02050051 CI BUILDING DIVISIONSINOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22206 QUINTERNO CT WATER HEATERS & MORE PL MBING 02050051
OWNER'S NAME: APPLICATION SUB DATE
LEON BURDA 388 BEACH RD 05/08/2002
IsPHONE: SANITARY NO. CONTROL NO.
(650) 548-4990
qqq z'02 ARCHITECTIENGINEER. BUILDING PERMIT INTO
WOO BLDG ELECT PLUMB MECH
LICENSED z y m I hereby affirm Nat 1 am licensed under provisions of Chapter 9(commencing Job Description
'EI—� pr REPLACE WATER HEATER
I-J with Seniors]OOOj of Division the Business nd Profeexions Code,attire license
naUw mnre,naerr� t r7y��a � (50 GALLON)
Lice se CI. Lic.
1 u H Conmoaor
a O ARCHITECT'S DECLARATION �
4 1 understand my plane shall be used as public records �g
i' y LV/,W I nGI
i o Z O Licensed Professional .J
OtvNER. tDECLARATION
I hereby affirm Mat I um exempexempt from the Contractor's License Law for the
C?<
following native,permit
7onsumBusinessand Professions Code:Any city orcnnr
F e which requires a permit ne romwct aalter.pplicant
improve,demolish,or repair any structuren
i3= mat hesscenseca,also requites theapplisof hermit permit mfikse I.awdma¢ment
thin he is licensed Pursuam to the provisions of the Cnmmcmis License lnw(ehaprer9 { „ e Sq.Ft. FloonAreaa,a ., aluation
(commencing with Section 70001 of Division 3 of the Business and Professions code) y.l,;l�,i �a.�i r.. i Ft.
S.+f::.A is . Malt+.t.
or Nat he is exempt therefrom and the basis for the alleged exemption.Any violation
ofSm,i.703 L5 by anyapplicant fora posubject.be application oa civil pot
of not more than r hundred dollar,S500) 2 g A um er .l.. . . Occupancy Type
C 1,as owner of ate propeny.Lir my employees with wages as their sole compensation.
will do the work:and the structure is not intended or offered for sale(sec:7044,
Business and Profession.code:The Contaetars License Law does not apply m an 506 — GAS TEST'equired Inspections
owns of pmpeny'arlit ids m improves thereon.and who d.such work himself 507 - FINAL PLUMBING
or through his awn employees,provided that such improvements me not intended or
offered for site.It.however,the building Lir Impmvctnent is sold within bac year of ' ' "" '_..". _. .. . .._ _._._._... ____..... . ...... . . ..
completion,the awncr-builder will have the harden of paving that he did nut builder
improve for purposeof sale J.
O Tax owner of the Property,am exclusively contracting with licensed contractors to _it
couturier the Project(gee.7044,Business and Profession,Code:)The Contmnor',
License Law tract not apply roan owner of property who builds ofd pursuant
the '
and who contracts for such.project,with a mmmctotts)licensed pursuant m the _ _.._ _ F I p�p A■ E®.
01 ren exempt
Liccnu L,ce tys'a`P 11t1
❑1 am e,empt under sec. � .B&P C for this msson Daten s/ p 1'
Owner' _ WORKER'S COMPENSATION DECLARATION IsflH1 3 + 2�U2
' I hereby affirm under penalty of perjury one of the following declarmions: I1 /'�
FI I have and will maintain a Certificum of Canada to,elf-insure far Worker's ;AILDING
Compensation, as provided for by Section 37W of the Labor Code, for the
_ peRortnance of he work for which his permit is issued.
C 1 have and will maintain Worker's Compensation Insurance,as required by Section
37IM of the Labor Code,for the feRnrmance of the work for which this permit is
sued My Worker,Compensation Insurance carie,and Polity mardle,art:
f u; s�yyrf// i Soo
er CERTIFICATION OF EKEMPI bN FROM WORKERS
dddddd v.
COMYLNSATIONI SURANCE' .. _.__..___...._._...___..._.._....._.__._.._
Of xr&6 need net he completed if the Permit is for one hundred dollars ' ' '
($100)or less.)
i
" 1 certify that in the pc,fommnce Who work for which his permit is issued,I ..
shall not employ any person in any manner so as to become object m the Workers
Compensation Laws of Califomia;Date
. Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should '
become subject to the 'mkere Compensation provisions or the labor Cade,you must
Q Nfnnhwitb comply with such provisions no this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
ai > 1 hereby affirm that there is a construction lending agency for he performanm
to work for which Nis permit is slimed(Sea.3097.Civ.C.),
LM Lender's Name . ._. .. ... :..._
jz Lender'iAddre,s + ..
I ccnify that I have read this application and state that the above information is
La. Fa correct .I agree m comply with all city and county ordinances and state laws aiming
0.t.) to building construction,and hereby authorize representatives ufmis city to enter upon
the nbove-mundoned Property for im,pectian purposes.
[}. P, (We)Sgre,to save;indemnify and keep hamdess the City of Cupcnino against
Z, liabilities,judgment,,costs and expenses which may in any way accrue against said
O.z City inconsequence of Ne gaming of Nts pernt.
APPLICANT,UNDERSTANDS AND WILL COMPLY WITH'ALLN N-P INT Issued by: Date
- SOU CE REGULATIONSlo� i' p y'
_ loo, signature ofAppcaanucntmno Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE'"
Will Ne opplidersturf t building occupant etre orhandle ha:ard°m,about Type of Roof _ . _ _ _._
as de[ntr by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety. _ _ _ 1.
Cod Section 25532(a). . Y • ' i (. tr,tl 'shc�'r t ' ,
°Y � All roofs shall be-inspected prior to,any_roofing material being installed.
Will Ne ap'Be or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspectidn, I-agree to remove
emit hazardous lar comamitmnt,as defined by the Bay Arca Air Quality Management
Distrina . . all new materials for inspection. Applicant understands and will comply with
all non-point source regulations:
1 have mind the hazardous materials requirements under Chapter 6.95 of the
Califodue Health is,Safety Code.Sections 25505.35533 and 25534.1 understand that
if the building does nm amenfly have a mnam.that it is my responsibility m notify the
occupin more requircurcom which most be'rnn prim m issuance of o Cemfic o of
Occupancy. O Signature of Applicant Date
wni oriuthona.e.agent Dat All roof coverings to be Class "B" or better .
_, .. . . ..__ .. OFFICE