01090013 CITY
umSONO
INPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS z PERMIT NO.
10970 MIRAMONTE RD JUST WATER HEATERS INC 01090013
OWNER'S NAME: APPLICATION SUB DATE
[ETER ZHANG 1764 NATIONAL AVE 09/05/2001
(510) 293-9901
PHONE: SANITARY N0. CONTROL NO.
t
z i ARCHITECDENGINEER: BUILDING PERMIT INFO
tal-O O BLDG ELECT PLUMB MECH
Hz. O 1'_ I_J 1.:. 1
5 N y LICENSED CONTRACTORS DECLARATION Job Description
_ ction7paffirm 0)ofDhtl e n p fnsCode9ndni,feet, REPLACE WATER HEATER.
ng
w t-u is in Section eOUB)e feet. on 3 of the dueness and Profession CoJc,and m)1 cane
n mane and arrear. (5 0 GALLON GAS)
;0—c-'
0-a License Class Lila.p
3 u6,y DateCammnor
ARCHITECT's DECLARATION
O S I undmmnd my plans shall be uud as public records
i L 0 Licensed Professional
Ox,I at
DECLARATION
^_a I hereby affirm on 11. exempt son the Cessions Code:License Law ill,the
county
t_ a following¢axon.(Section 70JL5,ct.1doasmprve.de iolihor Any city orcoanty
w p se which Its issu a permit ro construe,altar,improve,demolish,ore a sig any hw
i 3= pyo to It aac,also ret,' theapplicant f h pennino file u signed statement - - - - -- - - - - - -- -- -- -
that nF « ea pursuant t the n,of doo c ' rota License Law tenapmr9 S Ft:,Floor Area>• . , . ;t r Valuation
(commencing with Section,7001 of DivisionJ f theBusiness and Psotessde)ons Co _, q' �- t n r•' :. C A
or that he is exempt thc're0dm and the basis for the alleged exemption.Any violation
of Section 7031.5 by any applicant on,a permit subjects the applicant m a civil penalty'
of not mom than five hundred dollars(S500). APN NumberOccupancy Type
❑1,as no,of the property,or my employees mhh..,as n their sole com'tandion.
will do the work:and the structure is not intended or offered for sale(See:7044:
Business and Profession,Code: Ibe Comonome License Law d«C not apply to an 506 — GAS TES'IRequired Inspections
owns
r of progeny Who builds or impmees theme,and who docs such work himself 5 0 7 - FINAL PLUMBING
or throsh M1ia own eftaployahowesco t providedbuilding
that such improvement
is
art not intended or
offered for cele.If,how<vec the builJin� tis sold within one yea of .5107
�_ - .. . .... . .. PLUMBING . . .. .. _
gar amen of pro km
imcompletion,for the owner trade),will hoe the harden of proving that he did not build or
prove for pharpaa=ar.mel.
_ OI.nowner orate progeny.rane usinessadProf isiwhhrt Thla Commito _ . ..
_ - towner the cars
(Sec.
appl 70w,owner or mM oy who
cooed The Commit
License Law Jon f apply n an owner al progeny who bailee or improves thereon.
T
and who.eommcu for wch.prnjuts with a contractor(s)licensed pursuant to the ---_. . .. ... .... ... _. ..... ... ...
01 moors License Law.. ..
❑lam eeemq ander Stt. '� � .B&PCfor this rcamn
Dwnee Date FINAL-ED
WORKER'S COMPENSATION DECLARATION
I hereby M.under penalty of forij.y,one of the following declarations:
❑ 1 have and will maintain a'Ceniliche of Consent to self-inure for Worker's SEP 12 2001
t. Compensation, as provided for by Section 3700 of the Labor Cade, for the
perfonnonce of that work for which this ..it is issued.
❑1 have and will maintain Worker's Cumgcniativa Insurance,as required by Section BUILDING
3700 of the labor Code.for the ped'ummno,of the work for which this permit is
issued.My Warker'K Compensalion ln.�mancc tamer and Policy number am'air ;
CamPaltryNo. .r sty .. .)f• .
1 CERTIFICATION OF EXEMPTION FROM WORKERS'"
COMPENSATION INSURANCE _ , _...... __.___ .__ - _.. _ _ ..._........ ._ ..__.... .. .. ...
'"(This section need not be completed if the permit is for one hundred dollars
ISI W)ar texas) ,
1 emir that in the
') as an mantt of the work for which this permit a issued,1
:ompint employ any lxuon In any manner m us oo became subjen n the Wurkerd
Cnmpenmtion Laws of California.Date
NOTICE TO APPLICANT.the Work It.after Compensation
this C visions Of or eExemption,Laborrals,Y U Muld
st
bdcomc subject to the such
Compensation provisions of theLaborCale,you must
Q 0 forthwith comply with such provisionz or this permit shall be deemed revoked. _ -
Z,y a
-"t "CONSTRUCTION LENDING AGENCY
I b6m
which'his o In ueuea(sec.3( "
Lcnder'i No rte affirm that opoMatisamnamaionlgdinC agency:for the performance
- - - -
'Lead work for -
5 0 Lender's Address' "
V-0 1 ccr ohm I have mud this application and state that he above information is
fir+ [.. correct.1 agree to comply with all,city and county onlinances and some laws totaling
0.[) to building construction,and hereby authorize representatives or this city to enter upon
the above-mcnbnned� property for inspection purposes.,,(Wel agree to save,indemniry and Kim,harm it he City of Cupertino against ,S
Ir to liabilities,judgments,costs and expenses which may in any way accrue against said t P /VN17
V Z City in amow uence of the granting(31 u
l this penn .
APPLICANT UNDERSTANDS AND WILL COMPLY WITH'ALLNON-POINT Issuedb Date
SOURCE REGULATIONS..' y'
Slgpumm car A,vicansCorma,mr, - Data Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
' .'. .won'thc�SPpheamorfuture Wilding rxmprinsa,orhandle h;,aamoahmotenal Type of Roof .. _ .
as defined by the Cupertino Municipal Code.Chapsr.9.12,and the Health and Safety
Code,Section 25532(a)7 w -
ore, Mho : All roofs shall be inspected.prior.to..any roofing material being.installed. _
Will the upplicam or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, 1 agree to remove
emit haza firms air amuminant.as defined bythe Be,Area Air Qualhy Management
District' all.new materials for-inspection. Applicant understands and will comply with
❑rat ih". oNo __ . , all non-point source regulations,
^•, 1' ', 'I have'read the,hationd i materials requirements under Chapter 6,95 of the
Calrfdrhia Health&Safety Chadd Sections 25505.M533 and 25574.1 understand that -
dihe building oats not currently have a tenant.that it is my responsibility to notify the
occupant of the rea mimments which must he met prior to issuance of a Cenificam of
f olaeupanlay.., .
• Signature of Applicant Date
r ovine or aanmrizm agent tae All roof coverings to be Class"B" or better
OFFICE