03020090 CITY OF CUPERTINO '' * t ' ` ` �'"
BUILDING DIVISION PERMIT `CONTRACTOR INFORVIATIQIv:
BUILDING ADDRESS: HOT WATER INC PERMIT NO.
22394 RAMONA 'CT 01020090
WNEWS NAME: 2531 GRACELAND AVE PERMITLSUBDATE
LIN MAO H AND PI Y
02/21/2003
NE: 65O 298-8494 SANITARY NO. CONTROL NO.
ARCHITEC IENOINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p
Yo0 LICENSED CONTRACTOR'S DECLARATION Ib D
ee IY OOS 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing �P sl A pj wE dry
with Section 7010)or Division 3af the Business and Pnlcalans Code.and my license it e� YlmG Qm/
In License
to= off _3 ata• L y REPLACE WATER HEATER
y. Dam Canrmar APR 16 2003
?pQ ARCNnECI-g DECLARATION
1 understand my plum shall he used As public mcnrds
0 �
kLicensed ProfPf..ond BUILDING
5D OWNER-BUILDER DECLARATION
Ia E I hereby affirm that I am exempt froth the Conuauoes License Law for the
0 o following canon.(Section 7(313,Business and PoefeWon Code:Any city or county
$ which requires a permit to cournecs,alms,Improve.demolW,or repair any shoehorn
_ Sat prior to its issuance.also requires the applicant for such Permit to rile a signed statement
< that he Is licensed pursuant lothe pmvislnnsorthe ControcmhLicense Law(Chapm,9 Sq.Ft. Floor Area $8156tion
o (commencing with Section 7000)of Division 3 of the Business and Profesainns Coda)or ,
33$ Net back exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the Applicant to a Civil pemhy of .3 AP4 PUFk—r= Occupancy Type
not mare Nan Bw hundred dollars($500).
1,u oweer of tiro property,m my employees with wage u thetr sole compensation,
582
will do line work,and theswcwm is notineaded Or offered fm We(Sec.7044,Business Ire nS eCtIODS
and Pafessiau Code:The Contraction Lt..law does Out apply a an Ammar of 506 � — GAS T P '
property who builds or Improws thereon,and who doeuuch work himself ar through his -
Own employ=,provided thxauch improvements am notintended proffered funk.U. 507 — FINAL PLUMBING
however,the building or Improvement It mid widen ane year of completion,the owner.
Wilder onto haw the burden of proving that he did n=Wild m Improve for purpose of
Ask.).
❑1,as Owner of the property,am exclusively contenting with licensed eontrmlas to -
contract the project(Sec.704,Business And Pmfaslou Code:)The Contractor's LI- -
came Lew does not apply to an owner of property who builds or improws thereon,and,who contracts for such injects with a consulor(,)licensed pursuant to the L'Ontractoes
Licence law. -
❑lamaemptunderSee ,B&PCfarthtsresmen
we Dau
WORKER'S COMPENSATIONDECLARATION -
I hereby affirm under penalty of perjury ono of the following decimations:
I how and will maintain•Cerdfiaaal'Consent to self-loom for Wmker,sCompcn-
aatlon,=provided for by S=alon 7700 of the labra Cade,for de perfo,mancc of the
wor r which this permit it issued.
1 haw and will..!main Wmkers Compensation Insurance,a required by Section
700 of the labor Code.to,the Performance of the work for which this Montilla Issued.
My Workers nm en}tion In gnce eamief and Policy number art:: 6
Cartier, PoIIry No.; �-T Y l is
CERTIFI OFExcEMF1nON FROM WORKERS
COMPENSATION INSURANCE
(This stolen need nm he completed if the permlOs for one bundred dollars(SIM) '
-�—�— I codify that In the perfmmance of the work for which this permh Is issued.I shall not -
employ any person in any manner an as to become subject to the Workers!Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:IL afar making this Certificate of Exemption,you"old -
become suhject to the Workers Compensation amwisions of the labor Code,you mus
.,0 forthwith comply with such provision,or this permit shall Is,deemed revoked. -
11
'Z CONSTRUCTION LENDING AGENCY "
Lr 4 I hereby affirm Nat them its communion lending agency for the performance of
6i .moi the work for which this permit is Wo d(Sec.3097,Civ.C.)
1.7 Lenders Name
U z Lender,Address
U Q 1 cerdfy that I haw read ibis application and sou that the show Information is _
n.F coned,I agree to comply with all city and county ordinances and eau laws musing to
0 building construction,and hereby authorize repmsenutiwa of this city to enter Open the ..
Til Ahove.mentis
oned property for inspection purpose
Lir (We)agree m saw.Indemnify and keep harmless the City of Cupertino apWt
Lf) iabilides,judgments,cuts and expenses which may in any only acn=e against aid City
i
U7 nconseq=neofthegranlingofthispermiL
Fry APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Da
SOURCE REGULATIONS.
Re-roofs
Signuum of ApplicanUConRDO Dau
HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
Will the Appllam or forum building occuPmtuore or handle haardaus mautltl
as defined by the Cupertino Munic a)Code.Chap c,9.11,tib the Health and Safety
fide,section iss3z(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yea . u
Will the applicant or uture building occupant on equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
.colt hanNou air mnumiumu as defined by the Bay Area Air Quality Management all new materials for inspection.
DlsuinT
❑YesNu
I be.mad the ham tmaterialsuquimmena under Chapter 6.95 of the cover. L, n, -
meHealth&SefuyCode,Section 25505,25533 and 25534.1 untie H rsand that if enc building /„ yJ
does Amt currently haw a tenant.the It my wsponihlllly a notil'Y occupant of fie , r
requirementshe
which a”hot or Issuance Pm X of a Ce,d sof cu Signature of Applicant Date
jun 0 / eJ �/ All roof coverings to be Class"B"or better
O�uraothodagent y Dow g