00120017❑ has owner of the properly, or or, employees with wages as Ncir nolo cnmpcnsalion.
will Jo the work, and the someone is not intended or trertJ for ale (See 70,J.
business and Prolcssions Code: The Contractors Limine Law hes not apply to an
of mopeny Who build, walk himself
o lnprnvex thereon, and who does such whimself
m ibnmgh his own entploycen, provided Inas such improcm
es are to, intended nr
offered for rcle. IL h,vas., the holding nr Impromnt
vetis sold within ane year of
impletion, the owncnhuilder will have the burden of proving Ihit he did not build or
improve for purpose mf
❑ 1, as owner of the property, am exclusively concocting with licenced anmonors to
onnlrua the pmjmt (See 70t business and Professions Code: Me Contractor's
License Law does nor apply to an owner of property who bui Ids or improves Ihemen.
Gr t who mnlmele f.. such pmjcns with a e,in uac..n,) licensedm m moor the
mwm
actor, UceC Law.
p lam nxampl under See . H A 1' C lir this reason
Owner - Dole
WORKER'S COMPENSATION DECI,ARAI'ION
I hereby allin under penalty of perjury one of the chow in, Jeclanumns:
•❑ I have and will rommain a Cenificme of Consent to self -insure for Workcr's
Camper ion, an pmvirbd for by Swoon 3701 of the Labor Code, fir tire
performance mf the walk for which this permit is issued.
❑ I have end will nwinmin Wnrkcr', Gmopunnmlot Insurun e. us required by Section
3701 or the InM1ur Clnle, Ibr the peri rnumce of the work for which this permit is
wed. My Workers Contlwncrium Insurance cancer and Policy counter are'.
Goer, ' Policy No,
Cr:RfImCArlON OP EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Th., nenion teal urn he completed it the I ,rout is for one hnmdrcd dollars
S 11N) or fe".l
1 sentry that in the orromounce of the work for which this panni, i, issuad. I
shall not employ any person in any manner sit as in become subject nh the Workers'
Compensation Laws of Cnlifomia. Dam
Applicant
NOTICE TO APPLICANT: If, a0er making this CCniOcmi, of Exemption. You should
become subjectthe Workers Compensation prnvioters of the Labor Coale, you must
Qo Iimhwuh romply with such pro ..sots or this ry'rnIII ,hall be dccmcd rvsmked.
CONSI' RUC'FION I_IiNUING AGENCY
> I hereby ammo that them is a construction lending agency for the (performance
fire work for which this prourn is issued (Sec. L/J). Civ. C.)
S Q Icnder's Name
Z Lendvr', Add.,
V 1 cenily that I hive mad this application anti state that he above information is
correct. I agree to comply with all city and county ordinances and state laws renting
li itholding oconu 710 I, and hereby mcdc i ,epersunmivch of this city lin nncrupo.
�y p] the nhovc-mcmioncd prop, is for innpeai'm Puquhaes.
.n Os (We)of In save. indemnify and keep harmless the City of Cuieoinu again"
r{y lwhilitia. judgtmnm, costs card expense, which nosy In any way accrue against sand
U Z City in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WIT, AI.L NON -POINT
SOURCE REGULATIONS.
Signature of Applicant/ ommrmr Date
11AZARDOUS MAl'E:RIAI S DISCLOSURE
Will thu npplic:un nr altm building cccnpsnt slow or handl, hmmctmas national
as dcGncd by the Cul+nlno Munlclpal Code, Ctupmr q.In-, and the Ilmllh and Safety
Cn le. Section 25At2m)'7
❑Yrs El No
Will the applicant or future building oecupanl use equipment or deices which
nmit mond us coir ermaminams as dehned by IM tiny Area Air Quality Management
i,rdcn
❑re. El No
have tend the huoNnns mulcrial, mquircn a node, Choice' 6.95 at the
Cold niu flculth Rr Sandy Code, Seeions 25505, 25533 and 25534. 1 unde,,wa that
if the budding does nm crucially have a citric, that it is my msponoulify m notify the
occupant of the requirements which must to sect prior m issuance of a C<nilleme of
eruprnry.
ownerm uumnrocal em Dam
Issued by:
Re -roofs
Type of Roof
35708042. i99quired Inspections
505 — FINAL PLUMBING ENERGY
505 — GAS TEST
507 — FINAL PLUMPING
Date
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, 1 agree to remove
all new materials for inspection. Applicant understands and will comply with
all non -point source regulations.
Signature of Applicant
OFFICE
Date
All roof coverings to be Class "B" or better
CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUu.pING DIVISION PERMIT
BUILDING AUURP_tiS:
TERM] '1' NO,
10380 RIVIERA RD
JUST WATER HEATERS IVC
001.50017
OWNER'S NANIE',
APPLICATION SU3 DA'Ili
ZLIQ JEAN
1764 NATIONAL AVE
12/05/5000
PHONE:
SANITARY NO. CONI ROL. NO.
(510)593-9901
Z
A RCHI'I ECUENO l NEE R:HU1LDING
PERMIT INFO
w
B11)(3.Ii1,liC)' PLUM11 MCCH
s
5uE
L-1 t-1 =1 1=1
Sy
Sri
tthatIIaCONTRACTOR'SDECLARATION
Job Description
ur
I hereby of that 1 3licensed under Provisions sinhopmr9 (commencing
7 lousiness professions Cede, license
x Y L J
and my
with Section 11re t mid e f effect. Division of the and and
I
Is In lull fnmc aId cRvn.
ee w "
is of classCoo p
Dile Commanr
REP -LACE 50 GALLON 'GAS WATER HEATER
LLo„
ARCEITECT'SDIiC.ARAIION
1 u ide"tz I ny plans stall he lord un puNie rccood,
-
�r
hiccnu�J professional
aC j
o
fr
Oat con the
ContraON
I exempt m ctor laow for Inc
I ne .(Seal Ino I sen. Burin from the Comas
se Y_N
edFF O
Ce Any c
ora 70}L5. and Pref de ions Ca lc: Any oily or Comply
whichmyuimsue..rIi re drew the eller,improve,demolish, ore a sig any.waarc
whielvingmnwsn.IS it rltar.
antsof lar mchpermi's 1'.(ned Cammem
Sq. FL Floor Area
Valuation
it. —
Iprior hJr he slits Censim.alwrcquimnhovisio the mmeorsLiccnsulawlco4CodChapter q
IhothetoeingisdoSetionnthe pon Lien ce
ivisin3ofIhewul..... I, rCdc)
Division3r
(calif
thet13gedc a
them front ant the loans tin the alleged nian. Nry violation
or he its ewill IhureIour and
he is
Sec 31.5 b applicant
nI Section 7U31.5 by any applicant tura Iemhil nuhjwt the uppllcum nh u civil pewlry
ofnot more than Rvehundred callous (S51X).
APN Number
-
Occupar"T'ype
❑ has owner of the properly, or or, employees with wages as Ncir nolo cnmpcnsalion.
will Jo the work, and the someone is not intended or trertJ for ale (See 70,J.
business and Prolcssions Code: The Contractors Limine Law hes not apply to an
of mopeny Who build, walk himself
o lnprnvex thereon, and who does such whimself
m ibnmgh his own entploycen, provided Inas such improcm
es are to, intended nr
offered for rcle. IL h,vas., the holding nr Impromnt
vetis sold within ane year of
impletion, the owncnhuilder will have the burden of proving Ihit he did not build or
improve for purpose mf
❑ 1, as owner of the property, am exclusively concocting with licenced anmonors to
onnlrua the pmjmt (See 70t business and Professions Code: Me Contractor's
License Law does nor apply to an owner of property who bui Ids or improves Ihemen.
Gr t who mnlmele f.. such pmjcns with a e,in uac..n,) licensedm m moor the
mwm
actor, UceC Law.
p lam nxampl under See . H A 1' C lir this reason
Owner - Dole
WORKER'S COMPENSATION DECI,ARAI'ION
I hereby allin under penalty of perjury one of the chow in, Jeclanumns:
•❑ I have and will rommain a Cenificme of Consent to self -insure for Workcr's
Camper ion, an pmvirbd for by Swoon 3701 of the Labor Code, fir tire
performance mf the walk for which this permit is issued.
❑ I have end will nwinmin Wnrkcr', Gmopunnmlot Insurun e. us required by Section
3701 or the InM1ur Clnle, Ibr the peri rnumce of the work for which this permit is
wed. My Workers Contlwncrium Insurance cancer and Policy counter are'.
Goer, ' Policy No,
Cr:RfImCArlON OP EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Th., nenion teal urn he completed it the I ,rout is for one hnmdrcd dollars
S 11N) or fe".l
1 sentry that in the orromounce of the work for which this panni, i, issuad. I
shall not employ any person in any manner sit as in become subject nh the Workers'
Compensation Laws of Cnlifomia. Dam
Applicant
NOTICE TO APPLICANT: If, a0er making this CCniOcmi, of Exemption. You should
become subjectthe Workers Compensation prnvioters of the Labor Coale, you must
Qo Iimhwuh romply with such pro ..sots or this ry'rnIII ,hall be dccmcd rvsmked.
CONSI' RUC'FION I_IiNUING AGENCY
> I hereby ammo that them is a construction lending agency for the (performance
fire work for which this prourn is issued (Sec. L/J). Civ. C.)
S Q Icnder's Name
Z Lendvr', Add.,
V 1 cenily that I hive mad this application anti state that he above information is
correct. I agree to comply with all city and county ordinances and state laws renting
li itholding oconu 710 I, and hereby mcdc i ,epersunmivch of this city lin nncrupo.
�y p] the nhovc-mcmioncd prop, is for innpeai'm Puquhaes.
.n Os (We)of In save. indemnify and keep harmless the City of Cuieoinu again"
r{y lwhilitia. judgtmnm, costs card expense, which nosy In any way accrue against sand
U Z City in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WIT, AI.L NON -POINT
SOURCE REGULATIONS.
Signature of Applicant/ ommrmr Date
11AZARDOUS MAl'E:RIAI S DISCLOSURE
Will thu npplic:un nr altm building cccnpsnt slow or handl, hmmctmas national
as dcGncd by the Cul+nlno Munlclpal Code, Ctupmr q.In-, and the Ilmllh and Safety
Cn le. Section 25At2m)'7
❑Yrs El No
Will the applicant or future building oecupanl use equipment or deices which
nmit mond us coir ermaminams as dehned by IM tiny Area Air Quality Management
i,rdcn
❑re. El No
have tend the huoNnns mulcrial, mquircn a node, Choice' 6.95 at the
Cold niu flculth Rr Sandy Code, Seeions 25505, 25533 and 25534. 1 unde,,wa that
if the budding does nm crucially have a citric, that it is my msponoulify m notify the
occupant of the requirements which must to sect prior m issuance of a C<nilleme of
eruprnry.
ownerm uumnrocal em Dam
Issued by:
Re -roofs
Type of Roof
35708042. i99quired Inspections
505 — FINAL PLUMBING ENERGY
505 — GAS TEST
507 — FINAL PLUMPING
Date
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, 1 agree to remove
all new materials for inspection. Applicant understands and will comply with
all non -point source regulations.
Signature of Applicant
OFFICE
Date
All roof coverings to be Class "B" or better