01030098 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
1'ERMI"I'NO.
BUIL.DINGADDRP.SI:0831 NORTHOAK SO WATER HEATERS ONL 01030098
IN OW'NER'S NAME LEEMRY HSIN APPLICATION SUIT DATE
500 AIRPORT BLV 03/1.9/2001.
14 IONS: SANITARY NO. CONTROL NO.
(415)349-3747
((�� BUILDING PPRMI'I INFO
00 ARCIII'I'IiCTl1iNGINIiIiR: BLUE ELECT' PLUMB MECH
use
tN
z w LIur thin IIa n HosoRA onate.S DEc.rs of CION Job Description
y_a tion 7 allirnt rhes an in the J under pnd l.iaf„nt ChCode9 and
m licei se
wall Section IIMNp of Division 3 in the Iimines,and I'mfe,.inns Gale,and my lassos
<yf i,htlull forecand effect. REPLACE 40 GAL GAS WATER HEATER.
m z LL< Liccnx Claus Lice
K O a U Dale Commetor
m 3 a Ao,'IwlI'Ii,c e UECLAkNI ic'ecoN
vo 1 unJem:nW my pWnn scull M uxA as puhli.rears, % /
aa.d d O Licensed Professional
Iy /
o Oat I am BUILDERexca,fr front
the ORATION Q
e — I hereby.(Sec that 1 1. .,encu fmrn the —ion,lC A nee Law for the
lollovvmy O
C 6 a .]rich ingmc,on.I nos,tt lamor.D,r,rnc,.and Podor.th,lons a.or ep r carr or icame /
$9�o which requiresae.actio Inturostrae alter.nt lot suh pwanth...re a sig any swaure
,n j e chlorI I t y e n provisions
such t t I signed statement
G — (v i licensed uhpursuantI Jsp nn Contractor's 1 L, IeTalae,9 Sq. Ft. Floor Area Valuation
(con g 'tl I I ]fNMn f U .. Ill l J P I :l l a
,t Se h„ ,pt mann, t ththe la in suthe bject the pt n y Inhfa $700
of nor non911 L$by any appll doll fire p,rmil,unjccl,the applicant.,"evil Penalty
nr mm mare man live n.ndme dnuah,assn. APN Number Occupancy Type
01.a,ownernfinepropeny.mat,etnpwyee with wage,a,theirsoleermpen,aden. 31641020. 00
will do the work,and the sum atue is nor imeaded or offered rot sale(See.70sW.
..mince and Pn,te„ion,Cude:'I he Cman,......Iscrnsu Law Jac,ant apply to an Required Inspections
o,our of openly Who builds or Improves thereon,and who does such work him.xlf 204 — UNDERFLOOR FRAME
or through his own entployecs.provided that such imparmer nts are not intended or
offered for sale.IL howoci,the building or improvement is sold within one year of 301 — ROUGH PLUMBING
fcompletion.the nxoer Wilder will have the burden of pm,ing that he did not build or
nr,u,efnrprt nenf,:de.l. 303 — ROUGH MECHANICAL
0La,nxnrh of the property.amcaclusively. ounaaning with licensed nommen...to 304 — ROUGH ELECTRICAL
....,tract the project sec.]Dal,limine„and No4......Ctvka lite comment's
License Law does nm apply to an awmer of property who build.,or improve,thermal 505 — FINAL ELECTRICAL
and wIbu contracts for such projects with u umtmangs)licensed pursuant to the
Cnrarach",Live,—I'lw. 507 — FINAL PLUMBING
0 Inn,c,cmPt trader See. ,R,S PC It,,this rcmon
508 — FINAL MECHANICAL
Owner Date
WORKER'S COMPENSATIONDIiCLARAI'ION 514 — FINAL PUBLIC WORKS
I hetclay ullinn under penally of perjury ane of the billow Ing declared...u:
i I have and will maintain a Cenilicate of Cnnxnl to selhimum Iia Worker's
Cnnpensation, as provided for by Section 3700 of the Latin Curie, for the
perfurmance of the work for which this permit i,issued.
01 hv,'e and will maintain W'orker's Compen,alion Insurance,as recurred by Section
1700 of the Labe GNc,for the perfnrn an',of the work far which this peril i, '
sued.My Wwkw`%compensation Insurance sumer and Policy number o2:
carder: Pchcy No: '
CHR'I 111ICNI ION OP IiXEMPI'SON FROM WORKERS'
COMPENSATION INSURANCE
I Phis section need not Ise completed BW pecoal i,for one hundred dollars
($I INA or less.)
I emboy Ihut in me ptabac owe,nl"rhe work for which this permit 1,Issued.I
shall nal employ any perum in any manner so to to Iseomu.abject to the Workers'
CnmNn,aana Laws of California.Dare
Ap illwo
NOI(CC TO APPLICANT:If,alter making this Ceniheme or li,mnp•ilon,you should
he. ..e.object e,rhe Worker,C'nrrq,co,roor o— m,of the Labor Cute.you...
Wa
Q Q ..
mnhwlth"amply with such provisions or this planar shall be d.enmd revoked.
Z2
E' Zt CONSTRUCTION LENDING AGENCY
1 hereby a1Gnn that mere is a cinstruction lending agency for the performance
of Its work for which mi,ceroid is I.s"oil(See 31w7,Cos.C.1
Q Leader',Nano
Z Z Lender',Address
V C 1 cenify that I have read this application and stare the the aBwe infatuation is
4. V nen.1 agree to. m
aply with all city and county ordinances and scale laws relating -�o Wimingttnaas,ion.and lmrcbyaarhori'ucr,us,rouLcive-ol'rhi,citrin cmm-tpou
r theahnvcmcminnvd pmpcny lin ingsnum par,oucs.
p., a (We)agruc ,,save,indemnily and keep hannlea the City of Ca,mrio against
to liabilities,judgments,cost,and e,pcnxs which may in any way acerae against said
fJ .City in ttmxquemce of the gmnnng of this"ad.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGUI,A'TIONS. y'
Signature of Appll.am/Commena Dam Re-roofs
BALARDOUS MATERIALS DISCLOSURE
Will the appll'wa ,,future building rreupum aero or boodle hazard....mumrivl Type of Roof
o Jehncd by the Cupcnino Mm.ieipul Coda Cl..psr 9.12.in I une Health:nal Safny
Cute,Scctinn 255)2(1)!
G Yes ON" All roofs shall be inspected prior to any roofing material being installed.
4 Wil l the applicant or mare Brading occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
+nit hermlau,nes.....twomica ,use defined by the Bay Area Air Quail ry Management
'�"IM, all new materials for inspection. Applicant understands and will comply with
❑Yc, 0N all non-point Source regulations.
I have read the hazardous ntatcriah,rryuirements under Chapter 0.95 of me
Cold;...in Ilealth.@ Safety Code,Section,2550.1.25533 and 2$531 1 understand tbar
fm,building dna,cart e.rreally have a m.atu,that it't„ny re,pan,nnrny lo.aufy dm
,...pant of the raluireman which roue b:rust prim In Lsuamc of u Cenircme at
°Curyanay' Signature of Applicant Date
Omnerora,rth,,,i,N.,cut Dam All roof coverings to be Class "B" or better
OFFICE