03020084 r—C—ITY OF CUPERTINO
BUILDING DIVISION PERNHT igcow'kg
"'I"DINGADDRUS: JUST WATER HEATERS INC PERMIT NO.
10424 PARADISE DR 03020DS4
S SR'S NAME: 1764 NATIONAL AVE PERMIT ISSUE DATE
FRENCH JOHN S AND SALLY R 02/�1/2003
(510) 293-9901 SANMARY NO. CONTROL NO.
ARCHITECTIENGINSER: BLDG BUILDING PERMIT INFO MECH
z
0 LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am Imused under pronlahms of Chapter 9(connewaint, Job Description
with Section 70KIO)orDivision 3 of1he Business and Professions Code,and my license Is
I.full force 4.4 erred. REPLACE WATER HEATERIFINALED
LicvhsoCls_Lk,.#
Daw.Comexcuor (50 GALLON GAS)
ARCHITECTS DECLARATION
I mulcustand my plans hill la,used As public rodomis MW 01. 4 2003
It
Licensed Professional
OWNER-BUILDER DECLARATION
i�z I hereby affinto that I am ascorpt from the,Contractor's License Law for the BUILDING
�00 following reason.(Section 7031.3,Dulness and Professions Code:Any city or county
which m4ulms a permit to construct,And,Impown,domolith,Or repair any structure
prior to its issuance.elect requires the applicant forsuchradmiltuilletAignotill2woUnt
C1 that he 1.licensed pennant to the provisions,or the Contracurei License Law(Chapter 9 Sq.Ft.Floor Area Valuation
(commencing with Section 7000)of Division 3 of the Business and Predications Coada)or
that has Is exempt therefroom and bee,basis for the alleged exemptIM Any violation of $938
Swim 7031.5 by any applicant for a permit subjects ft applicant to a civil penalty of APN Number Occupancy T�pe
act mom thin rim hundred dollars(M). 35916027 . 00
0 1.As Owner of the iumperty,or my employees with wage,As thdrsole corepensaflon,
willdoth..o,k.a�dih,.mciu.i.n.tin��dw.fftmdf.,,.I.(Sm.7M.B.sines,
and Prefessions Ceade:The Contradem's License Low don not apply 10 In Owner Of 502 FINAL %IJAIW"' 13RGY
preponly who buildsor Intrarew,tibentermand who doesitchworlthimselfor through his
own employcers.pmided that soon impornworents arenot intended orofforce!for We.If. 506 GAS TEST
houxemr.the building or Improvement is sold within we you of completion,the owner.
Witter will how wo human of proving that he did Out Wild or finprow,for purpose of 507 FINAL PLUMBING
0 1,As owrod of the properi,nn e.ctusinly..=In&with tictondwitnewas in
construct ft pmJccl(See.70".Business And Protenions Code:)The Conuatuen,U.
town Law does not apply to an owner or property who Wild,or Improws thereon,and
who contracts for such project,with A communist)licensed pursuant so the Corturnactor's
Lt..Law.
1 arn exempt on&,Sm �.B At P C for%his retaxam
Date
WORKERS COMPENSATION DECLARATION
I hereby Aram under Penalty of perjury one of the following declarallow.
I h..nol will maintain a Continence of Consent 16 self-wimm for Wooled,Compam-
salion.As provided for by Section 37M of the Labor Code,for dew performancir of the
work for which this Permit is issued.
0 1 haw and will maintain Worker's Compensation Insurance,As m4ulmd by Section
370D
or she Lainer Code.for ft Performance or the work forwhich thia permit Is Issued.
My Worlon's Compensation Insurance carrict and Policy number Am:
carrien. PolicyN..;__
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSAnON INSURANCE
(Dh advicernmed.m becomplawd irthe paccomil Is for.Worked dollars($IW)
I conify that in the N11mon....r the work for which on,padmIt is issued.I aboall or
employ any person In any manner an As to become subject to the Workers'Compensation
Law.of California.Dow
Applicant
NOTICE TO APPLICANT:Ir.After making this Certificate of Exemption,you should
become subject to the Worod.OmoraftealliDo PMVISiOM Of ft LAWf Code,you WAL
Z forthwith comply with such provisional or this wonit shot[be deemed ramilood.
0
CONSTRUCTION LENDING AGENCY
I hereby afflorm that thert Is a construction lending agency for the panfornwam of
> ft oneric for which this powth Is issued(Sex.3097.Civ.C.)
Lzndees Name
is. Lender's Address
U I wifify that I how mad this Application ard!Abuse that the show information is
V, conrod.I agme to comply with all city and county ordinances and show laws mianing W
0 building construdion.and thereby authouria,mpancrusLinul or this city to color upon the
abow,nmoconed property for Inspection purposes.
(we)-ame in saw.indemnify And k=p hownwas sher City of Cupertino Against
liabilities,paignmos,costs And expenswit which may in Any way accrue against aid City
U In consequence of the istletiol Of this parrocil.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATION'S. Re-roofs
Signaturn ofArtiplicanalcmanocuor D.W
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the Applicant orfulum Wilding occurnunstom or handle hatordous material
--i!!d"n"by -Municipal Cock.Chapter 9.12,and the Hcalth and Safety
-do.Sx1t1.nt5,L3�1(P.!)M?w All roofs shall be inspected prior to any roofing material being inst a*lled.
0 yo. ON.
Will the applicant or future building occupant use equipment or dcAnc,which If a roof is installed without first obtaining an'inspection,I agree to remove
roll hamniour air cortarninants As defind by the Say Am Air Quality Management all new materials for inspection.
7Disuid?
Oyo. ON.
I how mad the Weardan materials requirtmenta under ChaNd 6.95 or the cafer.
me Health&Safely Cc&,Scobown,25505,25533 and 25534.1 undtortand thea ird,WildinS
duse,no,currently haw A wram,"it is my responsibility to notify flec oecupart of the
mquircrocrus;which mu be,met prior he morence of a Ccmrwam or Occupancy. Signature of Applicant Date
Owner or authorixed agent Dow All roof coverings to be Class"B"or better