01080066 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10490 SAN FELIPE RD JUST WATER HEATERS INC 010g800TE
s66
IB DA
QM�7M�IOS JIM 1764 NATIONAL AVE A08c/T14/ 2001
PHONE: (510) 293-9901 SANITARY NO, CONTROL NO.
❑ee z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
FOO BLDG ELECT PLUMB MECH
aiU CJ l= 1.=1 I - I
ad
Z H Z LICENSED CONTRACTOR'S DECLARATION Job Description
I hembyaffntrom lam licensdd unser provisions of Chap¢r9(commencing REPLACE WATER HEATER.
D iFu with Section 7000)of Division Sof she Businessand Professions Cods.,nd my license
a x f mu rnr<e ane erredt. 75 GALLON GAS WATER HEATER.
e s z License Class Lie.0
X 3 r Date Cantmemr
iu 4 O ARCHITECT'S DECLARATION
1 undersand my plans.hall be used as public mcmds
S.p 0Licensed Professional
yI n , OWNER-BUILDER DECLARATION
1 hereby off.that 1 sin exempt from the Contracmr's License Low for the
t e following mason.(Section 7031.5.Business and Professions Cade:Any city or county
❑ which requires a permit m emo.G,.1m,impose,deromi h.of repair any ssaucome
de C3- prior to its iszuana.alw requites he applicant se
for en penniulil
o easiyneJ stastatementateme - - - -
that heislicensed pursu3ntlathe provisions ofthe Contractors License Law(Clsapter9 Sq. Ft. Floor Area, . Valuation
(anomencingwith Su;ion70flXom Division 3ofthe Businessand Professions Code) - v ,
action he is esemps thlrtfom dad the basis for she alleged exemption.Any violation14244021 On
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
,of not mmethars five havered dolmr.(s5an. APN Number :LOccupancy_Type
❑Las owner of the proper,or my employees with wages as th it sole compensation. 502 - FINAL
'wilt do the work:and the structure is not intended or offered for sale(See law, 506 GAS TESRe aired Inspections'
Business and Professions Codc:The Commcmr's License Law does —s not apply to an q p
owner of property Who builds or Improves thereon,and who Jura such work himself 507 — FINAL PLUMBING
or through his own employees.provided that such impmvemems are not intended or
"'comple fon ethe�IChd build,the biasing m imep(ifp m n sold within ane Wild
of r
oprove for the owner-builder will have th<huNcn of paving that rte did not build or
improve for paryose.1"ins.).
_
O Las owner of the pJSc,7 am esduwss a comraming with licensede Contractor's noon to
LicenseconstructLaw does
no Iappl Ito o Business and Professions Cnde:)The improves
the
.. license Law dte.not amply man owner of property who builder or seimprove. .ra the
_ ..sort)who contracts for such.Projeeu with.a comactonsl licensed purswnt.m the
ComrunnCs Liccnsc lose. --
❑I am eaemp, oil.,See. l' s ° .B&P C fee this reason ,...I,"
_ Owner Gee OCT �0 3� 2001
WORKER'S COMPENSATION DECLARATION
.- '.� '�, �Ixleby importun�gr family of pci;ary ntte of the following Jeclaratinns: BUILDING
O 1 have sad will mourtain a'Ccniradm of Consentsdf roam fa Workers
Compensation, a,-provided for by Section 37W of find Inbar Cede, for the
- performance of the work for which this permit is rowed.., t
❑1 have and will maimain Worker's Composition Iniumnce.as required by Section
'37W of the Lahr Cole,for the ierfornomm,of the wink fur which this Pemtit is
:j7 issudd.My Worwe,Cntn'towtlon Insmarne carrier and Policy number
t., s...,tyl 'e:rf Put,,No. 'I ,f lys
CERTIFICATION OF E%EMPIION FROM WORKERS'' -
.:.... ._�.:. ZOSiPENSAIION -. ...._._....._._....____.____..,sees...._.-,_._._.,.._., sees_. . _ _ _. .. _._._._. _.._.._
... sees _ .,.. ..,
(Tris section neat nrn he complcmJ if the permit is fm one hundred dollar ''Y,d •' rx11C C' i•.ts
1 t ly that in the Pel a in(tirek fti wbuh thisPe t in i.vweJ;l
'sbalPnot employ any Person in any manner so as to becowblect to me Worker:
Cu p i n Laws of California Date "" me -
ApPlcant _ ..
NOTICE TO APPLICANT.If.after nuking this Cenif as of Esiarrinum,ybushould.
Z become suhco m the Workers Canlpcnrnimn provisions of the Labor Code,you must
p O fonnwitn comply with such Provisions m mit Permit snag be deemed revoked.
z0 -.. ."—._._ ... .__ . — _.. _ ._. .. - - -- --"- —. - r
E•' i " i- " 'tONSIRUCf10N LENDING AGENCY
" 1 be¢by oirrm that them isa conomition leading agency for ibe PeHomivtee
Q -linJer'sr's NaN.dme
Cender's Address
U Q I minify that l have mad this application and state that the above information is
rinse l 1 gree to comply w lb all city and county oilmorces and state laws islating
Q iJ thbuilding .t i dh by rho urcprc (t s fm.city to enter,upn
:the above-mentioned_ p pny f pa P hm Il pn f\s' //'
F-0. (we)udg t d , Jk Ph 1 he was
lCm, gain,,
said � t^�-Q-.i�
(O liab I t judgment, t d Pe res which may any y c agaitnt said Isr ✓ "` \ U
C.) .ZiCity'APPLICANT.onsc UND of me gn n ngg soap-rm t. - '
SUCEREGULATIONS
WICLCOMFLy WITH ALL NONROI,NI'° Issued by: Dale
SOURCE REGULATION$, .' 'i y'
-' Signature fWoolHAC ruh
'D t'
Re-roofs
t AZARDOUShLDISCLOSURE
Willapplicant or( uni ingoccpar ort o handle oSsandous 'type Of R
OOF
as defined by the Cupn Municipal Cos Chapter 9.L,and the Health and Safe[) r-- - -- ^' - ••-^•
I ,
.Gose:Scnion 2557]la)s , -- .. '. .. I. jq; •.r• ',• s _ .
❑Yea o Nn:. _ _All roofs shall.be.inspected prior_to any roofing.material,being.installed.__ _. .
Will theapplicantor Rome buildingrecnmanuseequipmentordevi.'cswhich If a roof is installed without first obtaining an inspection;'I agree to remove
emit haeardous air contaminants tis def nod by the Bay Arca Air Quality Management
District. all new materials,forinspection. Applicant gnderstands and,will comply with
ares t ?,No . all non-point source regulations. .
.A hall rca0imehiu nJmm
ob< <nal:I reyuirentcntx under Chepmr fi.95 of me
1 California Health&Safety Code.Senions25505.25533md25534.l undecmandmaf
'inns builJing ones not concntly hove h tcoam,Lha it is my resmonsihility,to umiify the
'.occupant of the requirements which must be met pnor to issuance of!Certificate br
.' occupancy., _ Signature of Applicant . . . ,. . . ..,sees ., . Date _
C ' Owner a,wil ri,r]r,rnt. , Date All roof coverings to be Class`B"or better
.. OFFICE . I . .t