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00050177 TINO CI BUDIN( mvISSI IIONPERMIT CONTRACTOR INFORMATION: BU1I.DINGY169I�$;0 LARRY WY HOT WATER INC FERMI"f NO. 1 c OWNER'S NAME APPLICATION SUB Ali NAMBA SHIZUO AND GRACE 2531 GRACELAND AVE HONE: SANITARY NO. O ❑z a ARCHITECT/ENGINEER: BUILDING PERMIT INFO OPLUMB MECH ELE LDG CT' <�E (650)298-8494 Bu �aN z S y' LICENSED to cuN'nsed rax R'S DECLARATION Job Description O z_o I hereby aRrm than turn licensed under Pnsvi,ians of Cbapmr 9 LLnmmcncing Foew with Imaion]gN))of Division 3 of the Business and Professions Cole,and my license is to lull Pince and ellen. S z`i a Licemse Class Lie.e °'O i O Dam Cordoust 3 a ri, ARCHI'1ECT'S DECLARATION C u O 4 I undemund my plans shall he used as public mcordx tit i p O REPLACE WATER HEATER '"twed Prufcssionml wo OWNERt exempt fo onTION =�, I hereby affirm that I am exempt fromrn thePr Contractor's License Low for the e 3x 2 following reason,(Section it 7031 s, 1.alter. and improve. d nens Cone:Any city or county FD whichrequirespsrmn o 1 h p � J ikh repair any:omctuc a.3$ prot t I. m4 0l ppf 1 f b ra o f Bred o mmem that hers licensed parstiont toda,tom, provisionx ofh Coat1oes LivenevLawo0mili Sq. Ft. Floor Area Valuation p ff, tu, nn ,I,exem Scnmr]OfABrf Dbaision orlezi B,,cd and optim, :' :Code) $50QI .,,bar M1c 7 31.5 b rang applicant anJ the brei,for otic allege)exemption.Any violation of action e b LS me any hundred doll fnr a pemtit subjects the applicant to a civil penalty of not roma man siva noodled dollar,tssau. APN Number Occupancy Type , ❑I.as owner of the p(openY.or my employees with wages m dmir ode corn,mmum. 31.602029. 00 will do the work•and the structure is oat intended or offered to,sale(Sec.9194, Business and Pmlb,sions Crde:'Ihe CorunNn is U,tm,e Law doe.,am apply m an Required Inspections r of property Who builds or improves thereon,and who doss such work himself o 11hrough his own entpinyvos.pow Wed that.each not, vamnm urs not inmari or offend lin sale.IL however.the building or impnn'cmcnt is sold within one year of cotnpletidq the ownc,lam ildv,will have the huNcn ofprovingthat he did not build our improve hit ...c o 502 — FINRL PLUMBING ENERGY ol.m owner or the property.amecm.ivdy contracting with licensed conimcmn to 506 — GAS TEST cnnamm the pmjceo(See.70,44,East—,and Pone ssions Cnlaa The Contractor', License saw does not apply to an owner of property who build,or improves thmenn, 507 — FINAL PLUMBING and who contracts for such Projects with a contracmrl%)licensed pursuant to the Contmnor's Licensor L-w. 0 am ce, In under Sec. .B&1'C fnr this ma,an - Ownet Date WORK17R'S Co MPI?NSAI'ION DECLARXI'[ON I hereby affirm under Penalty of perjury one of the following declarations: ] 1 have and will maintain a Cenificute of Consent to sell-insure for Worker's i•/ �� Compensation, a, provided for by Section 37W) of the WMr Code, for the / orfnrmunce of the work for wwhorl,this pmnnit iu'w,ncd. ❑1 have and will maintain Wo loos,Compensation Insurance,as requited by Section O 3700 A the Lohor Code.for the performance of the work for which this permit is issued,My Workers ContPensaoion Insurance carrier and Policy number arc: P Canrier: Policy No, CER I'IiICAI ION OF E%EM(TION FROM WORKERS' COMPENSATION INSURANCE ('leis section need not he compicied if ilia peanut is for one hundred dollars (5100)nr Ica.) I cenlfy shut in the p,,o...nou,c rel'1lie work or which this permit I,is,tu d.1 shall not employ any person in any manner w as to become subject to the Workers Compen,ation Laws of Gdifarni-.Dam Applicant NOTICE TO APPLICANT:IL after making this Cemif icme of H,emption,you ehouid Femme object to the workers Compensation pro,nme s of the Labor Code,you must Q OmfonM1wi it,mmPly w ah,mh psrvm I,or this permit shin l le dcenuvl revoked. z (ai CONSI'RUC ION LENDING AGENCY a > I hereby nlTim,Ilia(them Is u amstructino lending agency nor the arforrounce W of the work for which this .,it o,issued(See.307.Co.C.) L Q Isnder',,Name Z lender',Address V Q 1 certify that 1 have mad this application rand state that the above information i, ia. [a et rrcet.I agree no eomply with all city trod county onimmcec and Into,laws refuting Q C.1building con, uctlon,and hereby antlenm repmsenhnives of this cityru nmcr upon W th-e aMrrcrrenuoned pmpeny for inspaion purposes" F 0. (We)agrecit)sax e.i ndetnni fy and keep hornless the City of Cupertino against 4 halad,fic,judgments ena,and e,pen,c,which tory io any way aettue-1-61111 said C.) z City in consequence of the grunting of this permit APPLICANTUNDERSTANDS AND WILL COMPLY WITH ALI.NON-POINT Issued b � l Date SOURCE REGULATIONS, y' Signature dApplicar YCornramor Dam Re-roofs HAZARDOUS MAI i7RIAI,S DISCLOSURE Will the applicant or future bidding tecupom some or handle Bcomius m-nidalType of Roof as defined by otic Curynino Municipal Code.Chapter 9,12,and the Health and Safety Ctdc11tos 215320)? 0 N All roofs shall be inspected prior to any roofing material being installed. Wit the nppp.,ou mica btdldingteeupam ase e,mi mnent ar da.ica,which If a roof is installed without first obtaining an inspection, I agree to remove mil h chohms air conlaminant,as delined by the Bay Arca Air Quality Managmetn stun all new materials for inspection. Applicant understands and will comply with ID Ye., Cl No all non-point source regulations. 1 have read the h.ronfi materials requimmcnts under Ch-ptor 695 of the Califmniu Hauhh&Safely Calc.Seniors 25505,25533 and 25534.1 un ba,umd that if the building Atm,not,onrnily have a comm,the II is my re,prtn,.Inday m notify the occupant of the requirements which mu.a be stet prior m issuance of a Cemificam of f"`'-Pouv, Signature of Applicant Date ...',o,-,tmori.d-gent [)amAll roof coverings to be Class `B" or better OFFICE CITY OF CUPERTINO 1 of 2 BUILDING PERMIT RECEIPT OPERATOR: yvonnek COPY N 1 Sec: Twp; Rn9: Sub: SIR: Loe:31602029.00 DATE ISSUED.......: 05/25/2000 RECEIPT 0.........: 12326 REFERENCE ID 0 ...: 00050177 SITE ADDRESS .....: 10600 LARRY WY SUBDIVISION ....... CITY . ............: CUPERTINO IMPACT AREA ......: OWNER . . . . .. . .....: NAMBA SHIZUO ANT) GRACE ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-2057 RECEIVED FROM ....: MAIL CONTRACTOR .......: GUSLANI, CHRIS LIC K 21311 COMPANY HOT WATER INC ADDRESS 2531 GRACELAND AVE CITY/STATE/ZIP ...: SAN CARLOS, CA 94070 TELEPHONE . . .. . . . . : (650)290-8494 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ------- --- ---------- ---------- SPWHEATER PER HEATER 1.00 9.99 0.00 9.99 0.00 PPERMITFEE FLAT RATE 1.00 35.52 0.00 - 35.52 0.00 PERMIT . 45.51 0.00 45.51 0.00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ........ ............................ -------- ............................ 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING