00100224CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
111tiLDING AIHMUSS,
PERMIT No.
JUST WATER HEATERS IIIC
00100224
OWNER S NAME:
APPLICA'I'[ON SUB LATE
1764 NATIONAL AVE
10/31/2000
HONE:
SANITARY NO. CONTROL NO.
ARGHITLCDIiNGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
IUJ I=1 IJ I=-1
LICENSED CONTRACTOR'S DFCLARAI ION
Job Description
omeacing
1 hmereby affirrhe I and licensed under prevision, of Charter 9 km
with Section 71Ifg)l of Division 3 of the Buriness and Professions Code, and my liecoc
f all force and crfecl.
,
Lin
ivcnsc Class Lic.n
-
Uam Cialtraur
40 GALLON GAS ATER HEATER.
ARCHITECI'SDECLUOVI'[ON
REPLACE
1 undemmnA my plans shall he used as public records
-
f.iva,md Pmfis"innal
OWNER-BUILDHR DECIARAI']ON
/
1 hereby aRnn Nal I an, exempt form the Contracmr', License Lnue for the
folkaring mnwm. ISeen.. 7031.5, Basins, and Pmfexs;nn, Cralc: Any oily or covey
iso,h regwrta o peon m conmma, aper, improve, lanolbh, or rcpmr any sur m ra
f/
all
prat t' A 1 d npl� Ir hl a II i _ d.tt cm
Sq. Ft. Floor Area
j�iuutl
,hator i, enemedrm. u li, Una,prAmort,Ito Commuko,Ice:cl Cliage,9
netaimmuca,withSecturt 4(X1)) of0 3 ofte Bu,ina,s andl f_. Cde)
ended he t, cncmpt tnerefnnn and the bai s for the alleged exempuon. Any violation
of secrla, 7031.5 by any appficam for it permit.object, he triplication a civil penalty
APN Number
Occupp
fl I,,, re Iran live haelrcddnR,ra(g5Em,
. IWe
❑ll
ndthnymoy
,fe edfor lale(Se.
3591.9032. Ll gquired Inspections
BF4.
will ne the work. and the mrucluh s not l Li ore Law for sale (See. tflit.
do isnotintended
BnsincA .and Professions Calc: The Gmm,cmr's 1.icercc Law Jos not a, an
orply
r Who m t march), net who does tent
n ed
or
intended of
own lovec provided are not Inre
ugh his w rthadden mal .wen i errrn
ut erect
is that within one year of
for %al however. t t tssol year
for w1e. If, onwoser, the ll have t of ire en of proving
completion, win have the burden or proving mal he did tint nmad or
,
502. — FINAL PLUMBING ENERGY
inprovefn,menwmenboic).
mprove. lint rmwt,a m tm.l.
506 — GAS TEST
❑n r nwhet or he rreremy, ren ex sines, a d Prnlig n, CEde:) rhe Cormoi m
nueRushesandertywhobild%orThevesthinon.
507 — FINAL PLUMBING
Law tact not m an owner tit won) or improves
analionn.waw oesco(see,
fiec t a, th.
on who nminaens for wmm oojwts wait a rnntmam(.1 hnamwed halwnant m me
wh r such w atom
Law.
❑ 1 am oxenga uuJcr Sec. . N Nd PC lin his reason
[I I in exe ,o mak
owner rate
'
WORKER'S COMPENSATION DECLARATION
1 hereby ulfinn molar lxnahy of perlury nne of the mllmwing Jeelar:aionw:
0 I have and will maintain a Certificate of Consent to self-inwrc for Worker's
Cmnpcnsation, as provided for by Section 3700 of the Labor Code, Iia the
rn'Ikmnancc of Ile wok fur which Ihia Pana, is issued.
01 have and will maintain Weaker', Cnmrensation Insurance, as required by Section
370X1 of the Labor Code, for the pertimmance of the work for which this permit is
,
hued. My Worker', ComEnnwnion Inwrance carrier and Policy mm�her are
Carrico Policy Nu:
CURE iFICAI )ON OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Th;, ncoiu i need not be aunlpluaH if the Ia,nn;l is fur nuc hundred Joilurs
ISINd a, R11
I cenily that in the performance of the work for which this Penni) is issued, 1
shall not emrlay any prion in any manna so as to bceome subject in the Workers'
Cm..""iniun Laws of Calllomu. Dal,
Applicant
NOTICE TO APPLICANT. If, afro making this Certificate of Estannion, you should
become subject to the worker's Com, enation previsions of the Labor Code, you trot
timhwitn mmphy with suet' provisions lir this pend shall be deemed revoked.
CONSTRUC9]ON LENDING AGENCY
1 Ell aRn that there is a entrarre ion ]and,., aFemy lin the peK imana
of the work for which his Permit is issued (Sec. 3hrl. Civ. C.)
Lender's NI ra
Lender', AJdres
1 certify Ibm 1 have need Ihis ap,heru on and,cac mat the aMm infunatiou h.
urea. 1 agree to comply with all city and county ordinances and state laws relating
m Nubian, onwwmion.and herehy authorize rcpresentaiws of thiscity to enorupon
me uhove.nontioncd pmpeny for innpemiull..... ) .
'
(We) agree in save, indemnify and keep harlolcws the City of Caproimo against
liabilities, judgments, costs and expenses which may in any way accrue againa ,aid
City in conmgnenee of the granting of this permit.
APPLICANTUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by: Date
y'
SOURCE RI!GULATIONS,
Re-roofs
Signature ofnpplinu /Conaactor Dale
HA7VOXOUS MATERIALS DISCLOSURE
Will me applicant lir mote building rccupae.mm or handle hwordnu, mactial
Type of Roof
ar defined by the Cur,minu Mun;cipul Cale, Chup,mr 9.12, and dm Ilcalih and Safety
Code, Section 25532(m):'
O ye, 0N
All roofs shall be inspected prior to any roofing material being installed.
Will mcarrlir'ant or future bnadingr.capam use equipment advice, which
If a roof is installed without first obtaining an inspection, 1 agree to remove
bn haztlydnn, ait eatt,r loa n, .,darned by the my Alla Ab pu:mty M:magemem
i,mefr
all new materials for inspection. Applicant understands and will comply with
0Yes ONn
all non-point source regulations.
I have read the hmnrdous m:ncrials rcqu;mments under Chapter 6.95 of the
OJilinnlu Ilunhh & Sufvly Calc, gu9in1w 25505, 25593 and 25534. I undcrdmnA mat
Iftheantote«snotnrcnro%navenImam,Iet ;tis my ore
manure
eofa efiRg
coram of me mquirtmm�as which must be met prior m isuanee of a Cenilica¢ of
occupancy.
Signature of Applicant Date
IAll roof coverings to be Class "I3" or better
ownetDam
(it amlorioedagent
OFFICE