00050153CITY OF CUPERTINO
CONTRACTOR INFORMATION:
s BUILDING DIVISION PERMIT
BUILDING AIYAV.388 NORMANDY CT
JUST WATER HEATERS I
IVk. D NO'
Inloiva1-51
OWNER'SNABRAD CHRISTOFFERSON
1764 NATIONAL AVE
APPLICATION SUB DATE
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SANITARY NO. C01001, NO
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(510)293-9901
BUILDING PERMIT INFO
BI.UG ELECT' PLUMB MECH
all
a LICENSED CONTRACTOR 'SDECLARATION
Job Description
I hereby allirnt that 1 am licensed under provisions of Chapter 9 (commencing
"
with Section 7(NNp Of D'Id,lan Sol he Har,a ,, and Pmfeuiam Code,and my license
is in full roma tad aft'so.
hicen.w Clues Lie, a
;am Contractor
ARCI 111'EC'r'S DECLARATON
ai laadawand ter hints, aau be nod atwhnc record.,
REPLACE 40—GALLON WATER HEATER
O I.Ir Proroniaaul
OWNER-BOILDER DECLARATION
on 1 herchy car IWn I am e ear,, font the Co anican', License I,aw for Clot
following rcuwn, [Section >(k11.5, bueincM1, and Vmfcaion,, Ctdc Nty city m county
Owhich quires Imrn t t -t t cit improve. derrolvdir or repairy structure
psi ...... ', aImilli..h ppl tf hpe itt fl 6 dotcnant
Ihatn licensed al t the posisono ofthCommican's Lwar,c La(Chapter9
Sq. FL Floor Area
Valuation
(commencing with Sacuon 7INX0 of Division 3 of the Business and Prof .....ns Code)
$681
or to., he i, e.mntpt therefrom ..it the basic far the alleged exemption. Any violation
Of Section 7031.5 by any a,,1want fora Permit.depa, the applicant m a civil penaltyw�''.,'t,
AP
Occupancy Type
of not more than five hundred dollam (S500).
al JGS 00
DC J Y
01, convince of the property, or my cmpinyeo with wages as their wilt compensation,
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Required Inspections
will do the .,it. and the stmc,.m is not intended or offered far are (Sec. 704,1,
Business and Pmfcssions Code: TW Compactor's License law dces not apply m an
owner of propary Whir builds or improves thereon, and who does such work himself
ur through his men entployccs, provided that such improvements ate not intended or
offered for sale. If, hnweeer, the building or improvement is sold within one year of
the owner-builder will have the burden approving that he did not build or
502 — FINAL PLUMBING ENERGY
iimpletion,
mpmvc fm purpo,a of sant.).
506 — GAS TEST
❑I,asmwnet mlheproperty, atnexcm,inelycontracting with Iiensedcommmar,ta
Ingmet the p rjeet (Se, Tat Business and Professions Cadeo The Compacta..
507 — FINAL PLUMBING
Law pun Owner of prupertY who bnihL, or Intprov9s thereon,
and who eantracrs far such projects with a control licensed ptxunnt um the
Counm
iv,anotapply
Law.
Contacexe exempt
❑Ibis excunpm nndcrSw, .HA PClet this sura
Owner Dula
WORKER'S COMPI!NSA'BDN Ilb:C1.ARA'I'ION
!/
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' Ihr.cbyafbnn unite pemtItyal lw.j.,,,rwat'Ihe following declaran is
v
o
7 1 have and will maintain a Cenilicam of Consent to colt-inmm for Worker's
Coni'livation, a, pmvidad far IF, Section 37m) ,I the Labor Code, for the
perfommnca of the stud far which this permit is issued.
01 have and will ntaiamin Worker', Compensmlon Insurance, as rryuircd by Section
370() of the latter Code, for the performance of the work for which this permit is
sued. My Wader's Compenvtion Insurance carrier and Policy number arra
Carrico Policy No.:
CIiR I'IIICATION OF EXEMI"FION FROM WORKERS'
COMPENSATION INSURANCE
(Brix section need nut be.....plead Hire permit is fur one hundred dollars
(511X)) sir has.)
1 certify that in the performance of the stark for which this permit is issued, 1
,hall not employ any person in any manner w as m become subject to the Workers'
Compensation laws of Calilltmia. Dale
Applicant
NORCE TO APPLICANT: If, after making this Cemibcam of Exemption, you should
'
Z beelow subject to the worker, CompcmmlOn provisions of the LaMn Code younust
0 forthwith comply with such provisions Or this permit shall be deemed revoked.
uCONSIRUCI'ION LENDING AGENCY
1 hcrs'hy nttirun drat there is a cnn,trunion landing agency fm the pertornnmee
it lie work r, which thi, permit is la,uad (See. 3097. Civ. C.)
QLender's Nana
z Lcndcr's Addre
0 I artily tam 1 have read this applieuti..n and spm that the native ialmallation I,
E't correct I agree or Imply onto ill city and county nrdinaaw, and cape has, relating
U m huildingennslrocl in t. and acrehynmhnnn presentutiae, or hit, city,, enmr upon
Ibe ubavcancntioned popery for inspection purposes.
M. (We)agree ..sale. indemnify and keep nurmlesthe City Of Cupertino ciains
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(n liabilities, judgmc11.11scans casts and e,pls which may in any way acme against laid
z. City in canmquence of the granting of this Pamir.
APPLICAN'TUNDERSTAN DS AND WILL COMPLY WITH ALL NON.POINr
Issued by: Date
SOURCE. RLGULATIONS. ,
Re-roofs
Signature of ApplirantuCummemr Date
HA]ARDOUS MATER1ALs DISCLOSURE
oms nmriol
Will the applicant at future building nexupad wore or handle hvardw
Type of Roof
as defined by the Cupertino Municipal Cade. Chapter 9.12, and the health and Safety
Code. Set El Ya' 25532(x)"1 El No
All roofs shall be inspected prior to any roofing material being installed.
will the applicantor future building twcupaot use equipment nr devices which
If a roof is installed without first obtaining an inspection, I agree to remove
obit hasnrdons at, con amounts as defined by the Bay Area Air Quality Management
all new materials for inspection. Applicant understands and will comply with
Diariefr
❑Yes [D No
all non-point source regulations.
I have rend the hamrdaus material, rcquircomnu under Chapter c95 of the
Califorran Heard, k Surety Cala, Sections 25505.25533 and 25534. 1 ondechand that
It the huilding Boca nal cm'rcunly have a han:mr, rant a lx my m,1„mibility to nolily the
enlrum al the sac irements wach mast be met prior to ssu ince Of a Ccrifiena of
Date
Occnper,
Signature of Applicant
All roof coverings to be Class aB" or better
Ovial"n antlt..riredagettt Date
OFFICE