02090106v
CITY.OF,CUPERTINO.
BUILDING DIVISION -. PERMIT CONTRACTOR INFORMATION:
• BUILDING ADDRESS PERMIT NO,
"7520'KIRWIN LA JUST WATER HEATERS INC 02090106
�' tL61� , JEFFREY J AND BRENDA 1764 NATIONAL AVE APPu 09�17A/2002
PHONE:,. - SANITARY NO. CONTROL NO.
(510)293-9901
LICENSED CONTRACTOR'S DECLARATION
1. I hereby affum that 1 am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license
is in full tbme and effect. ,
S License Class Lic.as
,Date" Contractor
ARCHITECT'S DECLARATION.
unjerso od my plans shall be used as pubrc
lic coNs
, LicensedProfnsional'. . :. .. -
OW ILBUILDER DECLARATION
3c'(,1 hemry affirm that am exempt form the Contractor's License Law for the
fit win& reason. (Section 7031.5, Business and Professions Cede: Any city or county
pnono da lssuarce, also. or= the applicant for such Permit o file a signed statement
Net h'q is limit e- paraded to the prbNslons of the Commemot License Law (Chapter 9
fie omgeaicul4 yaS&lion 700(1) of Divisioli 3 °f the Business enJ Pm(ecsions Code)
or than he is.seas i therefrom and the basis for the olligc'd eixemplfon. Any violation
'of Section 7031.5 by any applicant fin it permirsuhjects the applicant to a civil penally
lof not more than five hundred doNvrs ($500),
. ° 1; as owner of the property, or or employees with wages as their sale compensation,
will` dottiewmk,' and the' structure ' Is not intended of offmol'for iale'(Sm: 7044(
rBusiness'and'Pro(essions Code: The Contractor's License Law does not apply to an
owner of property Who builds or improves thereon, and who does such work himself
`or through his own employees. provided that such improvements are not intended or
--loffered M, sele� If, lai 4ii the b.,Iding or impmvemetn is sold withili one y'eai of
eoritol"min the own—Mrildv will hmm Tri M:Mnn of nmeinn rho h, din nor h:ild n.
W L. aajlwnernl the property, am exclusively Contracting With Intermed contracwn m
consirua the project (Sm. 7044, Business and Professions Cole:) The Contractor's
License Lav divest not apply to an owner of property who Wilds or improves Neuron,
:and who,mmmcls for.,mh projects with.a. mm.t.h.d.licensed pursuant.m.dte
Commmols License Law.,_ ,, ;.,1,. -g sl.l': s ,
° l ora exempt all_, „PC,_ , Is leasee
, der Sec:"' B & fonh�
.,
'-t rt.., ..,.
e �x .,,. '✓ 19 NS
_WOkKER'S COMPEENSATION DECLARATION
(hereby air,. under pcwlly.of perjuryoiie. of Ne following decimations:
'°'I huvdi lnA'wIL"melnteih'o''Cenilleme °f "Cooatmt'al self -insure for Worker'.,
.Compensation, - as provided for by Section 3700'of the Labor Code, for the
-perfesomai a of the work for.winkh this aconu is (Swed., tin.
Came - y ..lf s a1.: a:.Sp li Nn.. _
i�tt CERTIPICATION, OF,EXEMPTION FROM WORKERS
�:. - It "p„ COMPENSATION INSURANCE' D y'
h I�Cfbslxer.`l i7iri neeJ nm W eirinpleted ifthe permit is formic hundred dollars
181001 or less.) .
I' '•' BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
= =J L_=.7 C=_D
Job Descriptjpn0NA IL_E0
REPLACE WATER HEATER
(50 GALLON GAS) NOV 2 n 2002
BUILDING
J V G L• 1LVHL4
506 - GAS T
507 - FINAL
i:Si�Vir�_� t !1``:'�r1'Itra'sni41 y' ,
,5. 1y P t \C'ONSTRUCTIONLENDING AGENCY "'
- - - ..l.. l\
- '
It reby' (firm that th rasa
i cti n IenNng3gency fur the pert nce
of thew k for hlch th pc t nd (Sec 3097 C'v C)
LI f 1 I I .
Lc A r Addres. I .:r
nn
ll'cerfify thm.IM dth'. a,pl' t and nate Nm be above infuvnmlon is
'c meet 1 gree t9 comply,with all, city antlunty, ordinam s and state laws relating
to loilding construction _an'd hcrebyStah irizi iepresemmives of this city to enter upon
ON aborememion6dpmpeny'for irmpcmion puryoses.
IW1 greems a demnifyhnd ke ph rml,sth"e Cly ofPeru gains)
habilitiesjusigzllems.mo imQexpenses hich may, in anyway a against euid
Cry oconsequence Mlheg rang of Ihl pemlti
$OUk10E'REGDLATIb\SVD$ `N{ WIl:LfOMpLY NhTH,sLL t;DN-PGINT'-
Issued by Date
. 4 t1 I l 4 Ir•1•
&Llnnturc of Applt<anuuminho Date, rpt':;
Re -roofs
HAZARDOUS MATERIALS DISCLOSURF 1 •'
W01 rite applicant or future building aeupam store or handle fiazardom materiel
. _Type.of R00f - •._ - -, ...
x del Ned by the CupeA no M ntcipal Code Chapter 9 12 arta the Health end Safety5y-
C
eode Section 25531(a1 �.
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t II
r '>,•"j'Se !. "� ` i!.- I / ,,,1;1 Irl
ei L**'T 1i i �j �M1iM1
111 ihYV
°Y "' °No l a -
.. J al 1 v
All roofs.shall be inspected.prior.to.any roofingmatenal.being installed.___.,_
r
r:oa IH'll N, xppliclm or fm... hulled gore p muse N ,merit or deviceswhch'
I - ...
1f a roof is installed without first obtaining aii'ihSpeetion;'I''agieeito ierilove
emu harm s air mountainous as defined by the Bay AicsAr Quality'Maeag<mmf
D61na1,, .' : , .. u •" ' - - , •
all new materials for inspection._. Applicant understands and will w_ith__
1 ❑Ye4 4- ❑Nn'- -
`s
_ _comply. _.
` all g
non -point source re ulations
o
attI have readh�lhe gerdous miic L requirements under of the'
CII(rota Health & Safety Code. Sections 25505; 25533 and 255141.understandthat',
t the building fines not currently have a tenant that the
is myssmomeiof
.__ .._,_., ..- .. .. ._._.._.....___. __..__. ._.___ ._._ ._...._._.._...
occupant of the,requircmenls which mdit Na mei prior to issban<e ofa mdfi'fy
p Cenifirnte; of
,h
Oce p my i \Ill I -' '-
Date
'Owner NonzeJ'; ora.
All roof coverings to be Class B 'or' etter '
,. ': _ '�_ `'i --..__-OFFICE-.