01060163 CITY mSIO
N
ENO
BUILDING PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10351 LANSDALE AV JUST WATER HEATERS INC 01060163
OWNER'S NAME: APPLICATION SUB DATE
CHEN CHENG H AND CHIU L 1764 NATIONAL AVE 06/28/2001
PHONE: (510) 293-9901 SANITARY NO. CONTROL NO.
G ccZ ARCHITEC tENGINEER: BUILDING PERMIT INTO
502
0— BLUG ELECT PLUMB MECH
¢i LJ I __.
z n z
LICENSED CONTRARderp DECLARATION Job Description
Ozy. Thereby )of thin lamlicensedunderpndPmnwfC,Code. (commencing REPLACE 40 GAL GAS WATER HEATER.
F"^F rel with fullSection7W01af Dlviziun3o(the Business and Pme+siom Cale.and my license
z c,of ,sin full force and elfin.
of a atClass' Lie.a
a
a O U DDoec CL
ARCHfTECTS DEDECLARATION
f-LL O S 1 undcrtwnd my plans[hall be used as public records
OO Licensed Pmfesnional
`off OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt fmm the Contractor's License Law for the
=z a following rerun.(Section 70315,Business and Pmf,,h..'Cade:Any city orcounty yS 515
E 2 O which¢ilnires a permit m conamet,nhef,improve demolish,or spur rc
any svuclu
cup pri tn g < alx 4 tI ppli< for...
the
(mmmn<nwith 1
Scc1 1 6 the pruietskare, fh
7")of D'is a ( License CommebaCs
beB ire nit promos'Cuneig . Valuation
or that he is cilmpt thenrrom and the basis for be allege)6turlaiod.Any vinformal
of Sution 7031.5 by any applicant for a permit subjecu the applicant to a civil Penalty
,of no,rmethmtfive hmmreddollars(ssoo). 502APJ V TMAL PLUMBIN ENERGYOccupancy Type
❑1,as owner of the Property,or my employees with wages as their sole compensation,
will Jo the A.and the structure is not Intended or offered for sale(Sec.IDA, s„, '-
Busme+s and ProfeWons Code:The Contractor's License law does not apply to an 507 - FINAL PIRFPQBrYNUspections is
owner of properly Woo Wild,a,improve,thereon d islao does wch work himself
r th h h'. PI Y p J d lot chimprovements t nu Jed or _ _ .- _..._. ... .. _
_... _.
offered r sal If howeve the b ng p Id 'tri -y of _
ompl t th a 1+a ld will have
N b Nen of pn n6 that he did no,Will or
impow.for pim"oe mrol.'),
❑1 r of e,property ho-vel,c t ,i { th l' sed mismas ur Y
oat e,the project(S c 701 1 Businessd Pteak ns Cade)The Conmctm s
n
License Law does not apply to an owner of proper,who Wildsor intensive,thereoa
T •: and who conlfuns for such Platens with o rontmcfortsl license)par rsmm to the ._.. ._. . . - ..... ...-.._.. _.. ._. .. -_ .. . .... _. _
Conaactod Lium c Law. Ip
c1 ❑l am exempt under sec.' ':B&PC forthis resson iJl I ;I" '-i'
_ Own Dale
WORKER'S COMPENSATION DECLARATION
I hereby vffimn under penult,of perjury one of the following dedaatinns:
❑ I badeamsl'will''maintain a Ce'nificam of Chosen,to self-immure for Wodari
Compensation, as provided for by Section 3700 of the Labor Code, far the
_- performance of the work for which this permit is issued.
❑1 have mW'w ill mairg in Worker's Compensation Inwmrce,as terminal by Seen.
37M of the Labor Cale,for the perfimmuce of IM work'mr which this permit is
issued.My Workers Compen,a ion Insurance carrier and Policy number are:
Cartier:�., i J k( . '.Policy No.: tlblu .1
4
n... CERTIFICATION OP EXEMPTION FROM WOR KERS') - - + "' •:31 �t ”+e
COMPENSATION INSURANCE "'
rtes scorn recd not be completed tithe Permit is for one hundmd doll
(31007 aro Ie's.l '
"I cert fy th t •th'Krimf,heork far which his perm t is wcd,1
+hall not employ any person n any manm 4rome.wda e''to the Workers
Cum'jwnsotion Laws of Califoriu.Date
NOTICE TO APPLICAN"e IL of..making tbia Certificate of Exemption,you should -
become subject m the Worker's Cmhh 'mmn provisions of the Labor Code,yod must
C) Q fbnhwiM comply
tech provisions or this permit'hich W be,ted reused.
Z :—: . - .... . ._._. _ .. __ _.. . . .. _.. ... . ...... . ._. 1 _ . .. .. .. ._. _
F-7 ' '.." ' 'CONSTRUCTION LENDING AGENCY. '
11' 7I hereby affirm that there is a'eantr
xciion lending agency he gency for tp._fma
once
W;Q of the work far Much this permit is os iicd ISce.31y)7,Clv.C.1
a- Lcndcrs Name
-� Lender's Address
V:0 I'ehary that I have rend This c"111utlm,and nine thus the above information is
corccrt
l agree m comply wick all city and county mdfnancc+and zu¢laws Haling
C).0 to building c I Lao d hereby nuthortic represemadves ofah t3 to enter upon
the
hove onchnimusedloTerry form1pechurn
p rp.
(W,) b om1:ocd and ke,,h "Ie.
sa a ,. at
liabilities1 dgmills td peneswhich.m y n nyway
aigaoast id
City in consequence thegrantingof thepma.
SOURCE REGULATIONS
APPLICANT
NDS AND WILL COMPLY WITH ALL NON POINT
IssuedbY'
Date
.
Signature of ApphcanvContraator Date.)., Re-
Widroofs
HAZARDOUS MATERIALS DISCLOSURE
'as ' l'hcupplic:rt or building occupant.unto or handle hm
uzardims mcriul Type of Roof
defin
al by the Cupertino Municipal Cale,Chapter 9.1'_,and the Health and Safety _
Cwld Dye, 35513(aj. t h .
"• ''' i. __All.roofs-shall be inspected.priorto any roofing material being installed.- - .... .
• e. SS'illthe applicant orfuturebuilding occupantuicequipment ordeviveswhich If a roof is installed without first obtaining an inspectiofi;'I'agree.to remove
mit Inuardous air contaminates as defined by the Bay Area Air Quality Management
Dintidc all new materials for inspection. Applicant understands and will comply with
CYex 4No all non-point source regulations. ..
I have react be hazdrdouc materials requirements under Chapter 6.95 of the
Caldmaia Health&Safety Code.Sections 25505.3553.1 and 255341 understand That
if the,building docs not couch),have a tenan6lhat it k my to.....bility roundly the
we'apam of the requirements ents which noon be met prior to issuance of a Cer ifcade of
Occupancy.
_ Signature of Applicant - _ ." Date
01
Game,or aathanaed agent Date All roof coverings to be Class "B" or better
OFFICE