03060028OF CUPERTINO
"7777BUILDING
DIVISION PERMIT
CONTRACTOR INFORM.D'r ''f
[CITY
ILDINGADDRESS:
HOT WATER INC
PERMITNo03060028
1607 ROSARIO AV
NER'S NAME:
2531 GRACELAND AVE.
PERMIT'S"M F)3/2003
ONY CHAO
NE:
(650)298-8494
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
ELDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 benby of sed Net 1 atm limned under provisions of Chapter 9 (commencing
with Saban 7") Of Division 3 of Me, Business and Profcaions Cade, and my Ikon¢ Is
mmOfmm. a r t _ ' - �-
Llecnse Clue Lw.4 -
REPLACE WATER HEATER �,f'pkt A ��®
NA
Date
RCHRcc, 'S DECti� ON
d he used
ayOQy
JJ
1untic pah nly4ahM1
u arcs /7_
NOV 1 G
Licensed Pmfcsuanal
OWNER -BUILDER DECLARATION
1 hereby that 11. exempt from the GOmteelC C License Law for the
�'�'�/�
Ga
.affirm
ne reamer. 7(01.4 Business P li Code: Any or county
_
mity
c. dere or repair ed tenechad
permit re cnnusMe, aluc impmw,
winch mquira poem a ap
which
Prim n h Permit t ment
thovisiosof.pplicart for anchpetor's law
Law
Sq. Ft. Floor Area
$rYad)i3tion
cfiles, (CMPter9
Mat isliecuaao.arungothe Llama
ortmenimnseapursuant to the Provisionsofothe f did, Cade) or
Section 7M0) Division NCBusinasanaon,
Any plauuy of
basis Mleged uempnm, Any
that he exempt taert(rom and the aper for
Nat ha
a Occupancy Type
be l
7 by any applicant fora permit subjects the applicant to a civil penalty of
net mon Nan five hundred tlalrn (g300).
.1. M. l
❑ 1, a owner Crude property os my employees wife wages As Mick sole compensation.
592
will do the work end theswcwre ie not inunded oferreted forsale(Sm.7044, Businns
and Profession, Cade: The Cantrsmes License law dons ant apply to an mads of
506 — GAS TE y�Dul nspecIons
property who Wild, ar improwa tharean, and who dura such work himal f or through his
awe employees, provided Net such improvements an not intended cro0entl forale.If.
507 — FINAL PLUMBING
however, Ne Wilding or improvement is sold within one year of compledon, Ne owner.
bullder will haw the burden of proving Nat W did not Wild or improve for purpose of
ale.).
❑ h as Owner of Ne property, am exclusively contracting wish licensed Contractors in
comtmst she project (Sec. 7044, Business and Pmfessiom Code:) The Conuacmr'a Ll-
bmme
CourseLaw does not apply to an owner of property who Wilds or improv themon, and
who contracts for such praeM with a contnemr(s) licensed pursuant o she Contractor,
License Law.
❑ 1 am exempt antler Sec. . B k P C for Nr num
caner Data
WORKER'S COMPENSATION DECLARATION
I hereby aRires under penalty of perjury, And of she following hclentionu.
v
1 haw.nd will maintain a CertlOmte of convent in aelf-imam for Workers Compen-
tmn, pe provided for by Section 7700 of the labor Code. far the performaae of Ne
ork for which Ni, permit is isued.
I
I have and will maintain Weaker's Compensation Insurance, u nquln l by Section
00 of the Labor Code, far the performance of Ne work rue which this permit is laced.
y Workers frampen ,tion Imunnce carter and Policy number xrd-� av r
rsier. Policy No.: JiLJ /YL'
CERTIFICATE F • ( PI70N ORKER
.VV/y
COMPENSATION INSURANCE
(Thr scum need not Uecompleted If the permit r Tamm huedteddollars (SIM)
or leu)
1 certify that In the performance of Ne work for which Nis permit is issued, I shall ret
employ any person in any murder an pe an trcame subject o Ne Workers' Compensation
Laws of Califomia. Dau
Applicant
NOTICE TO APPLICANT: If. after making this Cenificuc of Exemption, you Mould
become subject m the Workers Compensation provisions of the labor Code, you muss
forthwith Comply With such provisions or this permit Mall W ticemed revikeed.
I
CONSTRUCTION LENDING AGENCY
1 himeby thi the men I, s c n ending agency for Ne performance of
d (Sm.3
fur which this permit r issued (Sera 7097. Civ. CJ
which
'
Lewed
Lender's Name
Isnderi Ad was
I caNfy that I have read Ni, application and sate that Ne wove infomadun is
' correct. I agree to comply wit all city and county ordinances and atsu laws muting w
Wilding convection, and hereby authorize repruenutiv of Nis city to Cour upon este
for inspection
above-mcndoned property purposed.
(We) agree to pew, indemnify and keep harmless the City of Cupertino against
j liabilities,judgments, costs and expenses which may In any way accrue against said City
in consegwnce of NC {Tering of this Permit.
' APP�.(CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOUR RE�pULATION nn``
Issued by: Date
Re -roofs
Type of Roof
� ���
�- /lA4wvl k �"'I�—
Signe afApplidAWConmcmr a
HAZARDOUS MATERIALS DISCLOSURE
Will un applicant or future building occupant stun or handle huardous material
as deOned by the Cupedino Monte I Code. Chapter 9.12, and the Health and Safety
ossa. Seen.. 25532(.)?
All roofs shall be inspected prior to any roofing material being installed.
❑rue u
If a roof is installed without first obtaining an inspection, I agree to remove
Will ted applicant arm Wilding occupant use equipment or deviant which
emit harallous air contaminants As darned by the Bey Area Air Quality Management
all new materials for inspection.
District?
D Yes
I have and the harand s ateriais requirements under Chapter 6.95 or Me Calif.,
dieHealth& SafoyCorl Sauau 25505.25537 ansa 25574.1 understand that ifNc Wilding
Jou not Currently hew a man, that it is my nsponsihilhy 0 n 'ry Iht of Ne
hPd wiaL� r.c'mrca a e y
nq�mpyyygp�yAdmm 1
Signature of Applicant Date
A
All roof coverings to be Class "B" or better
0
•
G
�iCUPEkTINO
CITY OF CUPERTINO� Qoa
WATER HEATER
PERMIT APPLICATION FORM
APN# �3-:*
Water Heater / Vent
Date:
�fs
Building Address:
� �
PLUMBING
Owner's Name:
v
Phone #:
Contra tor:
Phone:
j
icense
Contact:
Phone:
Cupertino Business Cicense #:
Building Permit Info:
Bldg ❑
Elect ❑ Plumb
Mech ❑
Job Description:
l�
Residential 9x-
Commercial ❑
Cost of Project:
Strapped ❑ On Platform 0Bonded El
New Location ElReplacement P,
Qty. if
AnA)rc'�ble Fee ID
FaP rlPcrrintinn
BPWHEATER
Water Heater / Vent
BUILDING
PPERMITFEE
PlumbingPermit .Issuance
PLUMBING
BENERGY
Ener
BUILDING
BUSLIC
Business License
BUILDING