05120057 CITY OF CUPERTINOy' �z:,�
BUILDING DIVISION PERMIT ,aCON'.TRCTQR INFORMATTOI
BUILDING ADDRESS: JUST WATER HEATERS INC PRRMIr ND'05120057
7519 LEEDS AV
OWNER'S NAME: PERMIT ISSUE DATE
WELLUNG LAI 3400 INVESTMENT 12/13/2005
NE: SANITARY NO. CONTROL NO.
(510) 293-9901
ARCHMECTIENGINEER: 1 PERMRINFO
BL R MECH
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io$ ucFNSEDClammedC10asDEc1ARAnON Job Description ✓��
e V I hereby .1' ihel l am lifted i mea pmvlYau of Chapter n(mmmense 1. (ty�
Sj Hth3mtim]0110)ofOiviaianlo(thoBuunevuuProfnsdonsCode.andmylicenmu �9' Q
I.fall mrce.ndalrmt. REPLACE WATER HEATER J
Z Licence Class Lie.4 g' Dam Contractor 40 GAL GAS �
e7 g
ARCHITECTS DECLARATION
e 8 1 underwnJ my plane N.11 be used u public records live�///I�NI/!//e
$� Llfnma Proresataw rtQ\`.\�lVj
N
OWNER-BUILDER examOER DECLARATION
AN 1 hereby.(firm that 1 1. eumnt from tiro Cmtracmra Licenm law for the
p o following tu mss. eTuan 70713,Business and ve.de at Cade:Amy city as county
5$
which requirta.permit u catwc4 ilmr,wpuve,demolW,fisig any momem
that
prior b its issuance.d prse also uquiuu mM applicant for CuM1 fano'm file.crom signed sWcmem
oNukulkgwithSection
ememmthe 0D)aDiamtofNeConuinessadFreiran(Chapter
ode)9 Sq.Ft.Floor Area Valuat(coio 62
H that he s ammiint Smtion,and the but,n 3far the
the Busalleged
ass and on.Any Freiman,Code)or
— that w u esempt thercfmm and tiro s..m.for the illeged esemPtim.Any vlolsuan of
Section 70313 by any applicant for a permit subjects the applicant to a civil penalty ofppN Ngr�tyer Occupancy Type
rot mom man five hummed doll.m(SM . 36G 16Ul0 . 00
❑I,u owner after Property,Or my employes with wage as their able cempotation,
will do tiro work.and the svtmue Is ne,inundea or offered ren sale(Sec.7044,Base. Required Inspections
and Ptw
reot Cade:The Canammn License ace,mlaw us appy man aws nof 9 P
propeny wlm wilds Or importer thmmo.used wha does amh wok attraction through hit
own anployes,pmHded detrneh Imprcvemenu tie 0311-'- taRemdfursaln B,
however,the wilding t Improvement Is mid within ane year of Complaiim.the come-
builder will have the burden of proving des he did na build or immuno far purpose of
filo.).
❑1,as oavner of the property,am exclusively contracting with licensed mnuanm Or
cans,ue the project(Sec.7044.Business and Professions Cade:)The Coran cur,Li-
eeme raw dot mat appy m m owt'r of IntramyWw wild,Or Wit.dCman.and
who contracts far such pujecu with a anamam(O licensed puauant to W Conummrs
License Law.
❑lunmernumderSee .Bl Pcfarthisma.m
Owner Dam
Alk
WORKERS COMPENSATION DECLARATION
1 wmby Afirm under parody of perjury one of the following dwamions
Ih.ve and will milnuinaCaNfitm of Consemwself-InmmfoWahorteampen•
talon,u provided for by Secure 7700 of the Mbar Cade,for the perfmmeme of the
work for which mu permit is Issued.
❑1 have and will maintain Worhrt CompensWan Insurance,as required by Section
37Wo(the labor Code,far the performance,ofthe wmk far which this permit is isseed. '
My Workers Compensation Ina mux carrier and Policy number tie:
Carder. Policy No.:
CERTIFICATE OF EKEMPnON FROM WORKERS
COMPENSATION INSURANCE
(Thumatan need rot wcompleted if tie permit Is farm hundred doll=(SIM)
Or leas)
I certify Not in the Peritoneums of the wart fa which this permit is Issued.l sol not
employ any person to my manner an u m became aubjfl to the Worker'Compensation
Owe of Callfamia.Dam
APPllont
NOTICE TO APPLICANT.If,after making this Cerunom of Emmpdan.you awua
become subject to the Worke's Compensation provisions M the labor Cade you a=
.J O forthwith mmp1Y with much puvivans o this semi,shall be deemed muted.
z r~�i CONSfRUCnONLFNDINGAGENCY
E+ lwr which
this them usued(S .3 M.Cing.geay far the perfammuse of
(/V• `� /\V-��_��
W ti Liu work fur which this permit u issued(Sm.JDp'1,CW.C)
W 0 Lenders None
7 Z I<naeraAdarta
U O 1 ratify that I have read this application dna state that the move mformath n is
U,!' coma I agma to comply with all city and county oNhtsORe and itsm Lias mlaing m
DSV^ building cotumUon.aM hereby mhorim representatives ofthu City m enw Upsm ft
L,mLU awes-menuaned property for inspection papaw
(We)agree to saws in4mnify and kap hamlets the Cly of Cupertino agues
p..'i y liabilities,judgments.cam and expenses which may in my way accrue agilw said City
Z in APPLICANT UNDERuests Of the STANDS Of AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
HAZARDOUS
Signature of AppliaData
HAZARDOUS MATERIAu DISCLOSURE Type of Roof
WIII Lia e C iert m(mum veal C6 amupant rmrc aand t e hunNaua material
u defined by the Cupertino Municipal Code,Chapter 9.11 anti the Hwa and Safety
Cane,Section 257324)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes ❑No
Will mbe.ppriean,ar forum wilding oemp,m use equiPmmt or uerlees whichIf a roof is installed without first obtaining an inspection,I agree to remove
It haturamt air mnumlmunts as defined by the Bay Yves Air Quality Management all new materials for inspection.
District?
❑Yes ON.
I haw road theheurmnumamdab requirtmenu unmmr Chepmr A9y titheCilifo-
nla Health&SareLy Cade.Satima237U7,27777 uW 2ds74.1 undcnmid Lhaifum building
des not curmntlY bow a mnan4 duet It u my mapowM1llity m mtiry the mcupan,of the
requirements which mut be ma prior as Issuance of a Contrition of Occupancy. Signature of Applicant Date
Owner Orauthorized agent Dam All roof coverings to be Class"B"or better