01070114 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: - PERMIT NO,
7561 PROSPECT RD JUST WATER HEATERS INC 01070114
oZyTN'�bsl�TSA 1764 NATIONAL AVE 07724/2001
PHONE: (510) 293-9901 SANITARY NO. CONTROL NO.
O z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w-
Gas BLDG ELECT PLUMB MECHIt J L__1 L.-J IIJ
LICENSED CONTRACTOR'S DECLARATION
5„? herebyaffinalunderChapter Job Description
pz_Q ein.70B.1'Dhision3fthedsinessndprovisionssionsCde.anommencise REPLACE WATER HEATER.
pw Fu, with seecan 7a3o1 ar Dh;.ian3nnne eaxmeaa and Proreexima coca.and ter bemae
L4 u, m mg ass Lic,a
fee'' (50 GAL GAS WATER HEATER)
-a z a License Class
w 3`O Date Contractor
ARCHITECT'S DECLARATION FINALE
1v111O 1 understand my plans shall he used as public records
W Ot
w a Ot
Licensed Professional
d>Ioo.,x1 OWNER BUILDER DECLARATION JUL 3 2001
1 hemby m th
uRrat 1 am exempt from the Contmoor's License Law for the
F z< following reason,(Section 7031.5.Business and Professions Code:Any city uncanny
_o which requires a permit to constmct,alcor,improve,tarnish.or repair any oncom
n,3 pdmeislic sued petro Te qui res provisions
sof for suehrermit License aw(zwemem. . .
tnrth<isR<ppuaparztumtotnep�•Tiaionxertnecontraaor,ucenulawtehaptera $ .Et. FloorArea-•- BUILDAMuation
(commencingwith Seciian]IXI01 of Division 3afthe Business and PrpftssionsCode) ;'s., ; q`t <n ob •, ;l.
u
that rte is exempt therefrom and the basis fm the alliged uemptioh Any vialmim -
of Section 7031.5 by any applicant fora Want subjects the applicant to a civil penalty
,.four maredun r.ebandredd.1hos S5cnl. APN Number r Occupancy Type
❑Las Owmr of properry,or my empcyeelwith wages as their note compensation. 502 FINAL PLUMBIN ENERGY
will do he work,and In,amcmre in Or intended or offeree for.ale(See.7041 5 06 - GAS TESTRequired Inspections
Tp
Business and'Piof¢sior.,CoTh
de: e Contractor's License Law does not apply to an
Owner properly Who builds or improves thereon.and who does such work himself 507 - FINAL PLUMBING
tar through his own employees,provided in thur such improvements are not intended or
bRer<a'for sale If,However,ine building -'-- �- tis sold within on�year�-f
L or burden
f pro a o r r
oprood for the owner-milder will have the huNen of proving that He did not build or '
improrc for purpose of solei. �
_ ❑Las owner N the Sen.
7 n,4,Business
lively d Pructing with lien)TIO,Coublers to r ,. ,I .i
_ rnnswa the project Iappl 70JJ,Business and ery who
Crdea The Cam odder.
ad who
Law does not apply m an owner with
properly who builds or improves to he
and who comment for such.projeas wirh.a conuanngeLlimnsetl pursumt to he _ _ _..._. . _ .. _........... . . ..... _.._. __.” "... _._ _.._._
";cense Law. - -
am exempt ande «
r s .
01 am cacm . .B'&rgfor this reason
= Owrar .•. Dam.
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty Of jr<rjury me of the following declarations:
_ ❑ 1 have and will maintain a Cenificme of Consent to self insure for Worker's
Compensation:as provided for by Section 3700 of the Labor Code, for the
jedient ahre of rhe work for which this permit is i...ad,
❑I have and will maintain Worker's Crmpenmtion Insurance,as required by Section
370(1 of the'Lasor Cade,for the airfornnance of the work tar which this permit is
=l issued.My Workers Ctadp salon lnsamnce earn rand Pol Icy numher are:
1. , .- .. ._... - . .
Cam Policy No ` L rj.,11-,
1. s - ... ... .. 1 - .1,. _.....
.CERTIFICATION OF EXEMPTION FROM WORKERS'. - - '• • '
ni
section Had considered]
INSURANCE r ;r
s COOMIMPCC ....._... . . .. ._ .._ ....
• TIT ntpleted of the permit is for one hundred dollars 5 • rr, •, ••;" "s -
ISI001orlcss.3
sI' n fy sh., the p in any summer s er s work)f a which object
t'i e'Issued I
;hall notation coy person m any manner,so as to become,tab/cot m the'Workers
Copli6rt ion lawn of Culifomia.Dam'
:NOTICE TO APPLICANT
IL alta making this Certlreae of F.xentptian,you should •• -
become subject m the Worked Compensation provisions of the Ladner Cale,you most
Q 0 Rmhw its comply with such provisions or this permit be deemed revoked.
Z0 - .. _ ... _ .._ _ _ _ _. _.. .. ._ ..... -
,r•rn I t I CONSTRUCTION LENDING AGENCY - -
r..
1 hereby affirm That There in a cnalmedun ItIn ny agency for the performance
a-� of the work for which this p<mnit is issued(Sec3097. -. ,_r.- .-__r.�.-.. .... _ ._.. ... . - . ... ------- ...._._
G Lender's Address
V 0 1 certify tsar 1 have ruJ ibis applicaion anti stain rho rhe above information is
m'-F Goren.1 agree to comply with all city and county ordiroaaes and sum laws miming
� V
Ito building construction,and hereby outhurim representatives of this city to enter upon
the ahosomean red ponpary Ltar inspealon purposes., ., ,
F•tC. 1Wel agree m cave;indemnify and keep hamles,s the City 4Cupenino against
ZI liabilities,judgments,costs and expenses which may in any way decree against said
Q.,Z City in consequence of the graining of this permit.
_ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON"PUINT ISSUOdb Date
SOURCE REGULATIONS. i y•
Sinotme'urAppficom/Cammcm,. " : . ,t- - Dae, Re-roofs
r HAZARDOUS MAlrRIALS,DISCLOSURE
W II the applic t or Tum a bu Idmg cecup a store r handle naaaNaa,mater.,1 . .Type of Roof _ .. ....
a defi ed by rhe Capent mn Mviral Codc.Chapter 9 12,and the Health and Safety s l t r
,. . .r.s
Calc,Sauon 25532(al- - - '� � J'
• ❑Yet" t. 10 1}r„
e. NO -. .. _. All roofs shall be inspected.prior_to any roofing material being installed._. ... . .
Will
thcapv Ic t future building r secq rtodevices which
If a roof is installed without first obtaining an inspectlon; hagree'to remove
th N is artco t t. defined by the Ba.vAmaAirQuality ManagementDistrict?
M y
i tit toy
en ON -, all new materials for inspection. Applicant understands and will comply with
all non-point source regulations... ,,,_,;:,
I have read'the 1I.LN tar momnals requirements under Chapter 6.95 of the
California Health&Safety Cole.Sections 25505.25533arM 25534.1 andersmndthat
if the Wilding docs not currently have a tenant,that it is my responsibility to notify the
me6pam tar the injimbern rs which mint he met psior m issuance ofta Ceniticme of
°""p°"`Y" - " Signature of Applicant Date
ownar,ar autnuriepd alcor' - nam- All roof coverings to be Class "B" or better
OFFICE