02080083 CITY c DN
DIVISION
BUILDING PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7593 PEACH BLOSSOM DR JUST WATER HEATERS INC s
020�800�83
G009611!fXIMEN 1764 NATIONAL AVE APPLICABDo fg%r2002
PHONE: (510) 293-9901 SANITARY NO. CONTROL NO.
MOO ARCHITECT/ENGINEER: 1 BUILDING PERMIT INFO
E w- BLDG ELECT PLUMB MECH
l,, u u
�yy
o Zy LICENSED CONTRACTOR'SDF.CLARATION ,,f�oobb De fi tion
oe I hemby affirm that l am licensed under provisions of Chapter 9(commencing REPLACE WATER HEATEk P
t.=t_•w with Section 7Wn)or Division 3 ofthe Business and Professions Cods,and my license
I in full force and effect.
zc License Class Lie.a
O a.U Date Contractor
3 c ARCHITECr-5 DECLARATION
O I understand my plans shall w used at public records
Sort
test S o O Licensed Prufessi"nal
OWNER-BUILDER DECLARATION
I hereby affirm that 1 am cscrept from the Contractor's License Law for the
l=?a following reason.(Section 7031.5.Business and Professions Cale:Any city or county $600
Y m O which requires a permit to construct,alter,improve,demolish.or repair any structure
nam Pn" rats ssuarme.alsor� ra tM appliuntfwsuch pcmutmfl agned smremem _ _ p� _ _ -------
that hell kilgulomitom pro onsofthe Contractors License Law(Chapter9 _ he,s•� iGnl�,1� PR�'1}�t 1T1I Valuation
(coin - g 'nth Star 7000) fD'visot 3 ofthe Busme: dP f.sions Cole? a* y.0 .s��:
or door he is exempt thcrtfroin'and the basis for the alleged ekes tloh.Any violation `
of Station 7036.5 by any applicant fora permit subjects the applicant too civil penalty, OCCu ane
'of not mom than five hundred dollars(S500). 502AP-N VIItIftL PLUMBIN ENERGY P Y Type
01.as owner of the property,or my employees with wages astheir solecompensation, 506 - GAS TEST
-ram-do'the work.aad the simulate is a.,mtenaed or offered far sale(See 7044. 7s�r'�
Business ensm 507 - FINAL PLQ� j and Professions Code:The Contractor's Lice Law does not apply an 1cVfAsP eetions--- '
owner of propeny Who builds or improves therein,and who does such work himself
Is,through his own employees.provided that such improvements arc not intended or
-':oftemd'for sa)e.IC huwevee the Wilding or''improvement is sold within one year - "- ---- --- ----_
T:
completion,the owneowilaer will have the burden or proving that he aid not wild or B
improve for paryose or:ale.l. gg {�pt���
co I,as mwner of the progeny,am exclusively contracting with licensed contractors's
prose projects, parsers -. -_-'-------AUG_2-7 2 .
aoruvuet the � t(see.7t3u,Bactine::and Proreeslnrm code:)me contmcmr's ,,..
` License Law does not apply m an owner"f a contr who wilds saimproves t.w.dap qq
.. : and mho commas for such. ¢.with.a.commcwr(s).lacnsed. t.m.the _.__.._ .. QOL...._.............__
Conbactors License Law. - _....____.... ..__.._ .._.._.._..._..__.-
°IamexemptunderSee. B'&PC for this re
Owner Date BUILDING
WORKER'S COMPENSATION DECLARATION
1 hereby aftinn under penalty of perjury one of the following daluntiov:
:�I ❑ 1 have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation, as provided for by Section 37W of the labor Code, for the
_ performance of the work for which this gamut is issued..
- °1 have and will maintain Workers Compensation biwornce,as required by Section
37W of the labor Code,for the performance of the work for which this permit is
issued:My Workers Compensation Insurance come,mat Policy number are:
Cori' `AI '.l r t I\.Pol yNo.: : t -..tt�`fy. i S-1 S'!:aa r5 aa j. � ['I L,
- 1CCRTIFICAnoti OF EXEMPTION FROhf,WORKERS'; t�.'4 4 i t l ]. a l -
• . COMPENSATION INSURANCCE'
'CPC
(This sictlnn need not be,completed if the permit is for one hundred donors
(SIW)or less) _
I
,hall not employ anyinfec perifno'rmmyaLnmount,
eso a,tmf,oFr cwo'hmieeM1 Iubbijsectpermo itthies Wissurekder.s
CompensationLaws oCaIh inDam
:.y'••j,;• "
Applicant
-
NOTICE TO APPLICANT:If.after making this Cxrbrexm.f kxmnpmn,y .1hm1l
Z become subject to the workers Compensation provisionsof the Labor Cale,you must
Q' Q
forthwith comply with such provisions or this permit shall be deemM revoked.
F = ' CONSTRUCTION LENDING AGENCY s
I hereby affirrin that them c ns ct on lending agency for the performance
Q of thework for hchth fix t .'.ad 15 7,C
309
Oki v C) _.. ..- .._. _ .... .__. - - . ._... _.
Lde a 'Name ' ._-
,Z Leder,Address a .t
U 0 Iceertify that 1 have read this aPpl kation and alae that the above information is
tT+:E. as 1 agree m comply with all city and Courcy ordinances and state laws relming
Q U to building conswction,and hereby outherim representatives of this city to enter upon
the above-mentioned"Pony for inspection"'vas.
0.. (We)agree to save.indemnify and keep harmless Ne Cityof Cupertino against
H liabilities,judgmants,cost,and es,i which may in any way accrue against said
U,Z City in mruquence of the graining of this permit.,
_ APPLICANTWDERSTANDSAND WILL COMPLYWITHtALLNON-POINT Issued by Date
SOURCE REGULATIONS. Y<
Signature of ApplicanVComfactor - Data Re-roofs
HAb RDOUS MATERIALS DISCLOSURE "
Win rhe applieant or future wilding occ grso,store br handle haaatdous mated Type of Roof - - - - - _- - - •.—.
uJfined by.the Cupertino Mmucipid Code.Ch pt 9.12,andfle Health and Safety l,_ V. ,. y s •,;�, x', ± _• 7. •+x;. - _`Y '_ '
Codc.Section 25532(l.) - ,'r ,g 4 '; i At. s s o: '•!:" '• '... Y. :.
°Yea °N ) �(' - '•t• F All.roofs shall be inspected prior to any.roofing material being installed._.
will the applicant or future wilding occupont use equipment or devices which If aroof is installed'without first obtaining an inspeeti6n;'hagree'to remove
emit haeardnus air comaminants as defined by the Bay Area An Quality Management
Di,mefr all new materials for inspection.•Applicant,understands and will comply with
°Yes - ❑No - -' - all non-point source regulations. ,
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Heahh&Safety Cola Sections 25505.25533 and 25534.1 understand than
if the wilding docs not currently have a mount,that it is my responsibility to notify the
occupant of the requirements which mast w met prior to issuance of a Certificate of
O=,a"ey Signature,of Applicant _. -_ ._ _ Date
owner pr aamodam agent Data All roof coverings to be Class "B" or better
- .—' OFFICE. . . ... . . -