03030101 CITY OF CUPERTINO +?•' Our"
BUILDING DIVISION PERMIT 3ONTkACTQRI,NORMA'1tQN. -
BUILDING ADDRESS: PERMIT NO.
JUST WATER HEATERS 'INC
DW A 1764 .NATIONAL AVE PERMIT U DATRAINE38W BR N"E
(510) 293-9901 SANITARY NO. CONTROL NO.
AW HI7ECTENGINEER: BUILDING PERMIT INFO
BIRO ELECr PLUMB - MFLH
j O o LICENSED CONTRACTOR'S DECLARATION O
I C1 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
with Semlon 7IX10)ofDivltion3of we Bulinus and Profcalnns Collo,and mylkensela
In full forte and effect. �p,�
t�'3 ucenm cmc uc.R REPLACE WATER HEATERS �ii!' d -
q Dam Contractor (10 0 GALLON GAS)
ARCHMI eS9 ATION
1 uMerttend my plans adult he uused.public crtemde
APR 17 2009
e Licensed Profusi...I
OWNER-BUILDER DECLARATION
f 1 hereby affirm that 1 em exempt from the Contractor's License Lew for the BUILDING
.
O O following.non.(Section 7031.5,fullness and Profession Code:Any city m eoo ry
$ which rcqulme a Permit to cnwuuct,alter,improve,demolish,or repair any structure
�„ prior m in issuance,alsu mopurenhcepplicaut for such permit m file•signedsummem
�o that he Is licensed pursuant to the Provisions of the Conmaor's License law(Charter 9 Sq.Ft. Floor Area Valuation
27, (commencing with Section 70M)of Division 3 of the Business and Profusions Code)or
`�.. Net he H exempt therefrom and the bub for the alleged exemption.Any vloWfon of 82784
Section 7031.5 by any applicator for a permit ubjects the applicant o a civil penalty of APN Number Oe
not more than five hundred dolls.(5500). ccu Pane y Type
'
01.as own.of Bra properly,ser my employes with vm A at tiwlr wk compensation, 36638011 . 00
will do the work and the strwmre is not intended or offered Tonere(Sec.7044,Business
and Professions Code:The Overtones Liam Law docs net apply m an owner of Re cored Inspaetions
property who builds oNmprews thereon,and whodoes mchwarkhim-Iforthrough his 502 - FINAL PLUMBING ENERGY
Own employees,provided that such improvements are not intended cautioned torula.If.
. 'SQ6 — GAS 'TE$T
however,the building or Improvement is sold within one year oreompletion.the owner.
builder will have 0m burden of proving that he did not Wild or Improve for purpose of 507 — FINAL PLUMBING '
tale.).
❑1...owner of the property,em exclusively conuac0ng with licensed...raaos to
construct Out pmjecr(Sec.7014,Business and Profeaians Colic)The Connector's LI-
aense law does not apply In an owner of property who builds or barrows thereon,and,who contacts for such p rjeca with a contactor(s)licensed p rmsel to the Conbaoob
License Law.
❑I un exempt under Sec. ,B&P C for this reason
Owner Dam '
WORKER'S COMPENSATION DECLARATION
I hereby all under penalty of perjury arc of the following declarWons:
I hese ad.111 realnal..CeNncam of Convert te calf-htau ,fm Worker.Campers
-tion,as provided for by Section 3700 or the labor Cade,far the perfomence of the
work for which this Permit b Issued.
❑1 he.and will maintain Woken.Compensation Insurance,as required by Section
3700.170m labor Code.for me pertormance of the soued.
le for which this pennll is
My Wnrkces Compensation Insurance carrier and Policy number art:
Carder. Palley No.;
CERTIFICATE OF EXEMPI1ON FROM WORKERS'
COMPENSATION INSURANCE -
(This seolm rwad nor bocempleted lith Pamir Is reaane Wndredllollen(SIM)
or Icer)
-- 1 certify that in the performance of we work for which this permit is Issued,I Nell not .. .... _-— ......
employ any person in any m-nersu as;to become subject to the Woken'Compensation
Laws of California.Dem
Applicant -
NOTICE TOAPPLICANT:IL after making this Ceeincam or Exemplion,you should
become subject in the Worker's Compensation provisions or we labor Code,you must
'O forthwith comply.with such providons or this Permit shall W deemed mated. ..
Vy CONSTRUCTION LENDING AGENCY
I hereby affirm that thea is•eonstrecdon lending apenzy for the pertarmance of
Yv> the work forwhich Nis permit is issued(Sec.3097.Civ.C.) -
33 Q Iendcri Name -
Dz Lander's Address
J Q I cenity doer I l.w mad this application and sum that the above Information is
F correct.l agree to comply with all city and county on imams and state laws relating to
bullding c(Rmm[lion.and hereby authorial representatives of this city to enter upon the
aWw-mentioned property for Inspection puipoes
(We)agree to ave,Indemnify and keep hamlea the City or Cupertino.&&last
r cn labIIWu,judgmenta,casts and expenses which may In any way scenic against said Cary
in
Of
J his rmit.
APPLLIourestrof the ICCANT UNDERSTANDStAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
SiBnawre of APPliceAZARDO
HAZARDOUS Dam
-
USMATERIALSDISCLOSURE Type of Roof
Willy to Cupertino
futurebuildingode.Chaptemmnrand the
hazardous and Safety u dcMcd by the Cupertino MunidPal Colic.Chapter 9.13.roll rhe Health end Safety
d1ifipow,Section 35533(.)7
❑Yu ❑Nu All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It haarchnw air contaminants u defined by one Bay Area Air Quality Managemen all new materials for inspection.
wrio7
❑Yes ON.
I have read the hazardous mamrlabmquinemenu under Chapwr6.95 orthe Califnr- '
7mqd.=
Health&Safety Code,Sections 35503,35533 and 35534,1 understood Ballow building
- -
not currently how a meant.that it Is my responsibility mtify nothe occupenr of the
ulremcru;"tell mull be mel prior it)issuance of a Ccmricem of Occupancy. Signature Of Applicant Date ,
Owner or agent Dam All roof coverings to be Class"B" or better -