01070052 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUH-DINGADDRESs PERMIT NO.
10467 MARY AV JUST WATER HEATERS INC 01070052
APPLICATION SPB DATE
TAWMAWA 1764 NATIONAL AVE 07/13/2001
PHONE: SANITARY NO. CONTROL NO.
(510) 293-9901
a-Z ARCHITECTIENIGINEER: BUILDING PERMIT INFO
00 BLDG ELECT PLUMB MECH
up
I— I EZJ
LICENSED CONTRACTOR S DECLARATION Job Description
WE I family offitran that I ton licensed ardinriand,o,ind,ofCludds,9 blarrandamican, REPLAC WATER HEATER.
4 1-ad aoIhSa,:li..7"d.fDM,im,3.f,1m Bmirr,,ardPoaf:,,i.Codnddd nr,ficemt,
te j��� is in fall force and affecf. (50 GALLON, GAS)
Rot License Class- Lic.Is
0 w�u` Date Contractor
a.t; ARCHITECT'S DECLARATION
1 lindenclad any plan, hall ba used a,Public mpm,6
ad.�7Uc�med Professional
2.5:,� 4/1n
OWNER-BUILDER DECLARATION
v,,� I hereby off. hill I man��emot from he Cmdowill License Low far the I
� following reason (Section 7031.5.Business and Professions Code:Any city or county
0 which requires a parmil to commuct.alter,improve,demolish.or repair any scructuars,
lh�t He ishermaciplasumatuthic mdvkihn�oftheComment License Law(Chapart)
ad prior to its issuance,also requires the applicant for such Perrot to rile a signed statement $
Area
fccarrommil, imi Sescamin 7")of Dishion 3 of me Business.0 Phil...Colded 10 s 0_�!
or that he is cti�nript treatment and The basis(or the alleged 4ximijohah.Any Violations 6M2 0 7 6 . 0
of Seed..7031.5 by any applicant for u svoldit libi he.........................
order me thun rise hundred dollars(S50T. APN Number t Occupancy Type
0 1.as owner ofthe pro,parry.or my employees with wages as their sole compensation, S02 - FINAL PLUMBING ENERGY
will do he work.and the structure.,hot intended or offered E,sale(Saa'7(94-
Buinimis diad Pr6fessions Code The Contractor's License Law roses no,Opp), a san 506 - GAS TESMequired Insliections
owner of property Who thanith,or improves thereon,and who does such work himself 507 - FINAL PLUM13ING
or through his own employees.provided that such improvements are not intended or
offered for st If,however. he building or irs,rievadem ii old widmin an it.of
completion,me owner-buitcher will have de,Wort of proving that the did not build or
improve far purpose of sole')
a La;,;;risi of me pi�opersy old"atsmal,ecomishar,with licensed contractors,to
commuct the prejes,(Set.7W4.Business and Professions Cut The Contractor s
License Law does not apply loan owner of property who Wildi ortimproves thereon,
..ad who central for such projects wich o camitholka"S)ImCalwasTemsournal to the
Contractor's License Law,
1 all,almorp,under Sce. B At P C for this mason
Owner Date
WORKEWS COMPENSATION DECLARATION
I hereby affind under partially of perjuq arm afthe following declination:
ID I face and %ill maintain �Cerldfaceta of Consent to self-insum for Worker
Compensation, as provided for by Scc�ion 37W of dbe Labor Cons, for the
performance of the work f.or�which this permit,is issued.
0 1 have and will maintain Worker',Coinpai...litin linuming.ses miquirad by Sandilm
37M sif the Lathan Cade.for the Performance of me work for which this parratit is
issued.My Worker's Compensation Insurance carrier and Policy number im:
Policy No.:
Cardi i 4 �1 4 4q
T CERTIFICATION OF EXEMPTION MOM WORKERS' $
COM PENSATION INSO RANCE --------
mmi section need not be completed if the Permit is for one hundred doliam
PSI X)or Is,,)
I c,I Affy that,.th�e perfoommul,pfflm for which da is perrovit i i...ed.I
shelf old employ any Person in any thinner so as to become subje�t to the Workers'
Confirmation Law%ofCaliforma.Dam'
Applicant
NOTICE TO APPLICANT If.after making this Certificate of Eemption.you should
Z laccandetsimp,.In the Volker,Com,amnitnin prokion, dfth�Lulana-Code, an roo
C) C) handavid,ta comply,6 such provision,do this perrod half W decamd ravrUdr
z - - -
;� 7 ''1. .1 .� I - 1. CONSTRUCTION LENDING AGENCY
I hereby affirm that Ibex is aconstraction lending agency forthe perfmannica,
of,W,sm1,farhakin his paranit is illmadsec.307,Ci,C.)
Cander',Name
5 z Larda,',Add.,,
U 0 1
"I'll, I rince to comply with all city add county ordinances and state laws relating
:a building consamoion,and hereby handamirs representatives of this city to enter upon
he above-mentionscid propen)for inspection purposes.
C6 (Wc)i ot indemnify and keep harralesv the City ofCalticnince against
s� U) liabilities judgments.cootv and ,xpcar�as which may in ally way accrue againo suld
r Z Civ inconsequeaccofthe Prartingofffikpachnsit. r . . I. . ..
APKICANT UNDERSTANDS AND W ILL CO%IPLY WITH ALL NON-POINT
SOURCE REGULATIONS Issued by: 71�= Date
Signature,of A.,plicant/Cmardener Re-roofs
HAZARDOUS MATERIALS DISCLOSURE '
Will the applicant or future building occupant store or Whole beharmscam,material Type of Roof
ce derined byhe CiPpartirm Municipal Code.Challe,9.12.maddre Hanam ad Safe,,
Code.Section 25532(a)? s
�DY,,' All.roofs sliall-be inspected.prior-to.any roofing material being,inst.alled.
If a roof is installed without first obtaining an mspectiori, 1 agr�6 to remove
he tspirlicann or future building acculparn use cphiparmilt devices which
canit harando-or eondmnimaart�as defired by the Bay Arse Air Quality Maro'comm
District? all new materials for inspection. Applicant understands and will complywith
0 0 Yes 6N. all non-point so-urce regulation�.
I base me harmid wholk refairson,re,made,Chafer 6r65 ef the
California Health A,Safety Code.Sections 25505.25533 and 25534.1 understood that
if l A �l
if the Wilding does not cursently have a tenant,that it is my respor,ibil ity to red fy,the
anard
occupant or the marmatmem,which on,t tai a,milar I.o,uarw.c of Ccitificlat,of
Occupeare,
Signature of Applicant Date
Osvda,or call....ad agent Data All roof coverings to be Class "B"I or better
'OFFICE