03030131 CITY OF CUPERTINO '� i.n,a$p#+fxngsFx� '�`
BUILDING DIVISION PERMIT iJ6N�+T= UC,T0 VN'ppm ATION ,;y
BUILDING ADDRESS: PERMM NO.
JUST WATER HEATERS INC
PERM r Lsull 3 0 13 1
OWNER'SNA E: 1764 NATIONAL AVE "
SANITARY N L NO.
E' (510.) 293-9901
BUILDING PERMIT INFO
ARCHITEC"U"GINEER:
- BLDG BhF-GT PLUMB MECH
+�oo LICENSED CONTRACTOR'S DECLARATION lob Description
b+ I hereby affirm that I am licensed undo,provisions Of CMpmr 9(cemmendng
m with Section 7")of Division 3 of the Business and professions Code,and my license is �������
_=w in full forte and effect
SRK DaNnsoclsss LIC-0Contranmr REPLACE WATER HEATER
'—, ARCHIIEcTSDECLARATION - (40 GALLON GAS)' APR O 2 2003
1 understand my plans stiuse
ll he d as public mcnrds
it,� Licensed Plot
OWNER-BUILDER DECLARATION p g/�
<E I hereby affirm that I oro exempt from the Contractors LmnsI LD Iee Law for the ^ - g�41.G
i o o following mason.(Section 7131.5,Business and Professions Code:Any City fir County
a$ which requires a Permit to Construct,alar,improv,demolish,or repair any 1"clum
poor 41
it issuancO;tiro rcquimsthe,frdleanl ,such permit m rile a signed statement S Ft.Floor Area Valuation
that he is llcm.4 ponos .Ne provisions of the Comment lJcense law(Chapver9 tl• -
z�nt (commencing with Section 7")of Division 3 of the Business and professions Codc)or
$
that he is exempt doorman and ae buts for the alleged exemption.Any violation of
Section 7)31.5 by any applicant for a permit.ubjcca the applicant In a avil penalty of APN Number OcAmay Type
not more Nan Bw hundred dollars($5077).
1,as Owner of the property or my employees with wags as than tem mmpcmum,
will do the wor".d cCume.is hot Intended In offered for aide(S.C.Mass.Business Required Inspections
and profaa sioCode:The Co useamra License Law does not apply m An owner of 9
propeny who buildmdmpteves thereon,and whodms.uch work himselfor0uough his - 502•, — .FINAL PLUMBING ENERGY
own employees,provided that such improvements are not�lendedmrferedforrae.If. SO6 — GAS TEST
however, Improvement building or Imprument ismld within on uDfmm Iedon,the owner- -
builder will have da,burden of proving that he did not build or Improve for purpose or 507 — FINAL PLUMBING
sale.).
❑4a.owner of the property,em exclu iwly contracting wit licensed conbaclot to -
Construct the project(Sec.7044,Business and Profession,Cade:)The Comment's Li-
mac law docs not apply to a owner of property who build.or Improv Warton,and,
who contracts for such projects with.Conmtemr(s)licensed pursuant to Be Corrientes
License law. .
❑l am exempt under Sao ,B h P C for this reason .
Owner Dam -
WORKER'S COMPENSATION DECLARATION _
1 hereby affirm under penalty of perjury arc of the following declarations: ..
haw and will maintain a Cenifiata of Content to.elf-Insum for Worker'.Cheapen' -
73700
n,u provided for by Section 3700 of the labor Code,for the performance of Wes -
for which this permit is issued.
haw and will maintain Worker's Campeuation Imunnce,u required by Section ofthelabor Code,for the perf...ncC of the work for which this permil is issued,
Worker',Compensation inw mance corder and Policy number am:ier: Policy NO.: - -
CERTIFICATE OFEKEMMON FROM WORKERS'
COMPENSATION INSURANCE
CDII.KKIIM need not becomphom It the remit(stmot a hundred dollars MOD)
Or less.)
I unify that in the performance of f wank for which ads Permit is issued, shall not - - -
employ any person in any manner an as m become subject to Oe W-11COWCo orgAsC on
Law.Of Califomis.Dam
Applicant _
NOTICE TO APPLICANT:If,afro,making this Ccnineem of ExemPthm,you should _
become subject to the Workers Comformth n provisions of the labor Code,you must ^� -
Oforthwith comply with such provisions or this permilshall W deemed tevoked.
hCONSfRUCION LENDING AGENCY
f' I hereby affirm that there its connection lending agency for the performance of .
the work for which this permit Ps issued(Sec.3M.Co.Cd _
W Q Lenders Nem.
Landes Add.
(J 0 I mnlfy that I have lead this application and not,that Be eWw information is
W E" cormn.I agree he comply with all city and county ordinances and sum laws totaling m
p C.j building construction,and hereby omhotim representative,or this city to cover upon the
W .hove-mendonce property for inspection purposes
P. (We)agree to ww,indemnify and kecp harmless the City of Cupertino against
(q
liabilities,judgment.costs and expenses which may In any my acerae against sold City
V`1 in consequence of the granting of this permit.
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicantlContnctor Dem
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
will We applicant m futum Wilding occupant roto whendle harardons material "
as defined by the Cliental,Municipal Code.Chapter 9.12,and the Health and Safety
Cade,Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
ayes ON.
Will the applicant or forum Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
•It harardnua air contaminants as dcOncd by the Bay Ara Air Quahly Management all new materials for inspection.
oulct?
❑Yeo ON.
I haw mad the WeArdouamaeriaistoquimments under Chapter 6.95of the Calder.
niaficalthS,SaretyCode,Sections 25515,25333 and25534.1 understand thst If tie building '
'.a net currently haw a lenanL Wal It is my reeponsihlllry m notify the..,.I of the
mquloments which mum be met prior to issuance of a Ccmncem of Occupancy. Signature Of Applicant Date -
Owner tar aulhwimd agent Date All roof coverings to be Class nBo Or better