01080060cl OF
NNO PERMIT
BUILDING DIVISION
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO,
1100 NOVEMBER DR
HOT WATER INC
010800$60
Tf'`1't9` RALPH W AND GRACE C
2531 GRACELAND AVE
0811 N/�LB�aT1
HONE:
(650)298-8494
SANITARY NO. CONTROLNO,
Z ARCHITECT/ENGINEER:
BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
w
Ll IJ I.-1 Z I
i LICENSED CONTRACTOR'S DECLARATION
Job Descri [lOn
tt..700)ofDiaion3I min oftheBusndssand
GE PROFILE PERFORMANCE SMARTWATER WATER H
with Section f Division J or me Business and Profession. Cale, and my license
i mfssion%Cmr9kommeneise
ea and e
is in null face and effect.
a License Class Lin. tl
O Data Cnnur clmr
ARCHITECT'S DE,DECLARATION
4 1 understand my plans shall be used as public records
OLicensed Professional
OWNER-BUILDERexemptDthe
1. I hereby .(Brat that 1exempt from the Contractor's Licence Law for the
onsC
0 following wn. (Section 7031.5. Business mpr Professions Code: Any vary st county
$500
ui orepair any structure
o which rcqulrt<a permit re construct. aper, improve, d<ermit
t file
fue such permit Eleusigned statement
z pr,teto ,lits censed
36�fl@¢IgorQ�ea,t
Valuation
Valuation
parlso tuam oimsmovinno,ocant
— mgtnPi.unry,ea�aReaq:lamnpro.isir,n,:nnecnn:man.aueen.cl.awlenamer9
is Sobers BMgB of o
or
that he bt tany ap li and me basis for :he t exemption.
or mm he is conn a basisthe allegedexemption. Any violation
of Section7031.5vanyapplicantfora permit subjectsthe applicant macivil Penalty
31.5 the
of not Taro man five hundred aauar. anon.
5 02 A=Nf`fPt;Rhq PLUMB IN
ENERGY Occupancy Type
❑L(s awn«tarso pmpery,amy emplmy", wan w...... snehmlaoorpenmmr.
506 GAS TEST
_
507 — FINAL PURIlp aGnspections `
willBat.. me work and structure C nor con', i en a Lawaced doe snie (ver. ]oar
d .i he work. and h CWe: The is n r intra s anonsu Law goes nos (Spry man
0 caner of progeny lds etstr mwho ennscs men orrkeed
or through ti employees. providedttuchimprovements not nne
e dvltap
-oor
oferedTNiGsak. IL no rv<r,me bu (din6 mPro oentis sold 'wnh n one aaef
tiourpletwill have the 6uNen of proving that he did not build or
for me owc
p��/�
F I '
improve
improve for pugrose of sale.).
of sale.).
� Vt da"4. L E
❑ ,as owner at the Property am exclusively with ImensN contractorstoa
9l' w of
7 a d dating
(sec. to a. owneroa and ony Professions code:) The improves
m.arua ac does the on,
1nih Law Jocs nm apply man owner of who builds or improves thereon,
p PR 2 L 2002 .. _ .. .' \�j
---- V C
ampcny
.. and who commis for. such projects with a commcmrtz),IittrasW pursuant m the
.... ........ ._ ... _-_.-._... __. __- .
--
Cammnolx License Law. _
01ame1 empt under Scc' ,B&PC for this reason
'.
BUILDING
Dwner Dam
WORKER'S COMPENSATION DECLARATION
I two by mffirr under penulry of perjury one of the following decimations:
1 have and•will maimain'lu -Ceniriivic of Consent as self -inure for Worker's
Compensation, as provided far by Section 3700 of me Labor CWe. far the
perfonnaoae of the work for which this permit is isuad.
❑ 1 have and will mountain Worker'x Compensation Insurance. as required by Section
3700 a6 the Lat ur Gale: far the performance of the work for which this permit is
- issued. My W ukeh C.t_ pa m lmsti carrier and Policy number are:
C er, 1 s- „'..: Policy No.:
t CE RTI FICATION OF EXEMPTION FROM,WORKERS"
• - �"
' COMPENS1.ATION INSURANCE
- •- pins column need not be completed if the permit is for one hundred dollen
'' 'I" ➢ .: sP
15100) or leI.ss.)
-- -
1 cintify.tht m pef t ,I the kfhichM. pe t I,,sued.' I
,• a., rt,lta,t _ -. -
the Worke
�%cadfrion einpl ry any pecufin any mar a, t 1w ore subject m rs
mannerso,
Cnmpenmaen Laws of California. Data'
NOTICE TO APPLICANT. If, afar nuking this Centre.. of Esemgim, yonshonk!
it, 'ticomesubjecn to the Worker'. Compensation provisions of Labor CWe, you most
fonhdith'nniaply with such prnvi.iane ar ani, permit shall be deemed revoked.
—
""' CONSTRUCTION LENDING' AGENCY,
i IherbyaffimVthat theic isaconstraction lendingagencyforshe pofamarse
tnf
ti me work for which this Permit is issued (Sec. 309-1, Civ, C:)
...--..-._
Leodcis Nmne ... . 1. -_ .-,._. ....,
,. .. .,.. -_. ... _._...-.. _._ ._ __. ._ -. __.._...... .._.
L'Lender's'Addrecs
- , a ;a
I enifY th t l h d sti a a re application d state that the ba information is
c' t l g ptj th 11 ly ud count ordinances d state 1 rclarng
n
j u M1
ta le' yrs 't t dh byrepresentativesof this city to s upon
. p
b t pony f pea ro
�
L (W6) g to s itudenmify andkeep h City Cupertinoagainst
fI} —� �
n rabtlitijudgments,n and oxi,enses which mayin any wry weru,gmnw mid
C0
Ca'bnzquenec gofthiaprmit.
RSTANDSADWILLCOMPL\RITHdLLNON-ITAXfco. UNDB
Df✓at�eE
Issued by:
REGULATIONS$bURC
Signtum, fA,pIi m1Cammvt., .• .. Data
Re -roofs
- 1 -HAZARDOUS MATERIAIS DISCLOSURE "' ,
.t Willtheappllcantor,fmurebuiklogoccupant store orhandle haaaclousmatenal
Type. of Roof- -.— - — -
as Jtnned by the Cupertino Municipal Cade. Chapmr 9.13, and me Healn, and nafcty
"'tt
CWe: Seaton 25531(a),]
f7Y ON. - '-
All roofs shall be inspected to.any.roofing matenal.bemg_installed.--
W111 the ppin t or future building occupant nic,eq pmt or devices iihich
-prior _
If a roof is installed without first obtaining an inspection-"Itagree' to remove
c tha"mousarcontaminants adcrined by the BayAre Ar Soapy Management
D
all new materials for inspection. Applicant understands and will comply with -..
Dyes . ON. n:
all non -point source regulations.-
. 'I have read me hazardous material; requirements under Chapter 6.95 of the
Catifrnta Health .@ Safety CWe. Sections 25505. 25573 and 25534. l understand that
_
I the building Jots not have a taunt, that it is
rommorvibiliry notify me
hent, w
occupant of the requirement. which roti be met prior w issuance of a Certificate of
a
•' Occupancy. ,' ..
;;
Signature of Applicant, Date
_.
All roof coverings to be Class •'B'• orlbctter ,
Ocarina, antro ed agent "; Date
'OFFICE