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03010170 CITY OF COPERTINO � 1"1 BUILDING DIVISION PERMIT CONTRkCTORIINI+ORMATION— BUILDINGADDRESS: HOT WATER INC PERMITNO. 21450 MILLARD LA 03010170 OWNER'S NAME: 2531 GRACELAND AVE APPLICATION SUB DATE KING NEIL C AND SILINE 01/28/2003 ,ONE: (650) 298-8494 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH �0, LICENSED CONTRACTOR'S DECLARATION N-j G I hereby alum mal I am licensed under provisions of Chapter 9(commencing Job DCSCCIptIOn m with Section]Otx) f Division 3 oss f me Business and Professions Crulc,and my license is ta� zOyimm�rm��ndeffi . Z REPLACE WATER HEATER r�NALED Z LicenSJJ°° Lic.M y�,O Datc Conlractm 4oq� ARCHITECT'S DE A 1 e, a L crnand my plans shall he used as ¢reemds JAN 1 J 2004 cV ce uai 3 u Licensed Professional f=LLm OWNER-BUILDER DECLARATION 1 hereby Norm that I am exempt from the Contmetors Licenw Law for the BUILDING p O following reason,n (Section](131.5,Business and Professions Code:Any cityor county X m which requires a permit In co eruct,alter,improve,demolish,or repair any structure prior to its isouance,also requires the applicant for such permit m file a signed statement 5� < that he is licensed pursuant to the provisions of the Conmacture Licence Law(Chaplet 9 Sq. Ft. Floor Area &0-anon lig t—$ (commencing with Section 700)of Division 3 o the Business and Professions Code)or that he is exempt memfrom and the basis for me alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofe Occupancy Type not more than five hundred dollars($501) ❑1,as owner of the property,or my employees with wages as their sole compensation, will do she work.and the structure is not intended or offered for aide(Sec.704L Business add Professions Code:The Contractor's License Law does not apply to an owner of 506 6 — GAS TE y•nRC nspee M property who builds or improves themnn.and who does such work himself or through his own employees,provided that such improvements are not intended or offered for aide.If, 507 — FINAL PLUMBING howeveq the building or improvement is sold within one year of completion,the owner- builder will have the burden of praying that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed con,acmrs to contained the project(Sec.]IML Business and Professions Code:)The Contractor's Li- ce Law does not apply an an owner of property who builds or improves thent and who convects for such projects with a contractor(s)licensed pursuant o the Contractor's License Law. ❑I am exempt under See. ,B&P C for this.... Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penally of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for WorkcrsCompen- 7E] ood,as provided for by Section 3]00 of the Labor Code,for me performance of the rk for which this permit is issued. 1 have antl will maintain Worker's Compensation Insurance,as acquired by Section rIh boli Code,fm me perfnrma cif me woryfor lb irnme: permit is is7lic mherare:Policy N.: CERTIFICATED EXEMPTION FROMWORKE S' if COMPENSATION INSURANCE (This auction need not be completed if IM Ismail is formic hundred dollars($100) in less.) I certify that in the perforrnanec of the work for which this permit is issued,I shall net employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:IL after making this Cer ilicate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must O z forthwith comply with such provisions or this Permit shall he deemed marked, Z OCONSTRUCTION LENDING AGENCY F 'N� I hereby affirm met mem is a construction lending agency for the Performance of Cli the work for which this permit is issued(Sec.31017,Civ.C.) aLender's Name Zoo) z Lender's Address U Q 1 est ify mal I have read this application and sate than the above information is IL w-r correct.I agree to comply with all city and county ordinances and state laws relating to O V building construction,and hereby authorize represimmovesofthiscitytoenter upon the Oa abovetme mentioned properly rand extewion purposes. (We)agree m save,indemnify and keep harmless the City of Cupeninn against a,y y liabilities,judgmcnm,cnsls and expenses which they in any way accmc against said City U iAby: PP NT n con f the granting of this perm it. UNDERSTANDS AND WILL COMPLY WITH ALL N N-P NT Issued Date 'A lie EGULATIONS. pp �et1710Re-roofs Sigilse werfodApplicam/Contruclor arc HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will me applicant or future building occupant snore lir handle h tcaNrus material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safely Id,a"At de,Scdon 25532(ft n / All roofs shall be inspected prior to any roofing material being installed. El Yes 6 Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it haxoNnus air contaminants defined by the Bey Area Air Quality Management all new materials for inspection. strict' ❑Yes o 1 have mad the haamdmus materials requirements under Chapter 6,95 of the Califon aiding currently haven a tenant,mal it is my respond bility to notify IM x.cupan ofme nnswNchmuslMmmprinnrissunneeofaCenifica olOve an' Signature of Applicant Date Ow ra�mmixedagent DDod, All roof coverings to be Class "B" or better