02080062 CITY OF:CUPERTINO
,.BUILDING DIVMQN'-- PERMIT CONTRACTOR INFORMATION:
B L ING ADDREsS- - PERMIT NO.
��8,3 .JOHN DR JUST WATER HEATERS INC 022JS0880r0�62
G "My, 21 1764 NATIONAL AVE APPLICA0 L3A/ 2002
PHONE: SANITARY NO. CONTROL NO,
'y " . . (510) 293-9901
00 ARCWTECTIENGiNEER: g BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
a _t
s.ZZ LICENSED CONTRACTOR'S DECLARATION D
o N I hereby of that lam licensed under provisions of Chapter 9(commencing Ob,}y�gSCIT t10n
ari th Sutton 7")of Division Sof the Business and Professions Cade,and myliroom REPLACE. WATER, H Al}rR scrip
tion
f is in full force and ellen.
M Licenu Class Lic.p
Data Comrecmr
ARCHITECT'S DECLARATION
1 understand my punas she Bc mi
le MO)w
u 6 p .Lice sed Prof ssional OWNER. ILDER DECI.rRAT10N \ a
u� m I hereby am.Nat 1 am m the Coatrut r s Ixenu Law'f rithe
o g pe 1 The' Ion olssCode�nY',it oyc uro
ante ,. $870
nor to its issuance..als. - uirest a Ic tf r ch p oylphuo
3 or that fie lS Giem i therefromPend the basis for the aIle mu¢o lea tgnm stll i -._._.....
n followm reaso sen ]O31 s E ad Pro w:mr ars Genu taw( a�a y 1 s t Valuation
$ (bch regrew permitto
peer pr d 31ksAd�rOfossidls�C� �.. .� ..-• i aY..v,�..'-11.:1 i!Rs;
ons
Blal h a Cn9[d R W f0
(c mmeum ahSunon7 or the Bu - s a. s, L
ed uemant to Any l pen ion rt e
of Sectinot
than five
ydredant fn$50an.l subjects the applicenuoecivil penalty 5O2A t1TdORL PLUMBIN ENERGY p y1YP
of not more than Eve hundred dopers(85001. P-N OCCU anC e
°1,as owner of the property.errnYemployees with wages as their sole compensation, 506 - GAS TEST
wit[do the work,and the''swcmre isnot intended or offend for ado(Sec.]oat, 5 O 7 — FINAL PI p���TT{'+ P
'Business m&Professions Code:The Contractor's License law does not apply to an FP HIS eetions
owner of property Who builds or improves thereon,and who does such work himulf
m through,his awn employess.provided that such improvements an not intended or
-'oRemd for sale:If.however,ilia building or improvement is sold within one year of
completion,the owner-builder will have the burden of proving that he did not Wild or - -
imprwe far purpose of sale.).
co h mer Cheer of the pism.7 em Itis ly can,pat ng w th hunsetle Conten At.
- - - -
License Law
does
(Sec ]044 Business d Professions Cade)The Connect s
License Law dou nm apply,f an
pny who Wilds or impmves th
am.who cr such:Pmyetu with tecomucton(s)LttnW.puruant
to the
Contractor.License Lw.
01ant riasmpt . _ . . \I t/✓Y
under Sed � '� ,B&PCfor this reeaon
_ Owner "' " Data ' J
- WORKER'S COMPENSATION DECLARATION
1 hereby eRum under penalty of perjury one of the following declarations: I (/•!�
j'I-. .❑ 1 have and will'maimain a Certificate of Consent to self-inure for Worker's
Compensation; as provided for by Section 37W of the Labor Code, for the
- 'performance of the work for which this pmot is issued.
°I have and will maintain Windsor's Compensation Insurance,as rryuited by Section
- 3700 of the Labor Code,for the performance of the work for which this permit is
issued.My Workers Compensation Insumue carrier end Policy number are: s,„-,-.• -_.
Cariiec�: •' "•� `•n•: „ ',Policy No.: l_
1:ICERTIFICATION,OF EXEMPTION FROM WORKERS', ” a
COMPENSATION INSURANCE
(This section-need not be completed if the permit is far one Want dollars
(81001 or less.) ,
o empl y an in N<performance of the work far which this ct to
issued,I�
shell'en employ any person in any manner.so as to become subject to the Wonkcrs'
CompensApplicanation Laws of California:Dale
NOTICE TO APPLICANT:If.after Compensation
this Ceram s of of Exemption.you should
become subject y the Workers Compennthis permit ha of the tabor Cade,you must --
0 Q foMwith'comply with such provisions or this parotin dull be domed invoked. _
^F 1� CONSTRUCTION LENDING AGENCY -
m
1 hereby aFrm that then is a construction lending agency for the performance
of the work for which this permit is issued(Su.3N7,Civ.C.)..
CL. -Lenders Nemo Is "' .'. .'•• _ n
U.Z Larder'Address.. - .. .. :k..
0 , I unify that I have read this application and some that the above information is
lis Ea cortece I agree to comply with at.city and county ordinances and state laws relating
Q (, to Wilding cons non,and hereby authorize upreunutive,ofthis city toenterupon
the above-mentioned pmpeny for inspection purposes..
gger.a P., (We)agree to save.indemnify am keep harmless the City of Cupertino against
Fn y liabilities,judgments,costs and espen m which may in any way sccme against said
T.J wZ.r City in coasyuence of the granting of this permit. '
_
APPLICANT UNDERSTANDS AND WILL COMPLYWITHALLNON-POINT ' ISsuedb &ji� Date
SOURCE REGU.LAIlONS. '% Y
Sigppmmaf ApplicamiConnacam, - - Darr' Re-roofs
HAZARDOUS MATERIALS DISCLOSURE,
Will Ne applimnt or.fmurc Wilding oaupanl stoin or Hamm haradous nuurial Type of Roof
as d run al by Are Cupertino Municipal Code.Chapter 9.13,and she Health and Safety -
CoddSection3532(a)7:., . s. . f f- " s +1., sig • !'1 .sNi��s f, *(, ..... .... ... .. .. . .. . __
°Ye,"" °"° . .All roofs shall be inspected.prior.to.any.roofingmaterialbeing installed.
Wills eappRramorfon s,WildiagOccupant use aq°ipmentordevices which If a roof is installed without first obtaining an in'spectio'n'; (agree to remove
unit summations yr canmmiro nts as defined by the Bay Am Air Quality Management
Dismim - all new materials for-inspection. Applicant understands and,will comply with
°-. ❑No all non-point source regulations.,.
I Have reed the hazardous materials tectmenum.under Chapter&95 ofine
California Health&Safety Code.Sections 25505.35533 and 3534.1 understand that
if Ne Wilding does not currently have a tenant.that it is my responsibility to ramify the
,adcupsin of the requirements which mint be not prior to issuance of a Cunifl me of
Curie., Signature of Applicant Date
Owner or authorimd agent - Date All roof coverings to be Class"B'•or better
_ ..... OFFICE .. ._ ..