02040013 CI BUDI,c DIVISION NO
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10367 SAN FERNANDO AVE HOT WATER INC 02040013
OWNER'S NAME: APPLICATION SUB DATE
u EDWARD ,CAMPIDONICA 2531 GRACELAND AVE 04/02/2002
1 PNONE: SANITARY NO. CONTROL NO.
(650) 298-8494
OO ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACfOR-S DECLARATION
i z m o 1 hereby affirm that I am licensed under rens tw v(eLimmenda Job Description
pravieianaa r s REPLACE WATER HEATER.
wt,W with Section7")of Division 3 of th`Business and Professions/guide.and my license
emg7 ,isin full forte L -2X012
m,,< Liccns Cla. Lica
13 a." Dare Comrvcmr
u O G ARCHITECTS DECLARATION
eY 1 understand my plain shall be used as public records
z z O O Licensed Prnfc..imal
o OWNBW exempt fo DECLARATION
1 hereby e(Sect that 11-exempt from the Contractoro License law,for the
M>-< Inllowing m n(Section]f13 L5.Basions and Professions Code:Any city nr utmny $500
O which regain a Pascal 1n consumer,alter,improve,demolish,or repair any sounam
jm ""norm its issmn<e,also rcquircxine oppiicam for such permiuo file resigned vmcmcm
alt he is lice til worm the ti isionsol the Camitchn's License taw(Chapter 9 ,,,� Valuation
Section
pr v
(commencing Nc saii(damb]tIIlf ad the ha,i, a hthee si Badness and PmrAny si Coda i, ' IX
'"IF.,.V
of thin he ii exempt rhdcfrom and the nazis far the ct,ed a ,lfir.tiod Anis vipenalty - .. _ .. .. ,
of mann 703 es by any'apprc nt for a panne aanjema he appheam m o civil penalty
of nos room than five hundred dollars(1500) 502APNt�TAL PLUMBIN ENERGYOccupancyType
C 1,as owner of the property,or my employees with wages as their sole coinpemation,
will do the'xork:and the structure is not intended or offered for sale(Sec.7014,
Business and Professions Code The Contractor's License Law don not apply to an 507 - FINAL PlIkil4 rldMspections-
owner of property Who builds or improves thereon,and who does such work himself '
.or through his oxo employees.provided that such improvement
improvements d arc not intended or
'off<red for siJe.If:however,the buildingtis eulJ within one � � ( �-- -.. . ..- .-.—.- .-..
or u rden of
your o
icompletion,for the pose of wilder will have the burden of proving that he did not build or `
mprov for purpose ar axle.).
01,m 0 he ofje p pent 1 Iy t t' g to licensed e Contracts to
Liner t sheproject r(S ]to a B d e f s Cod`)The improves
shaman.a
Leen- 1 or-suet to pent h I Idsw impnves .tom
and who contracts for-such p )enc with mmww(s)licensed pursuant ro Ne
C nuaaols License Law.
C l am exempt under S
cc. ,B&PC for,hi,misson pR 0 g 2002 . . . t•;
Own6, ... .este - A
WORKER'S COMPENSATION DECLARATION
I hereby afGmt under penalty of perjury one of the following declarations:
0 1 have and will maintain a Cenificae of Consent to self-insam for worker's
t Compensation. as provided for by Section 37W of the Labor Cade, for the
performance of the work for which this p.it is issuN.
C I have and will'muiriam Wwker•s Comprmsmioa'Insmm,a,us required by Section
37W of the Labor Codd for the performance of the work for which this permit is
sued W rker•s Comp` sa mxl sur n<a carrier and P'ol7c,carrier azissl:
Cartier -en YN.. ..1��t D "/211[1• ....... .. . - .,. _.. __ ...._ _
CCRTIFBCATIONOFEXEMPTION FROM,WQRN1045'I�
COMPENSATION INSURANCE" "'
miis'xrAlion need hm la completed if rhe permit is for one hundred dollars '` ` - It
(11 W)Lir Ins.)
•1, J cemploy an in the n in any
ma of the wart for which this ct to the,Worke,1 t r
snail not employ any person in Lit. manner so as to become subject to the,WLirkcrs' -
Compensation Laws of Califsnnis.Daic'
Applicant ... .of .. ..:_ _ .. .. ._.. __ _. .. ..... _ _....._.. .. _ . .
NOTICE TO subject
tome
ANT:If.Compaaking this Certificate m of Exemption you should
st -
necame,comply
the Wcell In snion,smian provisions of the Labor CMe:you must
Q O I'pM1hwidt comply with wch provieinne or this permit ahall he Deemed revoked.
'CONSTRUCTION LENDING AGENCY
a I hereby,affirm that farm is a construction lending agency for the performance
W un ofthe work for which this permit is issued(Sec.J09J,Civ.CJ
Q Lender'a Name _ ..
-.z Lender's Ad dress
I cenfy that l have read this application undsrate rhatrhe above information is
aT+ [r
correct:1 agree to comply with all city and county ordinances and state laws mlaring
OU to Wilding construction,and heraby hurhoaze mpresentatives of this city to enter upon
rW the above m,rdwr ed pmpmy for inspection puryo,cs,
F L' (We)agree to save;indemnify and keep harmless the City of Cupertino...inst
h liabilities,judgments,costs Lind expenses which may in any way accruepgainst said
V Z. City in rnnsequcnce of the granting otters permit.' n tl V
APPLICAN');E�NDER57/CyDS AND WILL COMPLY WITH ALL NON-POIr ! -
SOURCER 'I S// dl �Iv Issued by: Date
Signature ofA onvacmr •: ... ate.. .. Re-roofs
H BOGUS MATERIALS DISCLOSURE .
.,. Will d PPI cant o ifm m bit IJ g occupant store o handle bentanimesonsumed Type of Roof. .. ., .. .. ...
itsui
as def°WNYitbe ymnt`heaP5Cphp`epnnt nr Mwta Cods.Chapter
h pte9.12.sad th Heads d Sfe, I f-' •• '5 5
art
Cde 1
All roofs shallbe inspected prior
rior tto any roofing material being
ng Inst•a.
lled..
ding .. .. _ .
occupant use egap of rde ice, witch If a roof is installed without first obtaining an inspection, I"agree.to remove
mit
ehazardous sWevnimminams as defined by the Bay Area Air Quality Management
District?' all new materials for inspection, Applicant understands and will comply with
all non-point source regulations. -
% ' — -1 nave read the'hazardoui marctials requirements under Chapter fi 95 of site
O.ner�st 2,met in 533 nd issuance
o a Certificate
met in or t nd uance o a Cerstana tem
11'cc
,mousier correctly h I.....bar it r mspomibilny tr norfy the - - ... .. .. ._.__ ... .... .
a n He Ith&5 fety C de Se ao
Y
recap t of th is which must be etp or m issuance Li(e CeniEwm of
°"rep Signature of Applicant Date
I2I fJ All roof coverings to be Class "B" or better
Dam
OFFICE .. . .. _.