02080086 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
10Dj�Ng,�5 ThOLA CT. #2 JUST WATER HEATERS INC PE 02
B�11080086
to GAf'Ar%INGH 1764 NATIONAL AVE APPLICA ff/lBM002
( PHONE: (510) 293-9901 SANITARY NO.. CONTROL NO.
q 8 ZQ ARCHITECT/ENGINEER: BUILDING PERMIT INFO
kC FF BLDG ELECT PLUMB SUCH
red 6 u
H= LICENSED CONTRACTOR'S DECLARATION II b�pp���� p
o M= 1 hereby affirm That I am licensed under provisions of Chapmr 9(commencing REPLACE WATER HE�x4hcri tion
FZI: with Sectione00o1of Division J ofthe Bo undersand Professions Code,andmy license
's in full fume and effmf �a
rc < Licenu Clazs Contract.,
- rI0�.1' ALED
S O Date Lic.# or
uL 3 ARCHITECT'S DECLARATION
�''�0 O I understand my plans shall he uud as public records
ecr a o Licensed Professional OCT 2 8 2002
e,6 es E� OWNER-BUILDER DECLARATION
I hereby afford that 1 am exempt form the Co arrea is License Law for Ne
C Z following reason.(Section 7031.5.Business and Professions Code:Any city or county ,1 $600
O wh¢h re
res perm t t construct
al¢q improve,demo)sh,or repay any n cwre �UI l D'
3$ �pnonoh ss e,al rtquirnth applicamfor Contrast fie astgned suterrmm, - -
th tM sl heed pursuant td do prvvisroos of the to Bees
or's License taw(Chager9 -,-r3 7W1100860 ,k �.tt lff. 4 Valuation
(core man'
iN Sea"ad
]0011) f Division 3 of the�usmeu and
Profession ,I,s a.^m<. `, al S'. 9:Y e'sr 1•.tit r-a l 0-S
or dam fie'a exempt ihcreho ni and the bars for the allege earempt:on.Any vmoleuon
ofarr nameBMe byan'im'oed do"rar.per,it aahjeaa me apphc.ni toaeivil pend"- 502AFNMNA& PLUMBIN ENERGY Occupancy Type
of not more than Eve hundred colla..ISS W).
❑Las owner of the property,or my employees with wags as their sale compensation, 506 - GAS TEST (�
-wit]do the work.-and the slrvcmrt is not intendM'or offered'for"sale(Sec.-7(1,14. Q - FINAL p y{ISpeC[10DS'
'Business mid'Professions Cade:The Contractor's License Law does not apply to an
owner of property Who builds ar improves thereon,and who does such work himself
or through his own employees.provided that such improvements is sol are not one year or
completion,
sale IL er ,wi Wildinge mpmof proving
cold within one year of _ '- f "
improve(a,Ne owne W Idrr will have the burden of pray ng that h did not wild or ''
improve far purposeofsole.l.
.
c I az owner of the progeny,am Business
exclusively d Prey ng with licensed,Comnars 'x
License
the project(Sec.7044,Business and erofeaiom Cade:)The Com hembees
License law does not apply loan owner of a com who W fids or improves Merton. -
::@ ]. _Co vector's kens.Law.ch.projects wird a codtmctor0s).liceasrd.pursuant.to the.
Contractor's a License Law.,
ct ❑lam mtuMer Sec' B&PC for this reason ;i , Ui'9C"�dp`?I
Owner' - Dau
_ WORKER'S COMPENSATION DECLARATION
-,, I hereby affirm under penally of perjury one of the fallowing declarations:
❑ I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation, as provided-for by Section 37W of the Labor Code, for the
-_ pEtfomunce of the work for which this p,mit is issued;
❑1 have and will maintain Walker's Compenimioo Insurance,as required by Section
3700 of the Lose,Cove.far the performance of the work for which this permit is
is J My We ken's Compc' I mnT suncecarrier and Policynumbor :
Qatr s '. i i .}' �Polcy Nho: - s r. .s 1
t 7t CERTIFICATION OF EXEMPTION FROM WORKERS"" S�LJ.,,j. Via(' tl.f.ta .1s+L'1. .` :3If./1
r 'COMPENSATION INSURANCE a''- '.a I
(Th s sewodneed hot be completed if the permit is fur one hundred collo.. i f ' :
(SIM)or less.)
,.. ....,._r. ,,.. - .,�.... .___
,bull
1
cent y that m the n in any a n the work for which this permit a issued.lf(Lsh II en employ any person any manner so us m become suh)ert ta',hc Workers '
Compensation Cnws ofCalifornia,Date
_Applicant .. I ._ .._ . ..
NOTICE TOAPPLICANT Workers her CompeaeammitsCenincmeoeLabor Code,you
r� f, \ ,
becomeh comp m the such pr Coins or this Permit shall
the a Labor revoka, must
0 fonhwiN comply wird such provisions or this permit shall bo Deemed revoke].
'CONSTRUCTION LENDING AGENCY - I
rr
Z 7 affirm Nat the .a coretruct on lend' 8 agency for thepe rho-omme . .
tae r 1 hereby ch this perut is issued IS 3097 Civ,C) -
y,C Lender Address __ -__ .- _-. . .. -4 - ...._ .__
of thew k for which
Lenders Na yy
2' , ° y/� li,'�✓ ,
. I certify that 1 have read thin city
and
and state do,thea above laws inion is
t+m E,m c6rrecc laeree.to comply with all city and county ordinance end state laws relaid,
to Wilding conswnion.and hereby authorize rtprtunmtives of thiscitymcmer upon
o
;a,7 Wthe above-mentioned property for inspection purposes. _.
� Q. (we)agree to save,indemnify and keep harmless the City of Cupertino against
3h liabilities,judgments,rests and expansea.which may in any way accrue.,airs,said
City incaxe,armoe of Ne granting of this peroon.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-PONT
SOURCE REGULATIONS: •;'� _ Issued by; Date
C. Signature of Applicunt/Contmctor Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE . .
"
will the pplicadt o future Wilding ac pant t re or handle mean ou material Type of Roof-
"defireesel by1heCu,mmothrationdpral Code Ch pt r 9 13 nervous H ahh and Safay i E J.• s _t .- �""�
Cale"(DYonSecu . ... e) c ONo }aaiF 1. ..�.I C4 � -�.f
All roofs shall be inspected poor-to.any roofing.matena].being.installed. _
µfl thtipplileata future building accapart use equipment devices whichIf a roof is installed without first obtainingan ins ection I a ree to'rernove
emth rd ucamam' t as d finedbyth Bay Arca Au Quality Management P g
Dtstner all new materials for inspection._Applicant understands and will comply, with
E;Y. :11)No all non-point source regulations. .,.
,I have read the Wzardo.,materials requirements under Chapter 6.95 of the
C.likerom Health&Safety Code,Sections 25505:35533 and 25514.1 understand that'
if the building does
liummercdtlyhave ach .tenant,that it is myrtspnceoila endraml the
'occuPant o(,he requirements which mug bo met prior to issuance of a Certinca,e of
Occupancy.,,., .,'. -
_ Signature ofApplicant. Date
Comer or audmrrizexla,sant - Date All roof Coverings to be Class`B"Or better `
OFFICE