02090132 CITY OF CUPERTINO
BuiimNc DtvtstON PERMIT , CONTRACTOR INFORMATION:
BUII.DINO ADDRESS: PERMIT NO.
938"LIBERTY CT JUST WATER HEATERS INC 02090132
OWNER'S NAME: APPLICATICry SUB DATE
�. ED.CLAASS,EN 1764 NATIONAL AVE 09/ 19/2002
PHONE:" - SANITARY NO. CONTROL NO.
(510) 293-9901
_ Q,ZO ARCHRECI'/ENOINELR: BUILDING PERMIT.INFO
❑ BLDG ELECT PLUMB MECH
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Z O y Z .s„'_ LICENSED CONTRACT'OR'S DECLARATION Job Description
�Z_'0 .. Iherctiy eRnn thin lam licensed on der provisions of Chapter 9 lmmmencing - REPLACE WATER HEATER p
Pa, with Section 7")of Division 3 of the Businessond Promosiom Cale,and my license n 200
m,f .is in full force And effect: (5 0 GALLON GAS) OCT O 5 2
s�'a ••Licenu class Lic.X
s�3. ,U 'iDme,,..• .Contractor
-r y plaRCH ll be use DECLARATION BUILDING
C¢Dy'g I understood ,, plans shall be used u public TIONS {./
wS o oLittnud Professional
s�,Q OWNER-BUILDER DECLARATION
ing reaby af0rm thin 11. exempt from Ne Cession, o License Taw for the
Z< , following reason:0emalt t ]031.A Business and improve,
da tali Cale:Any city or reallyl..
w F m
which rcquimx n permu re cnnswn,altar,int wr s demolish,or repair any suunum
c.3_"thathpnorot licensed
oreq the mision Ant for suchpermsmfilee,Law(uaumem. ._
'drol ha res homes it pars am i the p Donis of the the Bucmes Luenu law OC,Con 9 S :Rt. Floor Area y r Valuation
'•( mmermsna with tr t7ouo)ofDivson3ofrheBusincssor!dPr4fPsramCWe) E;UN:.('ii. .q , :7Q s;vty,.yl�Iv9:?c'1:�4+..y
or drat he rs exempt rhertfmm and the bun for rhe alliged eximgion,Anyviolation l
-of Section]031.5 by en,epplieorn for A pe.inuhlec s the Applicant A civil penalty-
• lofnotmorethanrsehundreddogara(s5o0). APNNumberirre":f Occupancy Type
01.as owner of the property,or my employees with wages as their,ole compensation. 502 FINALB NG ENERGY
—will do the work:said'the"StN[Wre'is'not intended or offered for 6ak'(SU:]OJJ; 506 — GAS TEST Required Inspectionsl�` e r,';e'
�I;
'Business and Professions Cade:The Comncmr's Licenu Taw docs not apply to an -
owner of property Who builds or improves thereon,And who does such work himself 507 - FINAL PLUMBING
y -
or duough his own employees,provided that such improvements arc not intended or —_ _--_ I
.___ _ _._.___._._ .._-_._ .._ .. __.__
—j olepl for-sele:IL howevere rbc kidding e t improvement s Bald thin one year or c. '.t r u
I'dompleu o,Pa owner bu Idcr well have the buNen of pmv g that he did nd build or
improve for puryou of sale.). ,
t]fos owner of the Property,am eadusivelY coAtractin8 with littnd emtrvc1. to r ECSII`::i:2✓J:::'1'.f..
consuuci the project(Sec.70W,Business and Professions Code)The Contractor's (::;)^ FL^C? !'I -s:B `s!:r'H
License Law does nor apply to an owner of property who Guilds or improves thereon.
and_who.contracts.for.such.Pmjena.with a.cnmracmrts).IicAnU„pwsom.to the.
_ - Contractors License Law., --- -------
''Ol am exempt under Sec8'�P C for moon
Owner..
tr WORKER'S COMPENSATION DECLARATION
I
thereby
h by aIRran underpenalty of pe)ry n;,.f she following declumnnns-
~0 1 hr ''nd II tan Certifc t 1 C' niio selbmsurc for Worker's
Compemar oro ms provided far by Seci ort IIO of the LOMr Cale, for the
_ - — f performance'of tie work focwhich this permit is issued„
El have and;011'mu mm Wl iker'i C a ti n Insum it s required by Section •
37001 of the Lalbaar'Cridel fn ih Performance of lhe'Am k f r which this pamii is
.h1sueLM,Worker s C mpcnsaunnhn. r ¢e and Policy umhe m 1
bT
"IRIPICA'IION,QFEKCMPTION R MWORK�F LRS — �.I ',4� �{.<t 1: s-r{!I
AL'I '�.
n l + F COrMPENSATIONINSURANNCLt a i
'6 r a111Lrs xesruan,nednnt hemplcuJ Ilhe pennh is for ane hmnlmAd Ips A1' Iar1;I Ci" 'T I I_• s , s s}'}r'
IS ,,.l _ !
.. Ithe'
i ru P rl run,xc fthT r N f f hlcl rhl permt iel d I is --
'sall lI tical y nyp r 1 any tar tl rcrYM1dn nc hlcct mrhdWnden ssjl: tC.x.I'h G!i lc h .
` C n pereuf
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' PP
,f ICAN p 11'Jr 'ukrns rhl Ce qfr r f Lse Pl' you ski dd
A 1
NOTICE TO API'L
b elm bl cit lheW k C npcnsl np v :'ftl Lab CJc,yanua
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ran,_,
art
�,(yam i I h reby'ff rh t rhe b 1 tl n I ntlmg u6 ncy f the Pe Tri mu
.ti bf thew rkf swh kith pA ictuses d15 '1fW) Cr CI �/�(,L/ �—
.
der
s
V'�CIttmfy ihot base read his appl¢mmA endsmmrhrt aMvemformmionis
W `•1 coma I agree re comply with all city And comay,ordinarrces and state laws totaling
end
^:i�.iV mboilding conaruc 66 hereby uuthmih'repre.senrarives oftlik city it)enrerupon
the aboscmanumed property'for inspection pumams. ,_ • -_
�p..,uu 6i: lWe)agrc<lossindemnify,and Imphmlecs Ne Cly ACpeton igmnsr
4:fA
liabilities,judgrams,costs And expenses which may,in any way areme against said
U'Z ',Cry�inconsequence of gr ming of thispermit
APPCIC INT UNDERSTANDS AND WILL COMPLY W'ITH'ALL NON�POINT '
SOuRC&REWLATIONSr tit.'t - +' Issued by; Date
Sig}Imuto of APdlicanVCoirmgbr'"';' -"'^ �i;l USte;�'��� Re-roofs
v : HAZARDOUS MATERIALS DISCLOSURE
Will the applicamorftre building acuponr store m handlo hoallous mamnal _ .Type Of-ROOT.r
.ssdefiad bytCapertonCapeno Municipal Cod Chapter.912 and the Health and Safety „ss` - (++ J
Cade rt❑To25532l41
r't IONn 1 ''I -fA4, JsL. t( sls{r•'t� s_�'!1!<Sly S 11"rt-C tt"Kt," -
! r, _ All roofs shall be mspected.prior to.any roofing matenal being installed. _
pP g. Wn ,—. ..
WBm applicant insamrehulJm a[- iumegmpmentot Marta em[h If a roof is installedliJithbut first obtaining an ins ection;I a ree.to remove
Fruit M1azad us rammanu a defined by the Bay Arta Air Quality Management g P g
4Distact11I.—l'. all new materials for inspection. Applicant understands and will_comply with
.; r.'., all non-pomtsourceregulauong:_ slHi
- '' `.I have read'the hawrdous mamrial,mgaimmcnu uedAr Chapter 11.95 of the
°t Celifomie Health&Safety'Code,Sections 25505,25533 and 25534.1 undersh nI that
-lif e u
oayPam of therequirementswhich must he mtehtaprior Aoylsmuawporcnesof.certificate
of
L-
-
Oa p in.ryl
. ._. _ Signature of Applicant . -. ._ _ _ Date
d
Owner orauthorr:ep get Date,, All roof coverings to be Class,`B"of better
t_; .:_..: -� ,.�. �,. ..--•'OFFICE .. ._ ._. _._ _ .. ____ .
�+- Aa ...1'f....- res. _ ... .._ s•;+rr-r... _.. t - lith r3iy, :7` '4t