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01030134 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 20302 NORTHCOVE SO JUST WATER HEATERS INC 01030134 OWNER'S NAME: AI'PLICAI'ION SUB DATA IAII _IAMS ROBERT B 1.764 NATIONAL AVE 03/23/2001 PHONE: SANITARY NO. CONTROL NO, (510) 293-9901 ARCHn'EC 7ENGINEER: BUILDING PERMIT INFO ❑ BLDG ELECT PLUMB MECII 2 ��✓ Ibcrtby all COVI RACI RNDCLARA'I'[ON Job Description s " z. fns Caer v n m ylice oe :t_-w with 7")of Division Sof the Bu,iaes and Professions Cada.and my license Din full dao anal d'itet. ow etas.. Lica REPLACE 40 GALLON GAS WATER HEATER. Dwc Contractormind 3 a C ARCHITI?CE'S DECLARATION I understand my plane shall he urcJ x,Mhlic ncnrJe - tp1+6 i p O Licensed Pmleveionvl i OWNER HU HA ER DECLARATION w 1 hcrehy allilm that I am c"ar,t fan,the Contractor.License law for the t Z following crown.(Scion 7031.5.Business and Professions Code:Any city or county C/ f x o which rtwg.ire,a Penni.u,cononmL alt,Impn,vn,demolish,....cite,troy..fracture r �3$ port . also ry dl pplic: tl t such 'G II signedstatement math licensed psma t to the provision,of theCortaclue.i License La (Chapter 9 Sq. Ft. Floor Area il[jon (c,ncor an,as illSection 70mu I Divi,ou.3 fhe lbu,rms,and Poll c,oi I,Cale) CJ or that he is exempt therefrom:mJ the basis for the alleged caempao 1.Any violation iAqq of Section 70315 by any applicant for a permit subjects the applicant a)a civil penalty m no,mom man five f ood.m dollars(s50 ). APN Number Occupancy Type ❑I,as owner of the propcty,or my employees with wages as their sole compensation. 31641072 Out will An the work,and.he maclaw is nal intended or offered for sale(Sec.7194. Baehr,,and Profession,Cade.The Contractor s Litt„ee Law mc.nal"'fly to 1 Required Inspections owner of property Who builds or improves thrown,and who da,such work himself or ill his own a„ployce,.pnwided man such imp...emem,am not ate do([m 204 — UNDERFLOOR FRAME ofle.1 for safe,If finee,er. he building ,,aralpowrould I,'oId eskifle re year of 301 — ROUGH PLUMBINGonmlclion.the owner-builJor will have the burden of provingthat he did no.Wild or �nnrnve for wmi,c iraale.) 303 — ROUGH MECHANICAL ❑1,as owner of the property.am exclusively contracting with IicanwJ contractors u, m,lmet the nmde ject(Ser.IM4.Business and Podr—on,C, :)The Contractor, 304 — ROUGH ELECTRICAL Llrenec Low does not apply of m,owncl of pigany who Mild,or improve,there...., and won comma,fir suet,projem,with a camracto.(o license([pursuant to me 505 —• FINAL ELECT R I CAL - oc,mmemrs Liansc Law. ltmn exanpI mMer.See. .B k P C b,l this m:oin _ 507 — FINAL PLUMBING - Owner Dam 508 — FINAL MECHANICAL WORKERS COMPENSATION DECLARNHON 514- — FINAL PUBLIC WORKS I hereby alLnn under penalty of perjury one of the following declarations: ❑ 1 have and will maintain u Cby Secti of Comem in sc Labor re fix Workers Crtormanceo as provided fir by Section 3is X1 of the Labor Code, for the perfinm;mm of the wn.A for which this permit is issued. ❑1 haw and will maintain Worker's Compen.wtion Insurance,as"dead by Section 37(g)of the Inla r Code,for.he perh,mumee of the work for which this permit is Bred,My Workers CmnPcn,aion losumnse currier anti Policy number are: Carrier: Policy Na.: CBRn19CAl'ION 01:EXIiMI"I'ION FROM W'ORKNdS' COMPENSATION INSURANCE fHis scion need not he cangtacd if the pcnnit Is for one hm,dred dollars . (S10in or less.) 1 certify that In doe perloriaam(if,he work for which.his periost is issued,I ,hall not employ any person in any manner so as to become.subject to the Workers Compensation L ms,of Cvlifomia.Date A,,he ret NO)IC1710 APPLICANT:If,afar making this CctiEcce of Esau I n,you should become suhjceuo the Worker's Compensation putsisiuns of the Labor Code,you must O O forthwith cmnply ,,If such provisions or this Permit shall be banned revoked. z ^ CONSTRUCTION LENDING AGI7NCY CL 7I hechy affirm that them is a cunsruaion lending agaay for the Performance nl'thc w, d.for which this Iemm is iasllal(Sec.30117,Civ.C.) D. Q Lender,Name oZ. Z Lenders Adde,, U O 1 certify that I have read the,application all ,.,a that the aMwe infmmarin is fso [-t c,teat.I agree m comply with all city and county ordinances and slate law,mining O U bonding ur,laclion.I iherchy motor repi,xcmmivc,of mi,ch,I,,enter anon tie five abuse-mcmioned property for inspection purlxne,. u6, (We)agree to save.indemnity and keep harmless the City of Cuperin,against Vl Il,bilitie,.IIdgnmot.s,costs anti expen.wx which may in any way"cam again,.said city in cndwyaemc of the Sounding of his samil. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE RI!GULATIONS. y' Signature of A,plicart Comencor Ila'° Re-roofs HAYARDOUS MAI FRIALS dSCLOSURI3 Wm the apphcwn i,forum holding oceu Tal law of handle hevmlons nh::mrial Type of Roof as cls ined by the Carefiun Municipal Cod.,Chapter 4.12,and the Health and Safety Coda Season 25532(a)' ❑Ye, 0 N All roofs shall be inspected prior to any roofing material being installed, Wi11 the applicant(It mturchuiMingoceupanause e,Iai,ronorde,et,,x'inch If a roof is installed without first obtaining an inspection, I agree to remove cmif rmtdoes air oman..nwm,as dewed by the Ihry Arco Air crudity M anagnncnl District? all new materials for inspection. Applicant understands and will comply with ❑Ye, 0 N all non-point source regulations. I have wad the havardous material,reyuirnnenu under Chapter 6.95 of the California Health h Safety Code.Sections 25505,25533 land 25531 I understand thin if nw buildingdor,tun ammntly heel,a venal, haliti,my wspon,ihi lily to nafify the ecepam of nsa the requirements which abe mel prime m issuance of a Certificate of Occupancy. _ Signature of Applicant Date 0..net iramhomed.,,a' Dme All roof coverings to be Class "B” or better OFFICE