00120037 CITY OF CUPERTINO
nun.DUNG DIVISIONpERMI'f CONTRACTOR INFORMATION:
BUILDINGA IjI1
185 PRICE RV JUST WATER HEATERS I JLMUNf''00120037
,WNI.R'SNh�ahRY hIOhIK t APPLICAI'ION SUR DAN:
1.7( t NATIONAL AVE 1.2/06/2000
'HONE. SANITARY NO. CONTROL NU.
(510)293-9901 ,
BUILDING PERM[ INFO
q ANCUI'I'[CI'/IiNCiIN1ASR: BLDG ELECT PLUMB MECll
w_
'k.aa I-1 CI CI I_I
LICENSED CONTRAC[OR'S LECI.ARAI'ION lob Description
O y_ I retch'a0irm tlmh 1;nn licence)under provisions nl ChaPhcr 9lnhmmennng
FN1. w"hSttlion]IXXBorDivi,iom3aftheBu,incssamdPndcs,iamCarl add atylicense
y,� is in lull Selection]effect. REPLACE 50 GALLON GAS WATER HEATER
�m
'.6 Liccmc Class Lu, a
i halo. C.... unar
m 3 a a, ARCI II M I LCr'S DECLARATIoN
C w—' I undrstan
ed my plans.hall used list public mcordx ,
yO O Licvnscd Pmlcseinnal
S o OWNI?ILI4 vagi IR UIi he ComIION
mon,
;3 I reama;:rlirsn that I ten exempt ligan;he Common, License Law rnr the
7Z¢ fallowingmama.(Section]031.5.urv,rut,atter. andve.frdefi Cede:Anycity fireounly
z o p i requires a permit re am,we.aped imfor such
dcmnli t m repair any structure
priort I -issuance, I : 4 1h SPI atf bloodt TI '.'g J.-In uhf
mann II a a,f the,00ki..... t'he C 0,icia,1 e I (Chapter 9 Sq. Ft. FloorArea Valuation
Icons umcm,wish Seem 700,b of Db soh 3 or the Bu,l ms%s td P ofassions Code) �78
or that he is exanpn there0om and the hnsis fur the allege]evxm,boa.Any violation
of Section]031.5 by my applicant for a Permit subjects the applicant to u civil penalty
of not room Ill.five hundred duham($500). A PN Number Occupancy Type
❑1,mo-w,elhr,,upry.ormyennhluyee,wimwnacna, hcu,,omcuao,<roiru, 36905041 : 0171
will do IM1e o,k.and the Nruaum is nm 'attended fir onered fav sale ISre.7141.
Businnz and Professions Code out Cantreeor's Licenw law doe,not apply to an Required Inspections -
ofpm,.yWho budd., ,,improve, hetuom.and who does wchweak lnmelf 502 — FINAL PLUMBING ENERGY
u through his ,on employee,r provided nna;,rich impruvcmenn art not intended at
m'1&red Innate.Ir.ho r.the building a cpm nn""'Id will:in o.yea ar 506 — GAS TEST
nnpletimh,the owner:buiider will have Furden of Proving man he did not build of
dh"mve fca"mir,%e er%ale). 507 — FINAL PLUMBING
❑I,as owner of the prvpcty,ant exclusively contracting with licensed contractor,no .
henw,I a. Pwlcet land ,,a,Ifisowner of and ey who hand,,J,, Tae Gmnmcer's
and wh law does ire a"ply m h n ow ar of acrouY who e fir pursua,there
l.
the
add who eomrmes.rat wen pmjm,with a emwnorc%) licensed pursuant to thin
Ch1 at ver Licenselaw.
❑1 ten excmpf ander See. .B d P C lid his rcanh / I
OwnsDate
WORKER'S COMPENSATION DECLARATION
I hereby 31TIMI Under befulty of perjury one of the Billowing declaration%: 3
❑ I have and will ;mJntain a CemiBeam of Consent m self.i-me Int Worker'% �S
Compensation, a% provided rnr by Secron 3700 of Ill. 1,mor Cella. for the v
Ierlommnce of the well:lit which this permit is issued.
D 1 have and will mhnimain Worker'%ComPen anion Insurance.as required by Section
3700 of the LUMn Code,for the"cro rnrunac of the work lot which the%pem;il is
%ucd.MY Worker,Compen,mion Insur.;nec carrier tad Polley mmrmer me:
Gorier. Policy No.:
CERTIFICATION OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not M mmPletud if the Permit i,lin one hundmJ dollars '
(SIIXB fir Ins.)
I mrify That in the perforreave of the work for which this permet is loved.I
ve'[1 I employ wry perms in airy nmrne.so as to hc,onm.object,or the Worker, _
Cono'nwtiun laws of Calilbmia.Date
NOTICE
N(YTICF,TO ct to the Walk B,Cher making this Cetincmc of LatuartCod you should
bcamm subject IM1e Walker's Compensation ie,pernal ns oftheInnnj Code,you mors
Q � Ehnhwlm ce,nPly with death rrovi,,n,n,ormi%pampa drainer deemed r--ked.
7
F
CONS)
Rd ' COCf10NLFNUING AGENCY
I hemwhich that them is a constructionlending al
for he n4mentt
arae work for which this cmis issued(Se.7097.Cie.C.)
L Q I.cnder,Nunn,
Z LenderAdm
's JArc%,
U Q 1 certify that I have read his application and state that the above information is
tL F. correct.I agree to comply with all city and county ordinances and state law%misting
Q U u.haddog nmmoinn.and hechy amhorim reprcenwtives of this city to cater upon
} G2 is,ahoy lion ed Prol,wry for aoenlinn Pur,ow,. .
Fy y 1We).,.ccea;wc.inde;mdfy and kcap hanoless me City of culucno against
C4 liabilities,judgment,,eon,and expeme,which may in any way.cane against said
U z City in roro gxmnm of IM1e greening of this Permit.
APPLICANT UNDERSTANDS AND WILL COM PLY W1 IT ALL NON-POINT Issued by: Date
SOURSgmmm of Apphcant/Contrao Dame Re-roofs
IIALARDOUS MATERIALS DISCLOSURE
Will the applicant or future building ectv"anh ebhrear hanJlc hasmdous material Type of Roof
m d.Ened by IM1e CupcNno Municipal Cn le,Cmm,,9.12,and IM1e heath and Safety
Cada,S.Oian 25532(a)^
❑Yes El No All ioofs shall be inspected prior to any rooting material being installed'
Will the applicant orfnturc building occupant use equipment or&-'ices which If a roof is installed without first obtaining an inspection. I agree to remove
oat hneamons air conwadoums its defined by the Bay Area Air Quality Mawagcomer
Domiel] all new materials for inspection. Applicant understands and will comply with
D Ye, 0N all non-point source regulations.
1 have and the haranlous material,requirement%under Claq.e'6.95 of the
California Health A Safety Chile,sections 25505.25533;rod 25534.1 undersand'bar
II the building docs not amemly hove a mown,thin i1 is my;'evponseEJety to notify the
,f a of the requimmem,which nm,;le ma prior o issuance of a Certificate of
D`aw"a"e, Signature of Applicant Date
Owner or wthoroed agent Tom All roof coverings to be Class `B" or better
OFFICE