03010185 CITY OFCUPERTINO - y �,I--•.-
BUILDING DIVISION PERMIT CONTRACTOR,INFORMATI,ON:
BUILDING ADDRESS: HOTWATER INC PERMIT NO,
11186 LINDA VISTA DR n-ioioiar)
OWNER'S NAME: 2531 GRACELAND AVE APPLICATION SUB DATE.
DEXTER CHARLES N AND LONNA C 01/28/2003
"E: (650) 298-8494 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
ccc LICENSED CONTRACTOR'S DECLARATION lob Description
u F I hereby affirm Ihac 1 am lice..it under provisions of Chapter 9(Commencing P
rYi<a h5 coon]Il(10)of Division 3u(thc Ousin a Professions Cock.and my lieenee is
itl fnrecanticffccn. /7 /_ (� 2 REPLACE WATER HEATER.
Lmensc 1 l� sv Lic.M
yF Dow Contractor , I 11A4
ROUTECI'S MiRTI N
K< I understand my plans shall]M used uc memoir
C.KOyU
+ILL0 Licensed Professl
iona
OWNER cmirpt BUILDER DECLARATION
1 hereby affirm that 1 1. .Rempc tram the Canlnmors cAnyLicense law for the
apO followingrtaon. erten to
]onstru Business and Pe.(denons Ca le:Any tiny or county
which its requires a e,also to c�nes the alter,impose.densities.t or repair any structure
vi prim m its issuance,also reqs ms the applicant for such permit m files signet statement ItM1.A
se a
that hnixcing wit pumtion70the provisions a the oftCummnessand Proelaw(ChnpterY Sy. Ft. Floor Area $ykal[IIt10❑
�~$ (can he
..pt Section and of Division rofnhegedramis an.Ad vi Code)or
- Net he u exempt therefrom and the btu for art alleged exemption.Any violation of
Secfion 7031.5 by any applicant for a permit subjects the applicant m a civil penally of 3 5AftlQ1Z_e3MOccupancy Type
not more Dun five hundred dollen($500).
❑Las me
the propeectur intended
withwagaathev salt G144.B sines
will doth work.and the s o Cort is not intended oro w do Torula(Sec.inOCC.owner
or
and Pmfcssiobu Code:The Committees License law does not apply lf an owner of 506 - GAS TE UITe nspec Ions
property who builds oded that
chicon,and who aeessuch work h roffe or missile his
howemployeaa,pmgorimarovehimprovementsartneyourofcompletion,
manertafoeowneL 507 - FINAL PLUMBING
however.me building or improvement is sold within one year of comm a for me owner
builder will have 01e burden of proving Net h did not hind or improve for purpose of
aale.).
❑1,as owner of me property,am exclusively contracting with licensed contractors to
consumer the project(See 7044.Business and Professions Cade:j The Contsanori Li. _
cense law does not apply to an owner of property who builds or improves daemon,and
who contracts for such projects with a conlrnclor(s)licensed Furs....the Contractoh -�
e
LicenssLew. _
E]e e exempt under Sec. B&P C for this reason
Owner Dal
Ah WORKER'S COMPENSATION DECLARATION
I hereby eRf under penalty of perjury,one of the following dominations: ( r
Ihavc end will in
Cenificamof Consenuosclf insum for Worker's ComKn. ... _-
tion,a provided for by Section 3700 tithe Labor Code,for the performance of the
work(or which this permit is iuucd.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700.1 the Labor Co7de,for daamfoofmmance of me work for which this pc.",aismcd.
yie,r (n-I-P,n{/LtIKicrand PN cyo ity num Sore: /
CERTIFICATE OF EXEMPTION FSOMWORK RS' •b
COMPENSATION INSURANCE
(Thisseccirm need not Wcompleted Vthe permit is foronc hundred dollars RIU)
orless.)
I certify that in the performance of the work(nr which this permit is iuued,1 shall not
employ any person in any manner so a to become subject o the Workeri Compensation
Laws of California.Dale
Applicant
NOTICETO APPLICANT:If,after making this Certificate of Exemption,you shnuld
become subject to the Worker's Compensation provisions of the Labor Code,you must
OO forthwith comply with such provisions of this permit shall be Jecmed revoked.
'zzCONSTRUCTION LENDING AGENCY
[ti n! I hereby alTred but there is a convection lending agency tin the performance of -
ai 7 the work for which this permit is issued(See 3(sG.Civ.C.)
aQ Leader's Name
z Lender's Address
C.) O I cenify that I have read this application and auto that the above information is
COMM,l agree to comply with all city and county ordinances and nate laws relating to
V building connmction,and hereby authome representatives of this city to enter upon the
Ualive-mentioned property for inspection purposes.
(~ W (We)ague to save,indemnify and keep harmless the City of Cupcdinn against
z� liabilities,judgments,costs and expenses which may in any way users,against said City
in
CJ `+
APPLICANT CUNDERSTANDS AND WILL COMPLY WITH ALL NKT Issued by: da Date
SOU R ATIONS
Re-roofs
alum fApplicandConracmr au
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fuure building occupant store or handle hvadmis material
as defined by the Cupertino Municipal Code,Chapter 9.12,and 0th llcalth and Safety
Me.Section 25532(a)'! All roofs shall be inspected prior to an roofing material being Installed.
❑Yes �o P P Y g g
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it haiarduus air contaminants a dcfirted by the Bay Area Air Quality Management all new materials for inspection.
idiot]
❑Yes 4y .
1 have read Jen Na haraomaterials fegairtmcnts anter Chapter 6.95 of me Califul
nia lfralda/4 Safny Cvtic,Sauna 25505,25533 said 25534.1 undcrstvd davit Jte Mang
Jeca rwt curtantl M1ave a l,nanr,Nat in ix my rtapoaihility to nndfy the xiupvt of dao
require m �m,or�nf 1,�mel pdono hismoccofa C 'rcaw.Nx ansy. O Signature of Applicant Date
ncror euthori'rcdagcnc Da All roof coverings to be Class"B" or better