02060119 CITY OF CUPERTINO * - . ' - 1
BUILDING DIVISION PERMIT ON_ RACTOR
BUILDING ADDRESS: PERMIT NO.
22003 RAE LN JUST WATER HEATERS INC 02060119
OWNER'S NAME: APPLICATION SUB DATE
ROBERT ROOHPARVAR 1764 NATIONAL AVE 6/18/2002
PHONE: SANITARY NO. CONTROL NO.
(510) 293-9901
Z ARCHITEC lENGINEER: BUILDING PERMIT INFO
w O BLDG ELECT PLUMB MECH
af-__I LJ I'--I LJ
LICENSED CONTRACT'OR'S DECLARATION
E?q 1 hereby aRmn Chat I am licensed under provisions of Chapter 9(commencing Job Description
�SGW with Section 7")of Division 3 of the Business and Professions CWe,and my license REPLACE WATER HEATER
7 is in full force 3 and eRem.License Class ' Lic.Is (75 GALL N Gr�rS4 _
Date Contrutor __I /y� `""•1
a te0 G ARCHrrECf'S DECLARATION !!!."' )'
S 1 understand my plans shall be used az public rtcaNs
O O Licensed Professional
a%m
OWNER-BUILDER I a. DECLARATION 1
tel= 1 hereby.Rete thin 1 1. exempt from the Conions Code
License Lew for the s
C?< following reason.(Baden 7onstr Business and Professions Code:Any city or county
F C which rtquim v permit to construct,alter improve,demolish,or repair my swcmre.
$ priocm iu issuance.dso requires the applicmufor such permit mfde asigiu�staainent.
3_ dant hq ljliaAged puRupnli6,Np piq¢isions of use Commctols License law(Chepter9 aluation
(camtslen5ing wins SianWn. )of Division rep ad r5ssians peas) f"f)I'yY(�A
or mar fie f5 liempi Neicfio`tst•and the basis for she alltgdt ep�m)ttbg.Any violation i
-of section 7031.5 by arryapphcant Cora Permit subjects the applicant to a ci.ibpenahr
burs handled d.ii.($500). A I,.. Occupancy Type
isf not... rumber ''r at:;:.o
01,ns owner of the pmpml or my employees with wages as Nair sole compensation,
—w, 'aa
Ihe
nmt�M
w 'the income isnot[.,ended or oRcred'far'sale IS.:7C44-
-
Business had PAimssime,Coda The Contractor's License law does not apply an an 506 - GAS TEST Required Inspections!•)'
owner of property Who Wilds or improves Clamor,and who does such work himself
or thmu h his own employees.provided that such improvements arc not intended or 507 - F I NAL PLUMBING i
-offriel os:le:achawatr.de Wilding or improvement Witold whfiinm arayeor - i' >:fr,'.':.r, r:n
ompletion,the owner-Wilder will have the burden of proving Chat he did nm build or
improve for Puryese of tile.).
-0
___..,.__.. _._-.._____...___—__..-.,...__..._.___.._.,_____.. _._._._.-_._._.___..__.._-____.____...__.___.__.._._.__j_...___._.___._.__.____.__.....___._ _.___._ _
❑has owner of ohs p(Sm.7,am exclusively cemrading wins lianscde Common's's ',1'I Vt:.:
- - construct the prosect(Sit,7044,Business ma Professions Code:)The Convector's
r License Lew does not apply to an owner of progeny who Wilds or Improves thereon,
-.and who-wn Lrsuch.pmjau.with e.contncmr(s).licensed.Pursuant.to.thc.
Contractor's License
Law.r til VV-e.'•�"
_ ❑lam exempt under5a. :ii&'PCfor this teeter It'? j�t:Sii lr•:I ITU
Done
WORKER'S COMPENSATION DECLARATION
Y L�•'" i hereby aRrm underpenalty of pe jury one of the.rellowing declmationan
0 1 hive•end soil irsomiin'u diiiacate-of Conseoi in self-insum for Worker's
Compensalimi-m-providea-for-by Section 3700-uf-the IaWr"Code, for the
perfa amine of the work for which this Permit is issued.-,
_ 01 haat and will iiwiniiin Worker's Coinperitidi nrinfoiioce,u iequinhi by Section
e 37M of lhs'Ci Wr'Cade;fo'r the performance of theworkfor which this p,,md'is
'.( issued.My Workies Compensation Insurance carrier and Policy number am
Car� x. I s�r7rlc;ny.0"+l polcyN .,. .. _.+ y � w 1, 'fs s 4 .a l.'-y
i I ,CERTIFICATIOMOF EXEMPTION FROMWORKIRE
r - �.irfl J.I•,..'��._. i`.a.? JiN�C s..jt't lhi')ILt`.!.T at:
r COMPENSATION INSURANCE P s a
INSUR-..I.,_,__,._...,.....
I6ection neeu not be complete)if the permit is for one hundred out]. --
(5100)orless.), I
itcfury Natmtheft in any ofIW rkforco e N pe se 'd I
Wall not employ any person in any m one iso as a become subject to she Worker''
Compensation laws of Collfornla.Data
Applicant-
:NOTICE TO APPLICANT.If.after making this Certificate of Exemption,e,y6u mull .s•.I's 21 .', +
z foc6me sbbjeci the such pr Compensation provisions of the labor Cade,you must
Z
ns with such provisions or this permit shall be deemed revoked.
� _ ,.,..,.._ —. ___._.__._. .._ _
forth Ih comply
CONSTRUCTION'LENDING'AOENCY' '.' -•' N,:I[ I t,.. ' 1i 1 . .__...
"-� I hereby ufr slut Vete ii e e nswnion lentling g ncy for lite performance n r
of rhe ork for which this perms is iesusd(B 7097,CI C) _ . _ _ -
W' --Gender's Name: .'" •.'-•.° .' :=.__._... 'u• _ .. .___ ..___. ._-__ _ --------
6' O Lender's Atldrcui•,'r ' - .
. i.`Tz
1cnifyee that
ocIhave read thisapplicationand county
nateances aW mawsrelatiu
0"U
comic".inacres trr.cnmply w Ih all hereby
asst ori county, meati es and tam laws enter
upon /`! "�"✓V _
�:C.7 m Wor- a construction,and h rclospFeo artp representatives of mu cry to enter upon
w the bo nit t neap perty f r ly a u n purposes.,, /
:rAi ieWe)agreerosnntindemnify and kapharmless thry,waof..almst sold -
-tA Cityliabilities,6cut,Eq e'rue coxa and expenses which may in nny way necme vgmnsi sold
CLT,M Cry c nscqumd of the grant n8 of th operator.
APMICANTUNDERSTAWSA\DWfLLCOMPL?�*HALI.NON'.POINT'' !
it SOURCC REGULAT ONS. Issued by: Date
Signatu - (AppgcortuCantranar,' 1,..,'. ':Dale,:' Re-roofs
ZA
HARDOUS MATERIALB DISCLOSURE
_ wB Inti pPl c t a ram w la ng ac pa t st re a n tel 'emrdi mmen 1 Type of Roof
Cdefedb7N CpeninM opal Cod ChP 9,13 and the HeaINa ad Safe,, •-- __—•� --•---
CodeIOY n1SSZ(a) I"',bdox ; .,,t.., tr 1+,.. _. 'All,roofs shall be inspected,pnor to.any roofing,.mate0al.belng-installed,,,.,
WJl me pppl cont or flit-rc W Id g p tune ar,ipm nt or devices which If a roof is iniihikdt without first obtaining an inspection; I agree:to remove
erst haraN us air contaminants ss dell ed by the Bay Arta Au Quality Management
Dstr,ctall new materials for inspection Applicant understands and will comply with
+ Cao HeHealth - _ _. .._ .. _
all non-point source regulations:;(,
I have"avd the haadrdous calstenals rcgmretnene ander Chapter 6.95 of the
hf
&'Safety Cade,Sections 25505,25533 and 25534,1 understand thm
iftheain,of
rcnuyhave st,be et tits my man.of.cenacrit the �.YV+ -- - -'
'occupant of the rtquiremems which,mustbe mel poor to issunna of,e Ceniticme o!
.. Occupancy: �. - :. .
Signature of Applicant Date
"1 - All roof coverings to be Class`B"of better
Owner or vuthodiN agent :Date g
OFFICE .. ..._..__. ..._._ .. ._ . . ... _ _.. .... s ...