01090018 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10038 OAKLEAF PL WATER HEATERS ONLY 01090018
OWNER'S NAME: APPLICATION SUB DATE
WELZ FRED C AND HELGA P 970 E. MAIN ST, SUITE 201009/05/2001
i•PHONE: SANITARY NO. CONTROL N0.
(415) 566-2209
o m Z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
W w O BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION Job Descri IIO❑
Z I thereby oRrm that 1 mm licensed under pmvismnx of Choice,9(commencing p
'yt-we with Section 70l of Division 3 of dwi Bc,iOf,,..d Poilt,inan,Code.and or,license REPLACE 50 GAL GAS WATER HEATER
in fell fore and effect.
ex6 a License Class Lic.0
O D Date Cornice r
I i a0 a ARCHITECT"S DECLARATION o
1 understand my plans shall be used as public records
co
1'Y p p Licensed Prol'caiorml
a o OWNER-BUILDER DECLARATION
1 heaby affirm that 1 am exempt from the Contractor's License Law for the
I_Z< following mason.(Section 7031.5.Business and Professions Cod,Any city or manly $700
2.a which inquires a permit 10 nmsuum,alar,improve,demolish.or repair any strvchre
w 3 priorm itsissuance.alsoq theapplicant forsuch permit r n 'grcd statement.
hot hi,islive d Pur,orritt thep- n.A he CrounwIms Limc,c Law'(Ch par9 Valuation
oras ewe,with Section]000)of Division 3 of he Business and Prefe. .n.code) , , 3 2 1 0`tl V_. V „v .-.i- i i Is -
or mat re ii encnipi therefrom and the basis for the alleged cxemptio 1.Any violation
of Section 70315 by any applicant for u permit chimes the applicant to a civil penalty
ofhot momethan five hundred dollars($5W). 502APNYTN1A'L PLUMBIN ENERGYOccupancy Type
❑I,as owner of the pmper,or my employees with wagcx as their sole compensation. 506 -
-w
will as the work!and the svactute is not intended or offend for.ale(sec.7044, 507 - FINAL PLR�¢tBrEttfd3tspections'
Business and Pnifessions Cala um
The Canacr's License Law dors not apply at an
owta
r of pmpery Who builds or improves thereon,and who doe.such work himself
or thhisroughown employees provided thinh improvements - t -t dee.r
offered for sale.If, c the building p ve e t IJ tyear of
completion.fire
erlwillhave the bud f provingthat he did Doth Jct or
improve forpurpose or at,.),
t
❑h as owner of the p pent am exclusively c t i g with licensed contractors to
construct the pmjw(Sm.7N4 Bmimn5 and Professions CWI:)Ths,Cmucconor s
Umno,Law Comwh oc Veen col suc f p perry I b lei. p (helicon,
c. M who comics,r, ash pro,an ow er I mntranI b licensed p em n the -
///
❑lamcaemtunderStt B&PC further rtaxnn ' r
O'ine Dale -
WORKER'S COMPENSATION DECLARATION
I heathy olTrm ander penalty of pcdury ane of the following declarations
' O 1 have and will maintain a Crtin icxac nI Comer to lel Ginsure Ion Worloca"
1N.. Compensation, as provided for by Section 37W of the Lamar Code. for be
perfarraii of me work far which this pcmdt is issued.
111 have and still maintain Wader's Compenswion Insurance,as required by Section
37110 of the Labor Code,for the performance of the work far which this permit is
issue J.My Worker's Compensation Ineuandc carrier and Policy number are
Cam .Pot yNo
CERTIFICATION OF ENENPr10N FROM WORKERS'i -
. .' COMPENSATION INSURANCE ' I- -.. .•__- .. ...... ...� _.._ .... .,_-.... ., r ._.. _-.._ .- _- . . ...
(This section need not be completed if the permit is for one hundred dollars ' '
1$100)or less)
1 eenify that in the performance of the work for which this permit is issued.I
.,hull not employ any penton in any manner an toad Ircmme object or the Wmomi
Cnmpenwtian Laws of California.Dia
Applicant. _
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
66come mnm
bjecthe W'orkcrs Compn
edia provision Of the Labra Cide,yam must
Q 0 forthwith comply with such provisinns of this pet if shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
a7 1bercar affirmthatIh.ins consortiumiSm. tenting agency C.) for(he perfonnenem
�,..
Lender
N for which this perms is issued Sm.3097.Civ.CJ
QFender's Name. .. . . _ ..,. ..„...... .. ... -. . . ... .- _
a^ Litcdc's Address '
D Z 't
V 0 1 eenify that 1 have mad this application and state that the above informaion is
kT. E+ correct.I agree m comply with all city and county ordinances and state laws mating
Q V to building construction.and hereby authorize mpfesenmtives of this city to enter upon
�."W the above-mentioned progeny for impectum purposes.,
.p„ (We).gfee to save,indemnify and keep harmless the City of Cupertino against
Fr'UO liabilities,judgmmn,,costs Intl expenses xlnch mny in any way.come agelmt said
V Z City in consequence of due gruning of this Permit. '/� (� l
_ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT [.,sued by:
efCj� - `C `'" t2 I V�-
370
_ SOURCE REGULATIONS.. -
Signmmeof ApplicantlContractor ."' Da¢ Re-roofs
red Y.'r-HAZARDOUS MATERIALS DISCLOSURE' 1
as defirW%:bbs,hc Cacam6r furore bmlding«c.,act.,rare or handle nvardous material Type of Roof ....' .... ..� .... ..
peoino Municipal Coda.Chapter 9.12,and the Heal and Safety I „
Cwe,Section 25532(a), (,
r.
❑Yew ','j �.oNn'; ' ' ' ':" r.. �' All roofs shall be inspected prior toany roofing.material being installed. . . ..
Will theapplicaut Of future buildingoe mpam use equipment ordcviccc which If a roof is installed without first obtaining an inspection,'( agree to remove
era hazard...air ammon a,,,ai defined byline Bay Area Air Quality Mamagcmem
District' all new materials for.inspection. Applicant understands and will comply with
OYes.� - 0No all non-point source regulations. -
t`-- 1 have read the hdzmdauti materials ociphonern,undar Cha le,6.95 of the
Cals
Hire mild Health&Safety Code have
aSections ant.that
t it is dna responsibility
1 ity minandify
that _ ... .. ..
ifthebuildingdocs.not
ment, yhaveamnte let itis 1. rcohnice bllity enotify the
occupant of the requirement,which muse h mel prior to isuuance of o Ceniffcae of
°rypancy' Signature of Applicant . , Date
Owner for a.madreaagain ., " Dae All roof coverings to be Class "B" or better
, )
.. ... ._... ,_ OFFICE