03070040 CITY OF CUPEWFINO
BUILDING DIVISION PERMIT ,CONTRACTORllD4FORMATION ,
< r, .
BUILDINGADDRESS: JUST WATER HEATERS INC PERMITNO03070040
3721 SANTA RR11A. PT
OWNER'S NAME: 1764 NATIONAL AVE PERMrr ISSUE DATE
ROBERT RT4T1qTrAWA 117 /[),z 12 in nA
°NE: (510) 293-9901 SANITARY NO, CONTROL NO.
AR CHITECIDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
j O o LICENSED CONTRACTOR'S DECLARATION
Ii1 hereby affirm that I am licensed under provisions or Chapter 9(commencing Job Description
< wi hit coon 7fKX))it tsin raihe Bu.inrss rad Prufns inns Cote.andmylicenseis
+o& reran Class r t. � Lk# REPLACE WATER HEATER
i License Class
f Co In or
QQ ARCHITECTS D ARATION
dja cremndmyplanss111bcaecdv hlicmcurds JUL 1 0 2003
So.
ep Licensed Professional
OWNER BUILDER DECLARATION BUILDING
5i 1 Wmhy.Turco that 1 t. cBcmpt from the Cnmramh License law for the ID V
C20 0 following mann.rotation
]1131.5, iainas and Professions de demolish,
Calc:Any city s county
5 m whichiirequires a Permit to uims iucl,alcor,improve,demolish,tar c a sig any ttmclmc
Za thane its censncc,pieorc I.the
thevishoram for such CmLm L.r'a Nese Law(ned swcmcm
�o thalhcisnwnadParstion7 )o(Disloanflhernmaness nicenselsw(Chork)or Sq. F[. Floor Area Valuatwn
(commencing with Section]On d of Division 3 of the aged ca and Professions Any vi Cork)or
that he u temp therefrom end dx basis for the alleged essmption.Any violation of 35622021 . 00
Section 7031.5 by any applicant for•Permit subjects the applicant to a civil Penalty Of APN Number Occupancy Type
not more than Esu hundred dollars(5500).
❑ I,an owner of the property,or my employees with wages as their sale compensation,
will do the work,and the awetum is not intended or offered for sale(Sec.7041,Business
and Profusions Code:The Conbaamex License Law does not apply to a owner of C
property who builds or improves ibereon,and who does such work himselfor dimugh his 506 — GAS TES
own employ=.provided that such improvements ere not intended moRered hassle.If, 507 — FINAL PLUMBING
however.the building or improvement is sold within one year of completion,the owner
build5l will have the burden of proving that M did not build or improve for purpose of
ea .
I.as owner of Ne property,em exclusively contracting with licensed canbamre to
consumer the project(Sec.70W,Business and Pmrrssions Cade:)The Contractor'L6 _
cents law docs not pply to m owner of property who Wilds or improve thereon.and
who contracts for such proi with a conmaemr(s)licensed pursuant to the Commons
License law.
❑ I am exempt under Sec. ,B&P C for this reason
O r
WORKER'S COMPENSATION OECL R
I hereby&from under proushy of perjury one or a following declarations:
1 have and will maintain a Certificate of Conant to self-insum ror Workers Camper.
ation.as provided for by Section 3700 of the labor Code,for the performance Of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
37W of the labor Code,for the perfmmance of the work for which this permit is issued.
My Workers Cnmp``E Ins�aartie'and PolvC, unr lam:/
— -Policy a.: t1/(/
CERTIFICATE OF EXEMP1ON FR RKERS'
COMPENSATION INSURANCE
(Thu seefinn need not hecompleted if the Permit is for one hundred dollars(SIM)
less.)
I certify that in the performance of the work for which this Permit is issued,I shall ma
employ any person in any manner am as to become subject m the WorkeraCompensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this CeniOcete of Exemption,you should
become tuhjwi to the Woster's Comperueri0n provisions of the Labor Come,you mum
J ,Z forthwith comply with such provisions or this Permit hall be deemed cooked.
zCONSTRUCTION LENDING AGENCY
[-i�+ I hereby arm Nat them its construction lending agency ror the performance of
l3i the work fur which this permit is issued(Sec.3097,Civ.C.)
W Under's Name
z Lander.Address
U O I terrify that 1 have mad Nis application end cute Nn the above inrmmetiun is
W H Correct,I agree to comply with all city and county ordinances and some laws misting m
0 U building construction,no herebysuthorim mpmsentadves of Nis city to enter uPnn the
�.4 W ahove-mentioned property for inspection purposes.
g. (We)agree Id ave,indemnify and keep hara mless the City or Cupertino aid against
t171 Iiabililies,judgmenu.casuadexWnswhich may in anyway accrueegainslCtry
UZ in consequence of Ne Starting of this Permit.
APPLICANT UNDERSTANDS A D WILL COMPLY WITH ALL N-POINT Issued by: Date
SOU TONS.
344_�
Re-roofs
s' lure or Applit Conm c r Date Type of Roof
HAZAR US MATERIA DISCLOSURE
Willlheapph oturc Wilding occupal nom or handle havard...material
as de0ned by the Cupenino Municipal Code,Chapter 9.11,and the Health ad Safety
Calc.Schon 23531(&)? All roofs shall be inspected prior to any roofing material being installed.
❑Yc. ❑
Will Ike applicant o &tam buu 'ns ocecpanl use egaipmanl m device.which 'If a roof is installed without first obtaining an inspection,I agree to remove
fit haaAnus air contsminanu u recd by the Bay Amo Air Ovality Menagemenl all new materials for inspection.
imriet7
❑Yes
I have mad Ne hmardnus materials requirements under Chapter 6.95 of Ne Califon
Iia Health&Safely Castle,Sections 25 )5.15533 and 15534.1 undersond that if on building
dries not' w e tenanx th itis my raNumbility m nodty the neupant of the
myu' menuwhi"no I elprirwmaenecofacertinaete r cupantr Signature of Applicant Date
rite .sant te All roof coverings to be Class "B"or better
CITY OF CUPERTINO
WATER HEATER
CUPEf�TINO PERMIT APPLICATION FORM
APN# 5� Z Z 0LZ- I Date:
Buildi,thdret I S(�1 10v> U LLA
Owner's Name: Phone#:.
��✓�.,� ,�Ike M l 6 v�e�✓a—
Contractor: Phone: License#:
Contact: Phone: Cupertino Business License#:
VILCr� �v � u ,510 - z01v ' o � �
Building Permit Info:
Bldg ❑ / Elect ❑ l�umb-0 Mech ❑
Job Description: ( 1 _ , � -� S—6 V W y C w& 6c15)
Residential I\ 1 ` ., Cod ercial ❑
Cost of Project: 1Z)-
Strappe On Platfo n� Bonded
New Location ❑ Re lacement/
Qty.
A Eable Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING