02040080 j CITY.OF CUPERTINO -
BUILDING DIVISION CONTRACTOR''INFORMATION',
1 PERMIT _ -
BUILDWG ADORESS: PERMIT NO.
j JUST WATER HEATERS INC 02040080
OWNER'S NAME: APPLICATION SUB DATE
POWERS ROBERTA R 1764 NATIONAL AVE 04/16/2002
PHONE SANITARY N0. CONTROL N0.
(510) 293-9901 .
ARCHITECUENGINEER: BUBDWG PERMIT WFO
a BLDG ELECT PLUMB MEC'H
< U C=1
C. U
b m i LICENSED CONTRACTOR'S DECLARATION Job Description
iv ih...by.fnmthe,l am licensed under provisions.!Chapter 9(commenc"' P
y t• ,whbSec,im]0W1otDivision3 of,k Business m,d Professions Code.and my license REPLACE WATER HEATER.
m�._ is in full fame andtrcev.
re
License Class Lica
o c .Date Con,mnor
,u O r'' ARCHITECTS DECLARATION
'g � • I underssand my pians shall k used az public words
0 O Licensed Profcesm,ul
e OWNER-BUILDER DECLARATION
' 1 hemby offrm that 1 oat emorp,from the Convector's License Law far,he
L x Y fallowing moson.(Section 70313.Busimus and Professions Code:Any city or county $700
7 O O
s which requires a permit to construct.alI,ar,improve,demolish,or., any uroc urc
63$ :priorwiuluuarre,els.requirquha applicam for tach panni..RleaxiynN surerwns. ._ _ _ .__ .. _ ___ _-�,.--.,__,___ _ _ _
(m he u Jim pursuanelu Ne pats oat of the Cmvxsols License taw(Chapter isCod 9 �(�t8 (�}'l�t�,�' /,/J���/�{
Icthathe Pp Business Olmldmoh.An.n31'.de) e••�'\ .JV aV:J Jr':V VaI, )�aiD.` Valuation
ar Na he Is ckcmpi therefrom and,k boss for Ne subjects
Oud n licom t Any viola on V V
� 'of SecOm 703I'.3 by any applicant for apermis subjeca sk opplicvm m e civilpemiry
-of more Nanfive hood rcad.It (SSW). 502APN irL N
PLUMBIN EERGYOccupancyType
01.as owmcofthc propany,wmycmplayces vuh..,as azlhousolcmmpensosion. _
5 OG
-w,ll'do ih¢work and the structure is not( ended"la oReed f a uIc"(Sec:"7wl CAG TEST
—
,
'Bushmis and Professions Code:The Contractor's License Lew does out apply to an 507 - FINAL PgI 4$l'$Q apection5•'�^'L- -'
owner of property Who Wilda or improv.thereon,and who does such work himself
or Nro gh h employees provided that such,_pm,emengam w intended w _,._-_ --.._-..
offved f le If however.the budder o m -'---'- --"" '_"--" -- '—" 7,_
B am cos is sold Nm one year ., --
improvlon,the owner-Wilder will have Ne kNcn of Proving tho k did n.build or
improve for purpose of sale.). '
1 Wownery a
of tho propertm excluss.ewnn
ly contracting with licensed contractors, .__ , __ ,.._ _ __
construct the pro,tts(Sec.]OCC.Buvnm aM Professions Code:)Tic Consnnor's ,Lly,, ..p:-
i +
License Lo d m owner napply to an owr of propeny who builds w improves thereon, C—• tl� _
- .eM.wbo mmmensor.su
. ch.projecu wM. m
a.eomemd[)hcamed ..
.purs... "k-
ConuacrotaLttmc
01am.e p, der Sec B&PCT Wu rcamn APR 2 4 2002
owner
WORKER'S COMPENSATION DECLARATION
thereby atTmm undo pemisY,of pc0ury,orm of sk fallowinY dedwsiom: BUILDING
O 1 heve'{nd'will°mainiiin e'Cenifcam of Consent to sel6inaum fm Worker'i
Compensation.as,provided-iw-by-Secsion-37W of the tabor-Code;'for Ne
peRwnunce of die svmk lm whiN shin pemds is issuN'Tif..
1 h o,d oeI nuum n Woke !.rope red. 1 i dna as rtp ircd bi Scvion
i 3]00 of ilia Leber,Code,for Ne perforin m.'of th ork f which Nuimi
pct i[
ssuml My Worker a Compeueauon a c
1 onsto arne e d Policy nourti, `
Camcr I✓ f,a,, tlA4A al Polley No. ..:' '. I , .a f r]I �• , C.ai:i 2'l < 4 �sll't,1..7
„ N CERT�ION OF.E%EMPfION FltOMWORKER$ .;,,u„
'COMPENSATION WSVRANCE' f ,
41 (Th,issec,idn ileeJ,ort he Iola lved f,he pennisis fa one huMrtE dollars :7
fl�(•ll-;J;I.i ,y3•
fS 100)
� I<mfy'N,lath perfmmurcc of tla ork for which Nu,pc t'u ssed 1 !U.'c I Is , I il -;aS's _-----
ehall n t emploY'rny;permn many manner so ass'become�ub,ea to,he Workeia '` ''r '
Coniperunioo lawi of C,aliremie:Dae
Z AppB _ .. __
NOTICE TO APPLICANT If afterm J.inf shi Cenf au of Exe pt on yuu should 1 '.. r ♦ KCl[
0 become blocs io Ne Worker s Compensation p ,'lav of the Labor Cotle.you muu
b
onhw,t comply wnth such prervajons W tt is pvm s sh 11 k deemed revoked.
fy rA S��' W. CONS7AUCTION LENDINGAB�ncy fa the rfoiinalrte.. .,. ._.__. .. . .- ` I" CI '. Y 1r) .._ ..
> 1 hertby alTmi',hn dor s a co iwm a led pc f I ly-.r
GT7 {r of ilia wk fa her Napc , ) -d(Set 309TC C,
D Z'. L6tlb[Add ;•' . . .- , 11-
V.�. - R' 1 --- :r :air^::.• ._ r.')'1
V,iy 1 can fy Nat 1 have read shli opplicei on end sense rhes,hc.bone inlormasion is
tT, ionea 1 etrce,o comply,withell cisy'entl coumy ordinanq.and mm laws tabour,
=U mbuildinE swmrve,ion,and tiercby au0lorire ieprtsensitivsi df Nit city to co at upon
,he above-memionpd, fa
against
ins
^'0.1 (Wej ejrie,b save,Indcmnlfy told kttp hiimless the City of Cupertino
h liabilities,judgments row aM eapcnses,which may in any way accrve agaimt,uid
V Z_I,, Chyl Fonsequence of the gra sn¢�of Nis per)t1I ', "-
", Af'PLlCA\'Tt:3-bfA'ST1.�Tl$A�D Is C4 C0(fPL1t N'IY{Fi AI.L Yb�:P01.Vf''c r
soL�ecE IiEGLi>Tids. >>.r.,. Issued by: Date
signamrc rApplitan on et '. •,, .,� tDa4 ;ia1'j:; Re-roofs
I C.I HALkRD0U5 MATERIALS DISCLOSURE r
"it apphianI fare WJd jampLl ,be.w handle harallous anal .. Type of Roof-
'def dbyth'Gupen Mv¢Ipel Code Chapter 992 andthe Hoehn end Safety ->,-
�Yo 85320) s•':O Po: e' r a 'n"sr f. '.t 1 v jt.. .,y"•sly lk Ya L?f . ,I,
„ ' .. ._All-roofs,shall;beinspected,prior.to.any..roofingmaterial.being.installed.........
,.. ._,, ,
Wilitheapplclinsorfusurebuld gwcu .mase mpmem. e I.>whan If a roof is itisfalled witfiout fust obtaining an nispectlon I'agree to remove
e is bawdous e r Can to m d! 'd by the Bay A- A,r Qua!ry Manageme ,
D slam - p r 9. " ,_,,, all,new.mateti alsfgr.inspection.-Applicant understands.andwill_comply_with _
' I 1❑haee otl Ithc ha:.rdaua'maen;k ' all non-point source regulations. - - , ,•;( .D
1 1 ❑No
ogtlp {u q, 1l t , n ' 11. . . ..
}. req255 : 55 3.�undcr Chaptedersta d at
Celifo eH Ith&Biter Cade ave.mmd.oam:lh.25533 and 2553C lundersund that,
icu tlYha easenens No
it 11 my,as Jbdry moot fy dre
dNe bre ldn dor n.menu. hchmus,kmerpnw ms umce of aCcmfiwc of -
. OgcupencY , '1 ' ] .
__. .Signature of Applicant_ .__ _ . _ ..-. Date
wcupant o she rcquve
owners
lian. ,I r.,, K Date ; All roof coverings to be Class"B"or better
'OFFICE _... ....