00120112 cl,BUILDING DIVISION PERMIT
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PITRN111NO,
21067 MANITA CT WATER HEATERS ONLY 00 1201 12
OWNER'S NAME: API•LICATION SUIT IIAi'E
NG MARY M AND FRANKI. TN Y 500 AIRPORT BL.V 12/1.8/2000
ONE: SANITARY NU. CON'rR01.NO.
(415) 349—,7
C z z All I ECT/ENGINEER: BUILDING PERMIT INFO
ae
IILUG .LP.CT PLUMB MI!CII
z J J — L=1
aH
HZ LICENSED iDCON'nRd made,
OIiCi.n RA TION Job DBSCflptlOn '
z_ 1 hceby udTrm the,I am of the B under provisions of Chapter 9(commencing
wid,Scaforce and
effect. nn i nrthc nnvino..and Pndmsiunx Gnlc.mal my license
xis m Ihm same etre evert. '
s t Llcm,sechl,s lj,.x REPLACE 50 GAL GAS WATER HEATER
O U Doc Comoumr
3 u a, ARCHITECT DECLARATION
Su_O I 1 understand my IF...shall he used as Public ncnals
Y Y
i c.p O
Licensed 1'nhlcssioml
o LL OWNIiHBI111PEH DECLARATION
vl—I 1 hxnH,y ellinn than I a snip,form the Como elode Llanxr Law ser the
f7Q fnllnv g (Section 7031.5.business ord profession,Cods AYctY or amny
F pcc O whsh ot I,permit tI vart'h p den 1':h P' y a clue -
j m Prior tot al. q IM1 ppb i t t h permit I fl gmvl lit mint
a. mal he,heenwie pmwnatno Ficnir5ni, if do ummb rs Lts cL (chapter 9 Sq. FL Floor Area Valuation
(commencing with Section 7000(1)of Division 3 of the Bluiness and l•mfessi(ms Castle)
or Thal he is exempt,heren.and the basis Ibr the alleged exmnption.Any violalion G 7
of Sectio 7031.5 by any applicant lu a permit subjects the oPPlicm,ui o civil penny
of r„mare mtm nee handred donna S501). A PN Number Occupancy Type
❑I.as uwncrof the prol ny.or niy employees whh wages as their sole cmnpunsation.
will do the work,and,he amdae is no,intended or olremd for sale(Sec.70,W.
Basins and profession.Cade:The CI marefir s License Law does not appy-1a as Required Inspections
orrnr propene Who huild,or impmvcs flmeom,and who etas yarn work hlmmh
through his own employee..rood d that such improvements am not intended or 502 — FINAL PLUMBING ENERGY
offered for sale IL howels,die building or improvement is saki whhin sac Year at
completion,the owner-builder will have the burden ofpros;ng that he did not buimnr 506 — GAS TEST
improve mepumiocul e.j. - 507 — FINAL PLUMBING
❑1.as owner of the prpetly,nr mrlusisely'uranin,wllh licensed c.... hrs e. •.
mslmcl the project(Sees 7044.Business and Pndecvlons Cadc)'fhe Contractor's
Lips a Law doe all apply W of prapc7ly who hdddx or irpm es niemoo.
and who contracts for such pronIt will,a la mmcton4 licensed pursuant to file
Conireants Lieensc Law.
❑1 am exempt under Sec. .R&PC for Ibis was in
Owner Dale
WORKER'S COMPENSATION DECLARNFION
I barely adim,order panahy lir perjury m,cof the following dcclertion, j
❑ 1 have and mill maintain a Cmilicam of Consent nh self-insure for Worker's 2�
Compensation, ax provided fm by Section 3700 or the Labor Cudc, for me /
performance of me work for which this permit is issued. - -
❑1 hmx and will maialm.Wurl er's Compcnwtion Imumnce,as xmired by Section O/
3901 of the IaMhr Code.I the pall nnrnce or the work for which this Ill is
sued.My Workers Comlemolion Imumnce carrier and Policy number em:
Carrie[ Policy shu:
CLII'I'I FICATION OF E%I7M19ION FROM WORKERS'
COMPENSATION INSURANCE
(Ibis section need not b,complied it the permit is for one hundred dollar
1 S 100)an I...I
I cenily that in the pct oranance of,he work for which this permit is issued.I
shall oat couple,any ,an in any manner so m to to l rc subject,n the Wn sets
Conhpanm,ion laws of Calculus.Oar
Applicant
NOTICE TO APPLICANT:IL aBcr making this CeniEcuta of Exemption,you should
hecon a subject m the Worker's Compensation provisions ntthe Labor Code,you must '
0 forthwith comply with well previsions ur Ibis pi t shall be doral re,okod.
HLoss TRUCTION LENDING AGENCY
> Ibotchy;it Fiat Ihm there i s a constrrlion lading ainucy for the wroarlo.
Liz of the work for which this pcm,i,is issued(Sec 3097.Co,C.)
d Q lender's Name
r1- Z Lender's Address
C..1 I ceniry that l have mad this application and state that the abuse infor a,ner is
rL L correct.I agrvn I amply wish all cit,Imd county ordinances mal xrule laws retailing
U u,students cmn.heart I,and herehy aulummrepresenmtives of Ibis city m enter mit
} W rat aha l-owatinned pmprrty for inspection On a.a'.
.FP. (Wei)agreemsor.indemnify and keep harmless the Caylir C.wrriao ugmnvl
a Vi liabilities,luegmcat I.co.5t.s and expense whrh may in any way oars against said
V Z_ City in amegncnrr of the gmining of this pctmil.
SOURCE
ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
TIONS.
signummaf Ap,licameconmenr Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will ies,.,BamorwlmenandingnauPinsla'carhandle III...dummmedal Type of Roof
as definnl by the Cupertino Municipal Coda Chapter 9.12,and the Health and Safety
Code,Seselan 2553200"
O Yes °No All roofs shall be inspected prior to any rooting material being installed
Will the applicant orIuture willing occupant use equipment ordel ices which If if roof is installed without first obtaining an inspection, I agree to remove
Twiner?
n
unnrin is asses nod by for Bay Ara n o m
Quit it,Mmwgeen,
Twiner? all new materials for inspection. Applicant understands and will comply with
DY" °No all non-point source regulations. -
I have read file hueuNons materials requirements under Chapter 695 of the
Califnria Health&Safe„Calc.Sections 255115.25513 and 25534.I undcr.mad than
if the building does not currently have a tenant,mm it is my resrym.ibilay m notiry the
occupant of me"ser mals which mus,he me,prior to issuance of n Cut Micas of
0...pane, Signature of Applicant Date
Owner lir aumaricd agent D.na All roof coverings to be Class "B"or better
OFFICE