02020087 CITY OF CUPERTINO "
BUILDING DIVISION' .PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS:: PERMITNO. .
10'546"MERRI'MAN' RD JUST WATER HEATERS INC .' 02020087
OWE NAME: ' - - APPLICATION SUB DATE
CNIRPgYBORN CHARLES"M AND MICHEL 1764 NATIONAL AVE 02/22/2002
! rHONE: SANITARY NO. CONTROL NO.
l (510) 293-9901
J,Oz ARCHITECDENGINEER: 'd' - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
^'-t I_l 1"'t
F LICENSEDCON'TRACfOR'S DECLARATION Job Description
0z=n I hereby affirm that l am licensed under provisions of Chapter 9 toommencing REPLACE 50 GALLON � GAS pWATER HEATER
p_F-w with Sechon7000)of Division 3 wi Business and Profeoians Code.and my license .
Y y; is in full farce and effect. - .
m se a License Class Lie.p
d n O Date Con manor
ARCHITECT'B DECLARATION
t u O g 1 understand my plans stall be used as public records
it,
z p O Ueensed P ofessionml -
o.S 0 OWNER BUILDER DECLARATION
I hereby alums thm I am exempt from the Contractors License law for the
[-Z following It, n.ISection 703 I.S.Busineu and tiofessioto Code:AnY city err coumy $998
which ne9 a3Permit t t t It r mpro d I'sh,ar repairany sw tum
Q Pnoi t aid rc9 . thpplic tforsuchpenuillofileasignedsmrc t
Nil-In'i 1 udpunuamI4thcp siftMC trazt LccnseLew(chapte 9. 4 34 �3e11$or a g r I Valuation
(Cato , g wu.i Seco 7111Yd)of Div s n 3 f roe Bus mea nail Profers mo Cal) �'s ply(„p t
.,,h. he u eximpt Iti2refio-m an a the basis far the alle6ed dxempaw.Any violaion .w.�4.a` 7:t
of Smtio .70 1. by. applicant for aPermit,Wtjmt the applicant m a civil petalty-
egpot mentitle. nat
five ndred a.11.m(55(g1.- 502AENP1T%k PLUMBIN : ENERGY Occupancy Type
❑h f th popery rin',empl.yew".ifthwislas u the r vdean npcovat on, S06 - GAS TEST
vviIld.Ihawmk'xmI a,vemrt s not t d d 'offenJ for sale(See'7Baa.
'Busmcss and Professs ns Code:The Contractor's License Law does not apply to an 507 - FINAL PL E41HENtIllspections,':
owner of propeny Who Wilds or improves thereon.and who dues such work himself '
or th th ,li his no. ply ..powided th t such improvement,art an,intended or. -_ - _-_ _ ._._ -----
offe edf sale.I h-If' theWill g -p t Id withiny ( __ _ ......_ .. \ _ \
completion,
e theWlder 'IIM1 theWNmirroringthth did twtbulJ ��aa _ - `
1 arp far p rpoo, rwIs) .. _
❑I .n , the Property, ly t tngwrol «d t narsw
oosmua he project(Sec 70W Business ad Professions Code I The C tarune, (SEP , .,s, , „
Li.twe La docs not pply t owner of progeny ho Wild, mm
pvef tomom. O -
_` _end who coir i is Io such pN)c('witb a o aacmrtil
licensed Pursuant m the .... .. ....... ...... . ...D,gJ_Zoo9. .. _ ._.._., . . _-. _-. ... _. ___..
Coamwm?,I L u L - G
❑I pt de S ” UAPCf this reason, x.�' ilt,is :r..VC
�. Owner, ,,rs Date „ L .
1 ; WORKER'S COMPENSATION DLCLAl AR10th
o
1 hereby effort under penalty of pe J ry maI of the fallowing Jeclarm ansa--
❑ 1 h nil n a II mamia Ccn heat f C' ani ro selfWorker'sre for WorkeCampegsuton. ;provded for by Sea 3700 .1 the UWr Cade, for the
'perfotmancc of the work(m.which this permit is issued. ,
❑1 ha4dvnd vvili'�yvdiniitn Worlseei Compensation lnsumnce .req red by Smmn
3700 or the Uhor Cad mi th rifoornance of the work,f ti h rots pcnmt,is
(,. ed!My Workeers Compensation Insurance carrier and PolicYuumber'arc:"
t1tU v a e
Care a d.c. I'v1 1.Y,' Policy Nn c
f IS,t CERTIFICATION OF EXEMPTION FROM
R MWORKER
$;\ '- s "�\ i f. C L,5J4{ailil l it�Nr,
1 COMPENSATION INSURANCE ...__,._. _.-- -.-- -- --
r(Tnsxewdn n`[u mneean,Plaed rhe Perron .rot ane nandma dao to y1•
(Stoo)ar lasd _
''• 1 Certify th t in the perf cc'of th rk'f -h¢h @ pP t iss da -- - _ s „i .._
'
shall'not employ ,person n any manner so as to be o bJectlo the Workrs
m
'Cdarnszt un Laws of Call .Date
Pe
'NOTICE TO APPLICANT If. m
alter gtM1 ut
C fc fEx n you
Exemption,y should
z become. bleu to the Workers Compensation provisions of the Lathm CWc you must
0 O fmih iih compy th: h provision,ooh pe n h ll be deemN m ked
z . __._.__ - -_ - - - \- 111
- ---- ...
%CONSTRUCTION LENDING AGENCY t , t •,t-
' I hereby affnn th t there 't ct I d g g ncy f the pi fu an
e
t., of the work fo which this permd is issued(S a 3097Cos.C11
'Laridee,Address
V' 1 amdy that 1 have read this applicamn and nam that the above inNmsmton is 1
rias F., comfit:I ogrro to comply with all city and county ordinances and state laws mlatini. ,
r 'ctu 'tnbuildingmnstmaion,and herehy uuthoriu represenmtives or this city m enter upon
.the above-mentioned property for inspection pugmsei., ,-- _.
:F,y -'(We)all to save.indemnify and keep harmless the City of Cupeninoagaiast
Q liabilities,jud,prems,costs and expenses which may in any way accrue agwosi said
U City tri consequence of the graining of this permit' -
.APPLICANT UNDIfR$'fAND.S AND WILVCOMIPLY WITHALL NONIPOINT' Issued ; Date
SOURC9 REGOCATION`s. •i -' r„ y
Signature of Applicam/Contmetar. ,.=,': i"! :.° :7'Date"` Re-roofs
HAZARDOUS MATE RIALS DISCLOSURE -
1"' wa rn PPl i t r f t rt W Idin a p t for handle It"do.nam I Type Af.ROOf -
asdefncdbythePen M Pal Cal [nn 912 and the Health and Safety r-. ,e„, _ .3 ,_; , ,1 a, . :iP
,Code S t .2553 fa)
7Y !: 0N.%l' r ,a I li t All Toofs.Shall be inspected prior to,any roofing.material being installed.. ..__._ . .
the aypic t r t mbulding occupant as ip t devices which If a roof is installed;without first obtaining an inspection;I agree to.remove
,61h wR d ,commminono,as darred by he Bay Are.A Quality 1A.mScroart
Ditnet - all new materialsfor inspection., Applicant understands and will comply,with _
�., ❑Ye,
, oNt all non-point'sou ice-regulations.
5 1 nave rtad the� hazardous mammals regmremenm utMer chapmr 6.95 of the CehG�rniu HealtM1&Safety Code;Sections 25505,25533 and 35534.1 understand that _- ...
if the building does nm curently hareamnam.thin it is mY reiponxibiliry mnbtifythe ”"" '- -
coca'
cafe of ,\..f 1
o[ w t yl.i n m giremmat- mm�most W met nor to iz aK r eegir Signature of Applicant --. Date
p „� v
1
0 mer or authorised
Data ,All roof coverings to be Class B"or betier
; ge r.
J4-.'
is
t .. , .. .. OFFICE .. .. .. ..... _._.
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