02040083 CITY OF CUPERTINO - -
BUILDING DIVISION PERMIT 'CONTRACTOR'INF.ORI4IA.@TON;
1 BUILDNGADDRESS: PERMIT NO,
. 10972 NORTT4.qF.AT, SO JUST WATER HEATERS INC 02040083
' ONTTiA'S NAME - APPLICATION SUB DATE
GEETHA LOGAN 1764 NATIONAL AVE 04/16/2002
PHONE SM7TARY NO. CONTROL NO.
(510) 293-9901
ARCHITECTIENGINEER: BUILDING PERMIT NFO
BLDG ELECT PLUMB MECH
�r_ • U C_I L'1 U
12y 2LICENSED CONTRACTOR'S DECLARATION Job Description
I hertbY aRrm that 1 am licenud under Drovisions of CMaa 9lmmmencing
yty ,wiihScc,ion7000)ofDivision3oftheBusinessand Professi...Code.alNmylicenx REPLACE WATER HEATER.
m y,_ is in full force andeHect.
a a 'License Class Le x �p
Cammanr �'I Y SOA A e C
ARCHITECT'S DECLARATION 14v 7�m
1 uMerund my pram shall be used u public records
�Y
zoo Licensed Professional MAY 0 2 2002
OWNER-BUILDER DECLARATION
'$-m 1 hemby affirm that Ism exempt from the Conlmctor's License Law fm @e -
i C following remon.(Section 70313,Busir:ess ad nProfessions Code:Any city or county
hicp $600
wh requirtsepemtino construe, demolish.or most,any swcturt BUILDIIY _
St.3$ tots n[une also req..ini appimm fa such Nino...fla.,grcdwamem S �p
out�esn esK} ti00�o)9f Df�xion3of nne�nw;�anerar�e.[oCedj f_�t'�f �-t3�I'�'4<t1: �;: 5ar�`.f ".)li.`t: Valuation
or that h6 is enempt Ihertfrom end the basis fre the alleged amesp,un Any v,olauon
of Seaton 7031'.5 by any•pplkanefora permit subjects the applican m•eivPpuhy- CCLL anC Type
L13-
, no dmatnahf.enandreddoRdn(ssoo). 502�N �1rL PLLTMBI ENEI2G� P Y YP
°Los owner of On property,ur my employees aio..,as m Ihcir sole compensation,
t Will do the work:and the tioucom is not intended br.Read Tdi stile tSed:701' - -'
Buaineis and Profeesimna Coxw
:The Connor•a License Low dues ma apply,a sn 507 - FINAL PBWhrgN QSPections '
. owner of property Who build.m improvm thereon.and who don sah wok himulf
or throu5hs own employees provided that such mimmtimpooemem;arc no[..a a d or _..__.. ....__...__.__ ._. ...__ _.. . ._. ..-..
complefor heownow theWilding or Im --------
completion
._..- -.___-._.. ..._.
provemem Is within one yemof tl,.•:T..,, „ „71,. ,
imroummn, he owner budder will love Ne buNcn of proving that he did not Wild or I'
impove fm pryou of Sak.). ,
. ._..- s __.______
m ___..._._,-_____._ ._____.___...______...
I: owneroLNc property am Business
mrocssionstCcda:)licensed Com torero
conawn Ix project(Sec. to a,owners ono Professions Cade:)The Contherco a Iii.::.. E:.£:fl'r _. .. ?ff:'I,
-` License Law docs not apply m an owner of property who builds or improv.Ihcmon, 1
.aM.wb,conwcu.fa soh. u-wiN.e-conuact ,. p•i•a _
,. -,r_'j:':. emd.prsuano m.the. .____- _.__.__..._._.___.._._.....__....
c.t'TIS.:.. _______.._...___.__...,______
❑lam nem ..Mer Sec;"t � .. .B P.C(pets,reason 1t.i:fl,L':ii:
p B
.:, ..,.:,,.. �. n T'
owner Data -�
- WORKER'S COMPENSATION DECLARATION
'" .pemhYof peijury;oat of the fallowing dttivatiov:-"
y Cl 1 a Cenificete.(Consent•to self-inauu for Worker'.
A Compensation,-as'povided-fm by-Section'37110'of the Labor Code; for the
prfom:irice of dte'wark for which this pmut is issued-�.
°1 here and Will maims n Wak ra Campenut on Intim unce or natured by Section
LaW,Code (or the prfomu tt of Ni rk( which N' Arndt Ia
3700,W the
issued,My Worker.Compenu4on 1 s mnce c"t Sad Policyi number .
_ _
_._
Cimer I ,C s ♦: NO .'rt'poliryl. .1 Y rv.l n, r4 �\ i .:, J _ f ,3 '.ii t t,4•,.,I. _'_
-CERT.....0 COMPENSATION
IN PRANC W RIO➢tS
.. , . ,,SA..-. S{1RI d. .''p s ""
t
. :I.I rte ,y . .,.... r.... ., -_ ..._.._- .-_ •_-'... -. .TI . ..... __
r:rr •! 1
trim seciton need not be completed if the permit is for one hurgmd dollen
(5100)aless
...J -,,l ._
a,.. ..., ,. oes• ..I : :o!: -
ploy. ...i ... _ __....
t\d'1 c rufY dwi to th prfmman&or the rt f which th p t s ssdM,l
_,.,, 1 i,.�_ -""- - -
Ihall not em ,any.Person in ny miner so as t beme'cobleu tp Jhe Workers -"•
001-
O mlmicant on Laws of Cel(omla Date
Co
Applicant I
NOTICE TO APPLICANT If aha muting.iithis pr6m mio of Ese poor You mould
Z becomesubject mdie.sder.C,i,s on t p oat./she Lama Cox Yo-must
� h me ply 'ati suchp s rlhspermtsh 11 be dee drevokd
..__._.._ . .......__.._ 1 .... _,-. _._._
t ' 1 I' 1iCONSTRUCIT- LENDING AGENCY; n•d u
:.'r I hereby efT lh t inert sac suue krMmy agency fade perfonmticd •: C1..• ,@,it
of the work for hch!his NI sIssbcd(S c'J�97 C.. C) to a-__ .�.h.. _-
__ _ _..`
Px. 'Lender[Nesse � - ._.._ ...._._ _.-.._.. ..........
Z Gentle sanifeasa. '
U 0, _ p
I cert agree
that I p e ad all city
Ind o•d um that she abm informationn
{L •rs eomxm 1 e{nee r.comply with all my aiio county wdina.me and.state laws relating """���-----
0,,V to Wilding comma On.and bcmby authorize kprtaematives of W[edy to enterupan
abof 0.8reaw.s.i. f9rif,rudonpurpozes,..dbe •.,,., „_,... .
'..Z) Is.judgme ts.c Indent. and keep ham.y i.Ne City of Cdpnino'against
rq liabilities.judgment..cos..artl., fihi %, mry inmY, Y,_oo against,Said
C)'Z' City n eanuquemm of Ne grhmm{of tilts pmut
AP,ELICANT v'.�DERSTA.\T)S�,�A«'�C(.CQM .YI'ti iflf ALL\b\�•pp-LYT`��
- SOURCE RE6L1ian0\S' Issued by: Dale
SlgmNrc WAPPIiexVC rima .r:� . �•' - D m''� .
'r xnawRDous MArEIUAIs msaosuRE t r � ' t Re-roofs
d wdl de'pplldxt a mina Maud g ampnt tar a naMle hawdws maimal
Type Of Roof.:- - - - - -
._
m dpfined bYJh Cupeiu o MUP c peel Cede Ch pt 9 13 due Health d Safety - - - _ - - �-
Cod Salo 355Jd(a) \SY L 45 II `�F4 t..S�.r� ( } Is. -_ .�
.,.All.roofs shall.be mspected.prior,to.any.roofing material.being installed. _...w...._.
wit dte Yppl antmfuture bu lxng ocupmtuu 9ulpmeamae eas which If a roof is iristalledkiihout first obtaininiobtaining an I - tio611'i to rem
emn h...duos,.r c numt ants m d f dd b)Ne Bay Area AIr l7uH q M.nagemem nspec , agree Ove
Drama
all new materials for„ins ection. Applicant understands.and.will comply with
.1r ❑Yea pNa ,. all non-point source regulations., "�'”
"�` •
1 vI ha e-rt�'Ihe hazadws,maeriels rtq remeinsdndcr ChaPur'6.93 of the
� r
«lifan ing do s om ry Cole.Sec 2 Cera 30s Z3S3J inti 2J3Ja'I unxrsmnd that. . ... . ._ _.._---
my
d cdP-tlof the ms mac rte which r m,be
at t.o,toI. Stomibil.C. in, the
cupmt (the rtqu rtmcnu which - p ett of '
r omopancy. ,.oit be in t o w iawaue of.Cenifc,
Signature.ofApplicant-_.___ _ ... . _Date _.-
owncr o o Inomca agent All roof coverings to be Class B”or better `
! B r r L�. Dem": ... 't ..
r. ';.. [ '.o :� ' —. '_L.._ :I :. •.._ _ _.OFFICE.. .___ . . _ . ._. . .__.. _. _ -- . _._ ..__ . - ... __..._. _..