01070156µms^[ O
�u
a
rna
�y
pZ-
a'E
dyK
W0
tu0
z�r
aid
I�
FZ_
z�
i3
i
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
'BUILOING AT)DRES3:
PERMIT NO.
7840 JEANETTE CT
HOT WATER INC
01070156
OWNER'S NAME:
APPLIC TION UB DATE
SPAIN JIM AND SHARON D
2531 GRACELAND AVE
07�31�2001
PHONE:
(650)298-8494
SANITARY NO. CONTROL NO.
Z ARCHITECTIENGINEER:
BUILDING PERMIT INFO
E
BLDG ELECT PLUMB MECH
w
t:_ C= I IJ LJ
z LICENSED CONTRACfOR'S DECLARATION
Job Description
E I hemby aRrm that l am licensed under provisions of CTapter 9(commencing
REPLACE WATER HEATER
with Section 7")of Division 3 of the Business and Professions Code, and my license
J is in full fore and effect,
aLicense Class Li, g
D Dam Comot
tv ARCHITECT'S DECLARATION
I understand my pl... hall be used as public record,
JLicensed Professional
T OWNER -BUILDER DECLARATION
I hereby affirm [hat 1 am exempt ]rnm the Contractor '% License Law for the
a following reason. (Section 7031.5. Business and Professions Code: Any city or county.
$500
I] which requites a permit to construct. alter, improve demolish, or repair any mmemm
prior m its ivuame, alsonespums the applicant for ..such pemrit to file a signed sraemem,
r g
5°.,
Valuation
- that he is licensed parmarr othe pnoviomrstifthe Coatmem", License U.(C1npmr9
(commencing with Section 70t of Division 3 oRhe Business ad Pmfesumv,Code)IL_T7,[0
,n,t
that be is exempt rhrimimin and the basis for the alleged exemption. Any violation
— or
f Scc,i,,n 7031.5 by any applieval for a permit subjects he applicam m a civil penalty
•ofnht. more thin Five hundred dollars (5500).
Grp Mho
502APNPijNkL PLUMBIN
ENERGY Occupancy Type
01, as owner refthe property, m my emplhyees with wages as their sole compensarinn.
-
,
507 - FINAL PL1C1I1�SdePI1$Ispeetions'•
-'will 'do'rhe'wmit.-mad fire'orucurne Is nor imanded or'oRcred' for "saIt(Set ]0111.-
Buslrteis and Professions Cite: The Contractor's License Law does not apply m an
owner of property Who builds or Improves thereon, and who dues such work himself
or through his own cmpio)m, Provided that such Improvements are not intended or
on d frit " le If. "hdwe a th building m v taw t Wood within ear or
Pre Y
comp) t o. thebu Ids 11 have the bntdc fpm 8 dw he did t Wild or
I
resp f purpose of 01
-pI fth P Pent I x ly r t g tel sed ontrctise r.
.- construct the project (Ste 9841. Business and Profess tats Cori The Contractor's
_ „• .
s L'- ' " Ir
- License Low does not apply to an owner of pmpeny who builds or improves thereon,
i and.wh..,trounrs fheweh projects.w'ido.h chntmcwrria.licenwl pursuant m.rhe
- Contractors License Law.
_ 0 l ten a." under Sec. ,•` ,B&Pcf.,hisamson
.Iai'. `�•••Cl''�`CIU:`
WORKER'S COMPf:NSATION DECLANATION
I hemby affirm under pe audy of perjury one of, the following declmut ions: -
0 I have artl will' maintain a Certificate of Cooter b self-insme for Worker's
Cnmpenwio.. as Provided for by Secuoo 37M of ere Labor Code, for rhe
performance dr the work for which this permit is kaued.I ,, , •
01 hale ird will maintain Workers Compensation Insurince.'as requited by Section
37M or tho"Inor Cele, for the pc'rfoimame of the work for which his Permit is
ivi etl My Wo kels Co m pe r l;,umrc - and Policy mbe m:
Cm r 'Policy N
VUII.l!7Uo.
s ;CERTIFICATION OF E%EMPTIO FROM WQp
COMPENSA(ION INSURANCE an'
....t ......
yam
_.__. .. -.— .__ -. ��_
'(Th' Pc perms cotton
is rection nxd'nat 6e lead if be r is for a. Worked
,.(stool
Lanes..! ..,..
` I ondify that to to performancef thek f which thispermit u. tl rl
_ . ,:,. _..-..-.._�•F �• ^ <, s r .... .tel i t, �._...•..... _ ., .
s I'{` ` L
shall n t employ any pend ,, rout . to beciri s bl ct us he Worker,
Compo; . mo law, of C limn! Date;
.. Applicant.- - •. •. •.
- _ --_ - -- _------__ __
-. _._.__ .___ _ -._ _ - __.___ ._
NOTICE TO APPLICANT If for ak gth CertificateEx pr you-houM
's' •• S •
� tiecome subject to the Worker s Compenvrnn pow isionx.1 the labor Cods, you must
forthwith'cosmply with such provisions or this Permit shall he deemed invoked.
-
0) " -s ot'''CONSTRUCI'ION LENDING AGENCY
I hereby'sdrich that there is a issued ctioo Icnding edC
ofthewiso (o'whmh thispe lisxued lS-309]Cv C) •. .
)
� -I:e der Nate '� .__L_ .. _y'.r
.._{�11}�
Lenders Address' _
' lr• r, ):� y.
I ceoify that I have read this application and state that the above information is
'to Willi agree m shortly wird all city and and stem town
c;cpu�omatinca
core,
,I thea Wilding .r ai e, by-ath p .' t rive fah' city to cnmr upon
p] the aMamenureds Perryf .pest phater •.
Y IW Isomem r d<m fyandkeeph 1 tan rC pen agars!
_
�- f "`�-
way
judgments. t d pen¢ h h may.in a" Y gain,! said
O liabilities. . again
e CI e�✓k
.
Gy m nusT UNDc of the granting of this permit. W -
AN I) WILL CL COMPLY WITH ACI. NON WINT`
's APPLCE'REG - ": •.
l
Issued by: Date
LATIONSND
z SOURCE'REGULATIONS!' �'�I"'., , ..
- SiBnaiure or ApplicamPComractor T'.,: ' ' , . ., lDa¢"' C
-
Re -COOTS
H %7ARDOUS MATERIALS DISCLOSURE '
' w u the PPlic t n r w bmld'ng nea,cthroe Loh wlf haartlon, nratena
....Type.of. Roof_ ...... _ _. ..... _.... .. _ .. _ _ _ ...- -----
as detmed by he Cu pini n Munic'pil C de Chapter 9.12, and the Health and Si fey
Cade Section 255324.).' kill - 1 t I:". -I.
oY: .._opt s - T_
'_7 s '
-All ..roofs..shaltbe. inspected. priorto.any_roofing material being.installed.
W11theapplicant orhome Wilding accuportuse equipmentordev¢a:which
If a roof is installed'without first obtaining an inspection; I'Saree'toYemove
cross haeurdous air conmminams as Jelined by rhe Bay Arm Air Qualify Manzgemem
D t
all new materials for inspection. Applicant understands and will comply with..-
.. ❑v ., . . ,„
,'orvm, '
all non -point source regulaftons.
1 t •�;
1 ha n read dhe h4,.ardisrgmen r q mcnts'uad,, Chapter 6.95 01 the
Calire6a HSlth & Safety Cul.. Sections 3505: 25573 and 25534. 1 understand !bar
-: if the building does not currently have a tenant, [WE it is my respomibility to noury,the._.
-,ni
qu - prior issuance of of
oac thf the em h¢h mu tbcmtt•
tat
F y
°"°'"` 1' _..
Si,matureofApplicant Date
v
_ .a. ..
All roof coverings to be Class `'B" or better
o e anth9rizee
get
OFFICE - ..-- -