03030032 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ��COON4fRACTORIN�'gRMA7QN: z;
BUIIDINGADDRESS: MUST WATER' HEATERS INC PERMIT NO.
7�py All
OWNER'S NAME: 1764 NATIONAL AVE - PERMITM A
RO
NE: (510) 293-9901 SANITARY N0. CONTROL N0.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
jOp LICENSED CONTRACTOR'S DECLARATION
II hereby sfnrm that 1 am licensed under provisions of Chapter 9(commencing JOb Descriptions� with Section 7IX«)of Division 3ofine Busimustld Professions Code,anti my license la
in full fora and effect.
>'q
License Class sac. REPLACE WATER HEATER
Dau Comrmbr r,(,��- (;.']j 7,T'O (,:'�L�'�
ARCHTIELTSDECLARATION O+ \\`YIT/r%''wC tp6'-�tY1
f 1 understand my plan shall he used u public records Q n fl o�
c W Licensed Pmfessinnel q '] ASIC 1 /0
a7m OWNER-BUILDER DECLARATION AUG, 1 8 LOOJ H
2�I - 1 hereby affirm that I am exempt from the Contractors License Law for the
D D following moon,(Section 703 1.5,Business and Profession Code:Any city at County
3$E which rectums a permit to enmuuet.slur.Improve.demolish,m repair any structure
-ZSn prior b its issuance.afro requires dm replicafor nt fouch permit to rile A signed tumcnl
< that he IslimmsoJInnocent othe provislonofthe ComracbriLkerscLaw(Chapur9 &(.1 .AoorArea Valuation
pq FCS (commencing with Section 7")of Division 3 of the Business and Professions Code)or
e a mel he U exempt therefrom and me basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant fon permit subjects the applicant to a civil penally of APN Number Occupancy Type
nm marc than fico hundred dollars(5500).
❑I,uownerofinepmpoM.mmyemploycawlmwaguuftirmlcmmpenullon, 32652015 . 00
will do the work,and the musum is not Intended mortared forseu(see.7044,Businessand Professmns Carle:The Congamors Usecon law does mi apply m an owner of Required Inspections
property who builds or mprovms Nemon,andwhodmssuchwmk him irm through his 502 - FINAL PLUMBING ENERGY
own employms,provided that such improvements tae not intended moaered for ask,If. 506 - GAS TEST -
however,the building or Improvement Is sold within one res of completion,the owner-
. builder will how the burden of proving that he did not build m Improve for purpose of 507 — FINAL PLUMBING
aale.L
0 h as owner of the property,am exclusively contracting with licensed contromrs to
construct do pmjecl(Sec.7044,Business and Professions Code:)The Cantndeel U.
came UW dna not apply to an owner of property who builds or it moves themon.and -
who contracts for such projects with a contractor(s)licensed pursuant to the Conlnctor's
License Law. -
❑IatnesemptunderSec, .B&PCfmlhIsmdxm -
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby effbm under pendly of perjury one of the following declaration -
I ban and will meinuin a Certificate of Consent to self-insure for Workers Camper. -
anion,no provided for by Section 3700 of the labor Coda for the performance of the - -
workforwhichthispermitlsIssued. _
❑1 have and will maintain Waft,;Compensation Insurance,u retained by Sedan
3700 of the Mbar Cde.for the performance of the work for which this permit is loved.
My Workers Compensation Immrronee carrier and Policy number am:
Carder. Policy No.: ,.
CERTIFICATE OF EXEMPTION FROM WORKERS',
COMPENSATION INSURANCE '
(This secdlm nail not Ile completed Bole permit Is forcoe hundeaddneara(SIM) -
or Wee)
"— 1eeNfy that In the perfmmanee of the work for which this permit Is load,lshall not- -- — ------ -------------_.. ._...._. _
employ any person in any manner an as in become subject to the Workerr Compensation
Lawn of C.1ifimia.Dam -
Applicant -
NOTICE TOAPPLICANT:If,after making this Ceniflcale of Exemption,you should
become subject to the Worker's Compensation provision of me labor Cade,ynu mug -
' 'O forthwith comply with such provision or this permit shill be turned revoked.
.Zr res CONSTRUCTION LENDING AGENCY of
L r Ihereby affUm that them is a consumdan lending agency ser the Performance of
x the work for which this permit is issued(Sec.3097.Civ.C.)
La Lenders Name ,
2 2 Underh Address
J O 1=try Out I have mad this application and mm ren the above information b
y comas.l agree to comply with all city and county mdinareer and rete laws relating to
building concoction,and hereby authorure representatives of this city to enter area the
N W above-mentiond propeny for inspection purposes.
Ew gys (Wc)agree to san.indemnify and keep ham less the City of Cupertino against
..�res liabilities,judgment,cora and expenses which may In any way acerae against mid CityS)
In ,
J eUNDERSTANDSof the staining of Ihis rmit.
AND
APPLICANT WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS,
Re-roofs
Signuurc of AppllsDau
HAZARDOUS
.
HAZARDOUS MATERIALSDISCLOSURE - Type Of ROOF
WIIl y the C peohno Muni bulling occupant gam or handle Health ad Serial
u defined by 0th Cupertino Municipal Code.Chapter 9.17.and the Health and Safety
d,,Seaon255324)? All roofs shall be inspected prior to any roofing material being installed.
ELY. ❑Nu
Will the applicant or future building occupant to equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
It h sardour our contaminants as defind by the Bay Area Air Quality Management all new materials for inspection.
Ie0icl7
❑Yes ON.
I hen and vudnn
the hameudausmquimments underChapr,6.95of the Csiifor.
nia Health&SgeIYCo&,Seedms255f15.25533 and 25534.1 containmentmatifdte Wilding
does not currently have a unset.mat it u my responsibility un notify the occupml of the
a
Imydronamts which must d met prior to Bsumce of a Cendfcam of Occupancy. Signature Of Applicant Date
Owner m autharircd eFcnl Dam All roof coverings to be Class "B"or better