01060158 I
CITY OF CUPERTINO
nun.Dwc DIVISIONPERMIT " CONTRACTOR INFORMATION:
BUILDING ADDRESS:. � ' ' ' � � - � � PERMIT NO. -
20631 -MC 'CLELLAN RD WATER''HEATERS .& .MORE PLU4BING01060158
OWNER'5 NAME:. ! r• ' - "' APPLICATION SUB DATE
ERHARDT 'RICHARD—D"'AND•JOYCE" — 1163 - CHESS DR,--SUITE'--K "-06/27-/2003-
• PHONE: - J - _ SANITARY NO. CONTROL NO.
(650) 525-9287
❑a0 le ARCHITECDENGINEER! BUILDING PERMIT INFO
of BLDG ELECT PLUMB MECH
Faz� tJ I._]
N¢°
LICENSED CONTRACTOR'S DECLARATION
i�v� 1 hereb term that 1 am oamee ander Job Description
O Z=O Y a provisions of ns Cade.and mmcocing
F,hCj Section 701 iun3ofineBmiressandPmfevsiomCode.andmylkenu REPLACE 30 GAL WATER HEATER.
iscefull Corte and effect.
m U Date
Class Lic.#
X c is.N Dam S ontractor
DELLA
ARCHITECTS DECLARATION P I ISI A L E D
C-O 4 I understand my plans shall be used as public records
zn�Y7
ad 0 Licensed Professional
d 5 C qOO(ui OWNER-BUILDER DECLARATION •f
1 hereby affirm that 1 um exempt from the Contractor's License law for the JUL O. L
I-z*
following mason(Section 7031.5.Business and Professions Code:Any city or county S 6 7 O
i x p which requirem s a permit construct.alter,improve.demolish,or mpmu structstructureany sere - - - -I-
LL�- poor t c I. yw d pPl' t l I I u`o
signed
c e tom,
a%p mml al Jp '. nu Ihpm "be
m Cum
t- t L Law
ICh'Prer9
(cu nc ngwilh Sut nn 7(NNsl of Dsi nJof the ltu.i be and Pp,fest ons Cole) I 3`x»2�1,J'�y;•�V ,{� „y1 x11011
or that he is exempt SM1erdrnm trod the bails for me alleged cxempllon.'Any violation
id,
f Smion 7W LS by any applicant far a Penni'subjects the applicam m o civil penalty
afiwt mare than nvehndurad dollar:lssool. ' 502ApN �Y`$ L PLUMBIN ENERGYOccupancy Type -
0I,as owner of the pool or my employees with wages as their sole compensation, rznr - '
will do he work.'sod the susedue is not intended or offered,for sale(Sec.']M-1; � -'
BLsincidand Profession.Code:The Cnmmcmr's License Law docs not apply to an 5 0 7 — FINAL P�hp.Bigy4(gspeetions'' _ s5-
-r
ilwiicr of limped Who huiln, r improving thereon:and who does such walk himself "•' _....._. ..__ _. .... ..__.. ..._.-._. ......_ ... . .. ..... ...
or through his 'n implored'.provided m t such',improvements arc not Intended or •'• " "' '
offered'far sale IL how er.(tie Wildingm t is sold within mm f
en fpm geldo a, ,,
completion,the owneo-buildcr will have the burden of proving that he did not build or
' improve for purpose of sale.(. I
❑qtr he she p npc Cyan Imbin ly contractingd, Nm T nsThttmarload M It" 1 -
cicense the does
(Sc,. too Business and Professionsilds or The Commcmr. \, ,
License law d«x not apply to of owner of apropertycantr who builds olpubsuimproves memon,
and who contracts for such projects wima cammnuds)licensed pumuw m.mc
C.mrk LJvcnse law..
C l am exempt under Sce.' ;B&PC for his reason :4". I:";• "s
_ Own .. Date
WORKER'S COMPENSATION DECLARATION
• I hereby alBnn under penalty of perjury orK of the following declarations:
Ll I have ami will maintain'.&nplicme of Cometh m self-insure for Worker's
_ Comper%a ion, as provided fur by Section 3700 of the Labor Cudc, for the
- perabourne of the work for which this permit is issued..
❑1 have and will maintain worker's Coripcnmion Insurance,hs Inquired by Section
3700 of the Labor Chic for the performance of thd work for which this permit is n f
issued My Worker's Conrpenmrion Insurance carrier and Policy number are: .i ,,l.•af - _,
Carri Yq i I�YI'• PUlicy No.: -
I;CERTIFICATION OF EXEMPTION FROM WORKERS-y,
COhIPEN5AT10N INSURANCE;.'.r" •• .... -._ . __-._ _ ..-._...... .. _ - _____._^._
Ohis'seetion need not W compineJ ifrhe permit is far one hundred dollar s� \ - - •\ , 1
' ISIINII or les) - v '
.. i. I"resuffy.y'may IM,n m f theworkto hick bjcO tot t naso'
Coll nut etion Laws
pe son in any munna.vo as.m hpcome mblea to the\vork<n I tUsi 1
I
Compensation Laws of California.Data _ _. . ._ _ --- .. - . -..... .... ._.. ...
Applicant-
NOTICE TO APPLICANT If.after making this Certificate of Exemption.you should
bee blatutheW k .0 pfp 'oosafine Labor Codeyou most
C O ford fl ply illi h p s or m pe if skull be dee nod rcvoUd
Z . . _ _.. ... . . .... .-.. ._ .. . _. .._ - -_ ...__
Vy ' , v CONSTRUCTION LENDING AGENCY
C' 1 hereby M.that them is a construction lending agerey for the performance
the work for which this permit is issued(Sec.31197.Civ.C.t
bendds Namc.. -.. .. _
Lender's Addiess U0 1 minify mat 1 have mad in,,application and nate that the above information is
Gsscomact:I n,mm m compl,with all city and county orditranccs and sore F.missing
0 inWilding construction,andhereby authorize representativesfths city to enterupon
ryj the akive-merfirrodto pc ty for Peet p p
I W 7 g w s ' J expense,
p l uric City ten i u o t .fit
% Cit . 1 dg a I. d p nae which y anY y gainw sat J
U .Z. City c 4 calm gramingofm Nbrrdi
SOURCE REGULATIONS..'
AND WILL COMPLY WITH ALT.NON-POINT Issued b Date
- SOURCE REGULATIONS..' Y'
5igpanimnfpppE<aMContmaor,- .,Date'.' Re-roofs
HAZARDOUS MATERIALS DISCLOSURE ' , '
Will do npphani or Mum baiWmg occupant note or handle havNous material Type of Roof - ' -•-- •-as de.S d by the ( nsi Municipal Critic.Chapter 9.12.and me HcaIIM1 amSofey
Cudccnion 3553:32m1^- , ,� rn 4:,lyA;. - •. ' s
° .
re` °
' No - All roofs shall be inspected.prior.to any roofing.material.beiner installed.
Will the apphn t'or future building , p t a,ecq .1 I or devices which If a roof is installed without first obtaining an inspection, I agree:to remove
I h d co r r t d tin d by InBay Area Air Q I Iy Mansgemem
o.act aWnew materials,for inspection. Applicant understands'and will comply with
., .. ❑vert\ -.• C3 ran all non-pomt source regulations.!
-
I have read the hazardous materials requirements under Chapter 6.95 of the -_ "- - -- -^- - -- --' -
California Ilcahh k S;dny Code.Senlon,25505.25533 and 25534.1 understand in,,
iflbebrnof gdoevlmnrem,vyhuveu¢na,:e, ii i,myssuanceof by 1p'nmlfy me ,
occupant of the rcquirenienls which blurt be ren piior m issuance of a Ceniticsm of
Qcupancy. .
' Signature.of Applicant Date
Owner nr,aamoaxm agent All roof coverings to be Class"B" or better
... 1 - OFFICE