02020130 CITY OF CUPERTINO '
.BUILDING DIVISIONPERMIT CONTRACTOR INFORMATION:
+ BUILDING ADDRESS:, " PERMIT NO.
20015 NORTI-WIND SQ JUST WATER HEATERS INC 02020130
.q OWNER'S NAME: APPLICATION SUB DATE
MICHAEL BOWKER 1764 NATIONAL AVE 02/28/2002
PHONE: SANITARY NO. CONTROL NO.
(510) 293-9901
n�O O ARCUITECTENGINEER: BUILDING PERMIT INFO
Wt L❑❑ ` i s ; .f - BLDG ELECT PLUMB MECH
ION
S 6Z } fj ft� �3RlIC NSEmnloNTRA undeR PrDE aLsof TChap 91 nc ngt Job Descripti6n - ..)
)so Cca with Sca'an 7(100).1'Dltslon 3 of thelimm sold Pmtcaslons Codm,admylcensc REPLACE 40 GAliliON GAS'WATER'-HEATER -
i e g is in fun force and effect. '
5 ai sea License CLns Lot.a t
Date Cnnuacmr
ARCHITECT'S DECLARATION
so S 1 unit nd my plans shall be used as public records
3
t.0 O Licensed Professional
o ',sr ' OWNER-BUILDER DECLARATION
w=' :',I hereby offiint't hat ramrcaempt fnun the C.,raclm's License Law Motor _
mgoxang mainp.(Section 7031 s,Bminess and Pacressrona Code:Any ray air county 1040
3 avi..an'of de Canwnoc Lt dP 1(as ons coda 'i
E F a which requires a scrmii m construct,alien unprorx:demolish,or repair any stricture
C prinrmils issuance.also mquar.the appIiamrarsucM1 parmnmfleasigrmd swtemem.
that he(s limtdzd purwani'd the Dio per Valuation
Ico'stmenne with Seciipro7Q70), (Division 7 of the Bu}i Po rP q ( , , Y ;' 1ti 3S'£� �� e. s:.{.;_s,'r 1.• -......
r thw ...a exempt Ter
dad the busts for the alleged exanp'an Any in
Men
of Sactioa'I",by any uppl lranl far a Pearn subjects the upplicam in a civ',penalty _
of not Marl five hundred dollen.($51R) S O L pN 1 Lyft UMB I G }ENER 'fkcupancy Type
01,m owner of the yropenY.or my employees with wages as their sole compensation.
x ill do the work,and she structure is nut intended or offered fur sale(Sec.]044,'
( ;Business and amfcsamax Com:,me Commrmn License Law does not apply to an 507 — FINAL IpEUvliI iIj gpections' .
owner of p'oper'y Who builds or improves thereon.read who does such work himself
or end fo h l awn mxevyce. p 'den tl ( h p din pt' t' sanded or
''Terrorfor sole'If how the Wildingimprovement
..p its 1, withininte Yeod of - -" - - — _-- ...._. __.... CX„IT/ .. . .
completion.M b Id will have theburden fpm g that he dant bald or '
prof p rya. f. 1 ).
p 1, 1''h p MnY m I I) t « B b licensed comracmrs to x3/ -
1conslonst'1 praect(Sec.70,14,Business and Professions Code)The Contractor's
License Law doirs not apply t f property F IJs or nopmoca Mclean
,add who.contracts for.such project,.with c vat O l e d Pubumffi.tO the _.. . ..... . .. 6 t
.Connectors Liciniai Tex 1 d - l
❑tense embt under Sec r l- - B&PC for this rtasod
'
—WORK[By COMPENSATION DECLARATION ,
r-!+'• :Pnearby affirm under penalty of Perjury_one of the following declarations:-
❑,1 haLc and will maintain u Ccoifcae of Consent no self-i...re for Worker's
.
Coca o'
provided for by Section 37W of the Labor Code, for In,
�, aperfomtana oRhe walk fm which this permit is issued.
C 1 have and will maintain Worker's Cumpcnsation Insurance,as required by Section
•' 37W of the Labor Code,for Me perfom.nce of the work for which this permit is
issued.My Worker's Compensation Insurance carrier sand Policy number art: - _ -
'c9rt 1 .'' 'f' I`7 i PsclikyNo. r— \ '.-5 S't t, a'..� ) tt
.'CERTIFICATION OF EXEMPTION FROM WQRKgRS. i.0• s s s a.s 1 r „•5„ ,
. . ', COMPENSATION INSURANCE,_. J ...... ., .___._... . ... _.. . .: _. _ --- .. ._.__..._. _.
y(This seciion need not be completed if the permit is for one hundred dollars
(SIg0lm leo.) '
1 kcnify'hut in the performance of the work tar whichMis permit is issued.I - �y
( sWlI no'employ any,pmrur in any manner so as to became subject to the Workers
'.Co riani,nic n Lows of California.Dom'
.Applicant.
•INOTICETOAPPLICANT:If.after making this Certificate of Exemption,you should'
beiotrc iebject to the Worker's Compensation provisions of the Labor Code,you must
•Q.O Forthwith comply with such prorWar,.,,his pe.itshall be dmmed revoked.
v,, . . .. .. ..__.. _..._... .... _
aF ,4 :i. ' CONSTRUCDON LENDING AGENCY .
CL ' I herehy all but them is a cooswation lending agency for Me performo ce
ti bf he walk far which this .it is issued Bes.3097Civ.C)
G Z - Add'1. -
1U 0, ),ai1. Y
I f n
rF.t correct.I sofy't comply with
d thII.city ad county
u ry t' 'hactel ch d.t is In.,
n( etreating
0CtId' contractor. ad herebyMoop ntt cs of this city to core, Pon
gana he W -mm o. dP layfar inspection
niPurpo 5
O. (We)sicam to m c Iridins(fy und keep harmlesi the Cuicif C pen s
-
- -
Ll!) liabilities,jdgments,costs and expenses which may to any way acerae against said
t) rZ.. City in consequence of the granting of this Pe'mit. "' 1.
APPLICANT UNDERSTANDS AND,WI LLCOMPLY WITH ALL NON-POINT " ISsucdb Date
'SOURCE REGULATIONS. Y'
sigmurtc of Applic HAA DOUS MATERIALS DISCLOSURE', Date Re-roofs
WIIth pplican'or from,Wilding ancient state orhandle hazardous mainland Type of Roof
Cale S t o 255J1(a7 Code,Chapter 9 12 and theHealth and Safety i
Ol<. CN". ;+, .I\.S I ."r• c r.; ,.�, v
aid f db)th Captain.Municipal
All roofs shall be inspected pnor.to any„roofipg material being.installed..11
Will the applicant or roma Wilding occupam use equipment or devices which If a roof is installed without first obtaining an inspection,d agree to.remove
-emit hicardoue air contaminants a de0ned by the Bay Arca Air Quality Managm'ten
District. all new materials for inspection. Applicant understands and will comply with
ave: ON. all non point source regulations;
'S I have;cad the huiirdmes materials requirements under Cot 6.95 of Me -
•CaliforniaHealth&Safely Code,Sections 25505.25533 and 25534.1 understand that -
ifamWildingdoesnotcurend)have a tenant:that it is my responsibility to no'ify'hc -
recepdin of the mcpuiremsm,which mos'W met prior to issuance of a Certificate of
o`erupapey. Signature of Applicant Date
All roof coverings to be Class a•Ba' or better -'
Owner or authorized agent Dom.
OFFICE .. -
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