms o ) 3 1Lt1IEl0"bC'�a,
(camme c g with 5 u 7000)of D von 3 of IM1e Busmen and Professiom Cod) rz SSra y"� 7 r`” Valuation
or that he R cxcm uhertfrom and Nc bass for the aIle cd cum `"
P B anion Any l Penson.
of Secnot Tru , hie 6 sayapplicantTI.Bfor apemal subjoin The applinmmadvil penalty- 502APN NdIP5;9 PLUMBIN ENERGY
.dr not moa mitnree nanarea aou.m(s5oo). Occupancy Type
❑I,as owner of the propcny,ur myemploys:with wages as their sole compen_tion, 506 - GAS TEST
will do the work:and Nn"o0cre is nbt intended metered for wle sn:70u4:- _
Busineis ond'Professions Code:The Contractor's License law does not apply to an Spect1011$' ''
weer of pmper y Who builds or improves Thereon,and who does such work himself
or:rough his own employees.provided Nat such improvcm ¢ahotcnrt t intended or
,mff it for-ible.If,howcsr,the building or improvement is said within one Year of -- - ----
completion,thepo r--W Idc will have The burden f proving Nat h did of Wild or
prover t noose s 1 )
01.asowner f the pr Pena I vv ly t et with l'e tl naacto t 2 _ -- --
construct thep ) T(See 70"4 Business d Professions .Code)no Conunm "
License Law does,not apply to an owner of pro,enY who builds or improns ithersom
_and whos an a-for such prokcu.wM a contractors).licensed-persumoto the.
Contractors License Law. ,,, ,.
01amexempnunacrSec.` B&P C for Nis reason
Owner r.U, '.''Date'..
WORUR'S COMPENSATION DECLARATION
1 hereby eIrm under pemIty of Perjury one of The following dccinodons:
❑ 1 hive'and will maintain a Ccnifica.of Coneem m self-imme for Worker's 1
Compeosmion:as provided for by Sermon 3700 of the labor, Code for the
performance of the work for which this Permit is issued. .
ii�e will maintain Worker's Compensation Insomoce,is required by Section
700 of the Labor Code for the Peromi of The work'for which this permit is
ssued My kifsCoTpcn cam
iFr
Till icyrat, her
Ni �'^`
U' RAn
EXE Ff10N FROM ORKER$r
'..{: COM INSURANCE:• :, .•:•
' .••. •Mis when need not be complencd i. _ .. • , -.Rm••.^_-••.•-.
ATION
(S10o)m to..)
the permits ear ane nawmd aml.m
.. ..
-". i certify That in the performance of N work f which thispe m 1 is issued'1 -- -"""'--- ----^---
shall I employ any Pc t y m e o to became b)ect N
I r Wwk - '
CompensationLaws of California'D te;
Applicant: q .. , ... _
NOTICE TO APPLICANT If ft eke N[C nfce.of Ex
neeo subject to the kis Co to Labor
Code
as, ,s -
zZ 1 pc p irons of the Lanor Cade,you muss
C fonM1 N comity with such provnrom or N s Permit[hall bed mW oked. - -
(
I•,T.h _' `CONSTRUCTION LENDING AGENCY 7 „',i '-- '--- ---
' -I Imet of ins That Nee is a construction lending agency for Ne performance -.n -
of the walk k for hick rah perm i is'ssmed f5 3097 Cl,C. ," ^
'~
Leader's Name ..n..., .. ... ... ..._ i
6as� - -_. .._ ... _.._... .. .. . ..___..._._.._..____ .
a.Z IsLea,, Address . , i. _. .... ___ _ _._.....-..._.
V � I certify Not I have mad Nis application and state that The above information is I j
ctinccr I agree to comply with allciry and county ordinances and sura laws rehting
U to building construction.and hereby au:odze repre_nmtives or this city to enter upon
y-PQ The abavc-mentioned property for inspection purposes., ,
ry 6' (We)agree to save;Indemnify and keep harmless the City of Cupertino agaimt
Fs-A] liabilities.judgments,carom and asperities which may in my way,accrue against said
V;z City in consequence of The jointing of this permit. -
APFLICANTUp-DERSfANrS AND WILL CO?fPLY NTTHALL'NOS-POI1.r i
SOURCB REGULATIONS. Issued by: Date J
Signature of Applicant/Con cmr' •.•• .. '1Da RC-COOTS
1;i N ,HAZARDOUS MATERIALS DISCLOSURE
NII „
.' 6lcant fume,Wld' goc pantsmrt.handleharudou noel Type of Roof
u
defined by Ne Cupen o M ¢t I Code Cie
912 and Th Health and Safety ., . �. --
Cade Section25532(a)
-
O Yes r r N
_All.roofs shall.be mspected.prior.to.any roofing,material being,installed.._.._
Will The ppl ` m Wilding«_ p"'use devices which If a roof Is installed without first obtaining an inspectlon,-I Agee to'iemove
mthax dos ma Imd "d by The Bay Are.Al Quality Maagment
..all new materials for inspection. Applicant understands and will com I with
Duca p Y
g l' i. all non-point source regulations.
I neve rtes Nc h us mels req rtmc u undo CTapmr h 95,of Ne n ' ' s VA
s
Gal's a HwIN&Safety Code Sttt ns 35505 25533 and 8534 1 undo tins Nat
fNe bold gds nm curteady Isve moat that t u y respo ittl ty 16 not ry the ..
oc p m fNe rcgm_menu hick must be ma poo to issuance of Ccnifica.of �Y//�
O cu
�/y�y _ .__ Signature ofAppYnt Date
mite
tea r Da All roof coverings to be Class."B" or better "
.....OFFICE