01010019 crrY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1098 NOVEMBER DR JUST WATER HEATERS INC 0101.0019
OWNER'S NAME. AP'P'LICATION SUIT DATE
BAJAJ ANIL AND RESHMA A 1764 NATIONAL AVE 01/04/2001
ONE. SANITARY NO. CON'LROL NO.
(510)293-9901
p-,67 ❑GILDING PERMIT'INFO
ANCIIITECfRiNGIN9EH: PLDC BUILDING
PLUMB M[CH
wp
F�y LJ I
e tr y LICUNSHDCO 'RACfOR'S DECI.ARAr10N
Job Description'
z_ 1 hereby uflirm thus I a Mr IidetneJ under provision,of Cnam=r 9(connnenc,ng
-m 1-ad with Sermon 700)of Davin,,3ofthe limines,and
Pmfesmns Csdc.andmy license
f< i, I `e""ldlf"'
{ z< verr,cClass x
REPLACE 50 GALLON GAS WATER HEATER
oao ])lifc Contractor
3 ny
AHCIII']be used
me rd
-u' I undmlunJ n,Y plans shall be used us public mend,
so
-W}
u p O Licensed Prce"jowl
%n OWNEnmucalfrmBUILDER Eme CmirDON
nereny.(S,,l mal I an excn,fod from me C...on, o Licume Law for the
rollkoC=<
which
hers,..fermi,t lar aro Blm'III,ho r,Bern on,Coda:Any airy nr coudry
w2d, w,itt RdI.IRiap=T...In,rio,,the uller,1111 four,[,df,N,ldr(,re ii,ged,attclum
w 'barhnn,Laou!pursu reynitheprovisions ill foemoll Crandunurs Lima,I.aalaaemcnt
-- (amor i,ree^v1mSecaon70B prnvi.art^nomftheBuemessann.elrs,iolC;dc) Sy. Ft. Floor Area Valuation
(commencingwish Satin,70IXp n[Division3ofid IHu,'Id Is.nd Prol Ali, rCale)
"h Sc he is 3t.5 b mmebml,sad It,na.a,tae and ct,the e,iumd w A„i ,'if im, $450
.1 Sntion'/ol LS by any.foplironl fora permit svhJm,me npplicam,o r civil pcnahy
un,..,mom man file bu„med m,11rrs 1s500). APN Number Occupancy Type
01.us,l the property,or lily employee[will,wager;,their wild compdnwion. *P
will do the wml„and tM+,Waum i,not imenlJed or olfe ed he.ale Nice.7W4.
E isiaer,and Pmfe,rion,C,de:7Te Coutractar,LMarsc Law tine,nm apply to an
Required Inspections
r.f property Who builds nr impruvfs flemon,and who does ouhi
ch work mself
or tbmugh his own employees.provided that such improvement,am not intended it 502 — FINAL PLUMBING ENERGY
mrcrcd fill sole IL however the rade 1,in imfonocall Is"old within roc year of
completion.the owner-M,iloMr will move the laden of purring,bar he did nm build o, 506 — GAS TEST
a,pbnrd m.form,,,[to,:'Ie''' . 507 — FINAL PLUMBING
711,a,owner of,he Pr,,,oy,ma c,clu...It,Gonane irg with ho msed commit.,to
, dmc,the proicm(Sce.7044.Hoinea and Ptre,, ma Gde:)The Comm=mr's
Lmune Law docs not apply to an owner of pn)Kny who build,or improver mese,,,
and who contracts Inr s^ch pmjeas with u aoarrtorpt hIscoC•d pursuant to the
Contractor',License Law.
❑1 all,czen,pt undo,Sec. .II h 1'C Iim this reaeon .
Owllcr Umc
WORKER'S C(MPENSAI ION DECLARNUON
1 hereby affrn under rywhy of prlury ane ill the following decluradion.s: 2
1 have and will mainmin a Ccnilicae of Convnd m ,ct.,,,.re for Worker', 3/
',mpcn,airn, as provided Inr by Saturn 3700 of the Labor Clde, for the O/
,d rmunreof dhc work dim which this pfradd is iss^ctI
O 1 Ms-and will rami^taro Worker's Cono,osudiun Insurance,as required by Section
3700 of,he Llsor Coda,for ase performance.1 the work In,xI,i,h this'coma,Is
euu1.My Worker'x C^ngn^wtion Insurance carrier and Policy number are:
Carrier: Policy No.: ,
CERI'IPICATION 01;UXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
phis section need not he completed if the permit in for one hundred dollars
S 00)”,Ilse.)
I oInity that in the perb mance of the work for which this permit is issued.1
,Mill our employ ally Mrum In any manner,o;is to histone subject e,the Workers
C^mpcn alion Lows if Cali forma,Doc
NOricud
NOnCE PTL\P',, he NI':IL Consmari his Ccn.....o fl Eauttor Code
Youshould
ho,nmc nu comply
it suchprCnion%or tics pervasion,,hied LnAuCode,you meet
Q O forthwith nim'ly with eucM1'nrvinion,or this Penni,shall he Jcen,cJ rcvukcJ.
F = CONST RUCTION LENDI NG AGENCY
a , I hardly allinn that there is aconntmtion lidding agency for the perfnmmnce
of me sum),fin which thi,permit is issued(Sec.7097.Civ.C.)
G Q Lenders Nano
;D Z Lcndm',Addros ..
U Q 1 candy the,1Irov,rend this appli.dinn lad,wte dot the above information is
I.. E. wren.1 agree..,comply with all city and comity mJine.ces and ante Tawe reMJng
Q U to hiding c"naretion,and hcrchy authorize representatives ofthis city to enter upon
the above-mentioned pol lira immeel a purposes.
F a 1we)ngrfcwssvc.indemnify and keep Toric,the City of Culenim,agnim,
r VJ Ii.bilidis,,judgments,Ino and e,foasc,whish may in try way as'lle agado,,paid
U ZY City in aonw,whaa of the granting of this permit. '
APPLICANT UNDERSTANDS AN U W I LL COM PLY WITH ALL NON-POI Nr - Issued by: Date
SOURCE REGULATIONS. y'
Signature of A"hell zCo orator nam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the afofohdanl or firm,doulding macaPam Nom(it hank hazardous nm=rial Type of Roof
as defined by the Curyrino Municipal Code.Chapter 9.12,and the Health and Safety
Code. c ,25512(.)"
OYes ❑No
All roofs shall be inspected prior to any roofing material being installed.
Will m=applifa^t or mom M,ddi„g«=alum.,e equip^,=mmeoi.<,w1^m If a roof is installed without tars,obtaining an inspection, I agree to remove
emit h;,ennlune;ur
ala,def ni by the Hay Area Air out it,Management
istricv all new materials for inspection. Applicant understands and will comply with
LIQ[, ON. all non-point source regulations.
I have read the hazardous,natcrials requirements under Chapter 6.95 of the .
Cali Lorna I reahl,a Sufe,y Code.Sections 255105,25533 un 125574.I un la,,land mat
if the building does run cwmmly have a tenant,that i,is my responsibility to noddy the
c,a t of It,aqui mon,wIm,I.,oust be mat prior ue i,amnce at Ccnific.dc nI -
Occupancy.
Signature of Applicant Date
Dwat,r a„mrd,fJ„gnr,t oma All roof coverings to be Class"B” or better
OFFICE