01090088 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUBDING ADDRESS: PERMITNO.
7513 LEEDS AV HOT WATER INC 01090088
` OWNER'S NAME: APPLICATION SUB DATE
2531 GRACELAND AVE 09/20/2001
PHONE: SANITARY NO. CONTROL NO.
(650) 298-8494
O p�o ARCHITIiC `ENGINEER: BUILDING PERMIT INFO
kC FF BLDG ELECT PLUMB MECH
r3 m` '?f Cs s.LICENSED CONTRACTOR'S DECLARATION -Job Description
z_ ^I hereby atBnm that I am liccnxd under provisions of CWpec9(commencing n
mnCwith Section 7D00)ofDivisbm3ofnheBusincssondProfession,Code.add mylicense REPLACE WATER HEATER
f m Y� it in full force and effect.
rc z 6 License Class Lic.M
a u
Data Con Tab or
0-ki, ARCHITECTS DECLARATION
g 1 understand my plans shall W used as public retools
Y
3 w O O Licensed Pmfaasi...I
OWNER-BUILDER DECLARATION
= 1 hereby pffum that I aexempt from the Co.o.itir's License Law lar the'
C Z following reason.(Section 7031.5 Business and Professions Cade:Any city or county $500
sF m which acquires a permit to construct,alter,improve.demolish,or repair any structurewa.3Ow pnon n c Ire requires theom
applicant far such put files signed stuement• - - - - - - -- - -- -- - -- ----- --- - - -- -
tUtheis,liccm%cdpuintiaoprbvisionsofffic Contractors License Law(Clopar9
(commencing with Section 7910)of Division 3 of the But pare aad Ptofe}slom Code) Valuation
or that he is exempt therefrom and the basis for the alleged elemptimi Any violation
of Section 70313 by soy spplicant for a permit subjects the applicant In a civil Penalty.
of not nmrt than re hundred dollars($50[b. 50241N11"YfrL PLUMBIN ENERGY0-cupancy Type
0 Cas owner of the pmpany,or my employees with wages as their sake compensation, t
will do the work,and rile awaure is not intended or oRcred'far sale(Sec.70ta4,-
Business and Professions Code:The Contractor's License Law docs not apply to on 507 - FINAL PI4I01441aspections "
wnu of propcny Who builds or improves thereon,and who does such work himself
or through his own employee,provided that such vermancmcnss art not i ase dedyear or
comple for sale It,however, will
building or sem en of Prov n sold he
one year of
improve for the itc. f.
illder will hove me burden of proving that he did not buil)r 1
improve for purpose oLsale.).
❑I,as ownerf Ne progeny, exclusivelycontracting.with licensed c tracmrs 's U'
consumer the project Iii 7047 Business d Professions Cad )mp C t oar's
License la dint of apply n with
P.cavy h build p thin Me /
Ms ib twansea eluh poled lith c t mods)b sed'p t no Ne .. _ f .. /
Iiibet'iL
'.o r ;c'lem cxeMpi underS - .R&PCfor this mason "t's•i 1( , --0
Owner Dcan
ale (;,//
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Mnalty of Parlury one of the following draimatiom:
j O I have and will maintain a Certificate of Consent to self-insure for Worker's
q Compcusaion, m,provided for by Section 37W of the Labor Code, for the
Performance of the wad for which this pcmrit is issued.
❑1 have and will maintain Workers Compensation Itvunwe,as required by Section
3700 of the Labor Code,for the performame of the walk for which this permit is
issued.My Wader's Commpansafon l_rmtcc aarricr End Policy numbu are:
Cvner . C tXEM Na r t'r' .. t ..,': l c it.•,•f�. a• :1 r, ;I...
CERTIFICATION OF EXEMPT ION FROM WORK RS'q' i�'-.;'. ? ' 1 - - - -
"'" _ COMPENSATIONINSURANCE'^:... `.. ... ........__... .._.. .._ _..."... .. _. .. ...._ ._"..... _. .. ..
' (This section neW not be completed if be permit is for oro hurdred dellen r I•\ "
(SI00)or less.) ^
adtthat in Me froo nn rithe wad for this
Workers' .. .. .. '" ... .. .cii_ .rriiii is issued,I
'shall not employ
Canu or sto bacoma sub) m rise
Compenm oaoalifrniDate
•,
.Applicant . . - .... .".. . . _
NOTICETOAPPLICANr.If,
sfTer making oris C<nifcate of ExemMion,you should `
ha sbla arto tau Worker's Compensation provisions of Ne labor Code,you must
se.
O forthwith comply with such foreman,or this permit shall W deemed revoked.
... .. t 'r. ..
E ` ., CONSTRUCTION LENDING AGENCY
' '• I hereby nRvn that there is a conswnion lending age for the perfoimmm
of the work for which this permit is issued(Sec.3097,Civ.C.)
llentla;p"Name -. . .
i sdlbr's Address - -♦ .. r„ ti' .m -
V ,1 cavity that I have mad phis application and sone that me above information is
'i+ F covhci.1.gree m comply with all city end e.umy ordironce,and sure laws relating
0.V no Wilding...situation,and hereby aWmonae......us,,of.his city to eider upon
the above-rtu_ntioned property for inspection purposes.
b0./) liabilities.
judgments.rte tcosa and xindemnify
nes soh<ham less the City oe."o against
inst
V:z Cit e of the pftnia 't. yin any way against .
y in CANT NDS Ago Permit..
REGULATIONS.
AND WILL COMPLY WITH All NON-PoINr' !
- soueceP.Ecuunorvs. Issued by: Dale
Signitm of ApPliciairContractor Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of ROOF -
NII the'p ft2ant m furore Wilding ata '
app 8 west Sart m had Me F Health
o material .
as de0ned m the Cuwnino Municipal Code.Chapter 9.12.and me Hcala and Sofeny
Code.Bailees 2333110^ r >•' 1
❑Yea. or+o'• '. 'a,`I-,k'.l„ __All roofs shalLbe inspected.prior to any.roofing material being,installed.. . ."
' ,Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspeetidn",I'agree'to'remove
emit binrdous air rontaminams re dented by rhe Bay Area Air Quality Management
Distrim all new materials for inspection._Applicant understands and will comply with _
•� oY�i, ❑rvo all non-point source regulations.t
�� •t'1''v, 1 hive bud the hawdo s vmaterials requirements under Chapter 6.95 of the
California Health St Safety Code,Sdtibns 25505,25533 um 25534.1 undersand that
if the building does not currently have a tenant,that it is my responsibility to notify the ,
.,.,art of the requirements which most be at or to issuance.1 a Certificate of
°"ap°day.- ' Signature of Applicant Date
.� Owner oraathodiodagent '. Date All roof coverings to be Class "B"or better
OFFICE