02120016 CITY OF CUPERTINO .", ^� •"
BUILDING DIVISION PERMIT ,,ONTRACTOK INEORMAT_ION 'y
null 4 0w-`NOEL AV JUST WATER HEATERS INC FERMuN62120016
owN7:WFI,prMIH 1764 NATIONAL AVE APPLICAn?2SP"T/2002
IONF. 51 O 2 93—9 9 01 SANITARY NO./ CONTROL NO.
ARCIII'ITLT/ENGINEER: BUILDING PERMIT INFO
BLOC ELECT PLUMB MP.CH
0 0 0 0
w0, LICENSE])CONTRACTOR S DECLARATION p
auZ G 1 hereby affimn mai 1 am lieeo ed node,pnwenar s aI Colmer 9 a'ammedoi"g REPLACE WATER -WkArT�tion
NZ6 wdh Section 70XB of Dinkin.2of NC Busioc.avandPnnfcsxions Code.and mylicenxcis
< in full lo.and riled. (5 0 GALLON GAS
ZO
�&HK License Class Lic.p
ozyW Untc Cnnvamor
ARCHITECTS DECLARATION
a 1 understand my plans shall be used as public records
uNiiii
o
FLLa. Licensed Professional
£N}@dam OWNER-BUILDER DECLARATION
z w a 4 1 hereby affirm that 1 am exempt from the Contrectois License Law fill the
ce
c 5:no following mason.(Section WE1.5,Business and Professions Codc:Any city or county
x m which requires a Permit hr common,alter,improve.dentolicb,or repair any strucmm $1022
1°—'^ prior to its issuance,also requires the applicant for such permit o file a signed statement
that he is licensed Purmnnun the provisions of the Contractor's License Law(Chapter 9 Sq. Fl. Floor Area Valuation
SFOmommencingwithScction7000)ofDivision]oftheBurinessandProfessionsCode)or 32647059 . 00
y 3
that he is exemPI therefrom and the haus for the alleged exemption.Any violation of
Section 7011.5 by any applicant for apconit subjects the applicant n a civil Penalty of APN Number Occupancy Type
not more than five hundred danara(S5BB). 502 — FINAL PLUMBI G ENERGY
I.M owner of the popery,or my employees with wages as their sole compensation.
wil I do the work,and the structure is not intended lir offered for sale(gee.7IW4,Business pyS�Qa�[�f,D
and Professions C dc:The Cuntractura License Law does not apply w an owner of 507 — FINAL IJf`1)311V 1Y ections
property who builds or improves thereon.and who does such work himself or though his
man employees,provided Nat such improvements arc not intended or offered for sale.If,
however,Ne building lir improvement is sold within one year of completion,me owner-
builder will have the burden of proving mat he did not mild or improve for pugmse of
sale)
1,as owner of the property,am exclusively contracting with havaced continental m
cormmet the project(Sec.70,W.Business and Professions Code:)The Contracmrs Li-
cense law does not apply to an owner of property who Wika or improves❑noon,and
who coulombs forsuch projects with a coaractor(s)licensed Pursuan'of the Comracmr's
License Law. S•{.�+t'
1 am exempt under Scc. .B&P C fill this Orion
Owner Dae DEC 13
`.7
WORKER'S COMPENSATION DECLARATION
I herchy air.under Felinity of perjury one of the fidkwing declinflu ria:
Ihuve and will maintain a Certificate of Consent toself-insuo for Worker's Compere �11'CL�"U y '
scudo,as provided for by Section 19(X1 of the Labor Code,for the performance of the fir/ I Iy�W
work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
37B0 of the labor Code,for Ne performance or the work for which this Permit is imbed.
My Worker's Compensation Insurance carrier and Policy number arc:
Career: Policy No.:
CERTIFICATE OF EK EM"]ON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not M completed if de permit is foronc hundred dallms(SIIX1)
lir lem.)
I cenify that in the performance of the work for which this Permit is issued,I shall not
employ any person in any manner so as become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If:after making this Cenif icate of Fsemption,you should
become subject m the Worker's Compensation provisions of the Labor Codc,you must
Cforthwith comply with.such provisions or this Permit shall be deemed revoked.
zO CONSTRUCf10N LENOINGAGENCY ✓W\
[--r IhcrcM1y infirm mat STRUefIONLEN lending ENcy for me Mrinrmance of
ail the work l in which this perm h is issued(See.1(H"l.Civ.C.) p
W Lender's Name / /'
az Lender's Address
V 1 cenify that 1 have read this application and state that the above information is
W correct.I agree to comply with all city and county ordinaries and cum laws relating to
O V building construction,and herchy iuthorim representatives of this city to enter open the
W reeve-mentioned propcny for inspection Purposes.
G (We)agree to save,indcmniy and keep harmless the City of Cupertino against
F'o N liabilities,judgments.costs and expenses which may in any way accrue against mid City
U z in consequence of the granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITII ALL NON-POINT Issued by: k6f Date
SOURCE REGULATIONS.
Re-roofs 6kL
signature of nFpheaHAZARDOUS
AZA DOr Darr,
IIA,in folOUSMATERIALSt,lomoSURT; Type of Roof
Will theapplicantnr future hulkingoec Chapter
lir huddle Health anmaterial
as delincJ by the Cupertino Municipal Code.Chapter 9.12,and me Ilcahh and Snlcty
case,seeean 25512(.)1 All roofs shall be inspected prior to any roofing material being installed.
❑VCs 0N
Will thea applicant or future building ant use equipment tat devices which
If a roof is installed without first obtaining an inspection, I agree to remove
pp d by a
emit int? s air eonuminants as delincJ by the Bay Area Air Quality Management all new materials for inspection.
DistricR
❑Ya 0N
1 have mad the hazardous materials requirements under Chapter 6.95 of doe Calder-
niallcalth&Safety Code,Sections 255(15.25511 am12554.I und,w, that if the Wilding
Inns not currently have a tenant,that it is my responsibility to nod fy the occupant of the
requirement which must bre met PAOT it) monarch,of a cervi ficate nfacbp�cy. Signature of Applicant Date
Owner or authprixcd agent Date All roof coverings to be Class "B" or better