01090012CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT NO.
10850 SANTA TERESA DR
JUST WATER HEATERS INC
01090012
OWNER'S NAME:
WILSON RICHARD D AND HELEN T
1764 NATIONAL AVE
APPLICATION SUB DATE
09/05/2001
PHONE:
(510)293-9901
SANITARY N0. CONTROL NO.
2. ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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z LICENSED CONTRACTOR'S DECLARATION
Job Description
I heidp affirm that I am ficensed under previsions of Chapter 9 mommencing
REPLACE WATER HEATER.
with Section 7000) of Division 3 of the Business and Profexalom Code. and my license
Lin fall force and effect
(5 0 GALLON GAS)
a icense Class Lic. a
Dam Or nadim
v ARCHITECT'S DECLARATION
I understand my plans shall be used as public records
OLicensed Prulee.siowl -
LL OWNERHUILDER DECLARATION
' l hereby of tin that I am exempt from the Contractor's Li,mr. Law fur the
-
following reason. (Section 7831.5. Business and recession, Code: Any city or county
O which requires a permit to construct, alter, improve. demolish, or repair any structure
- - - .... _.. .. _
� .p,I tons lu , fluermfiewinl cM1parai, to file r so redwammem
3- - f Sq. -Ft: Floor' Area �.. j;,
ValuaDon
— Ihath'il' dp ru loth pr sf@eC mrsLnnsc lawlChapmr9
hommennng w lh Section 70001 ofD ion 3 of thea sines and Professions Cuba)t`
,s
or that he is exempt therefrom and the basis for the alleged ezcirrion. Any violation
-i4ri -Ani n no
-of Section 703 L5 by any applicant for a warrit subjects the applicant to a civil Penalty
APN Number
,
Occupancy Type
.ofa., moe than five lunched dollars (55W)
❑L. as owner of the property. or myemploy id, xith wages a their sole compensation,
— FINAL PLUMRIN�
5 0 6 - GAS TES12e Inspections'
wRGY
ill do the wink, and the structure is not intended or offered for sale (Sed. 7044.
Business and War ...on., Code:'Ihe Conua,du, License Law does not apply m an
uired
I] P
oxine r of property Wba bullas or imprevea metean. and who does such work himself
507 - FINAL PLUMBING
that such improvements is sol a. not intended or,
or Ihfou h his awn however. t building n sold within one year of
dfr«d or sale. 1f, however, the building of ins
. _'.. . .
en of Prov
III, IM1c owner -builder will have IM1e burden of proving that he did not build or
icompletion,
mprove Ins parpose of Hale.).
'
dcommctomrI
❑Lasct they ofthe p(Sm.
lame usinesely sadPromugwithcdc:)
IM1e projectlace. ]Ik14. Basics and Codc:) The Contractor 's
whops
Char
Law uses earn apply m an nwnvr of property who builds improves thereon,
iecas oes
Lid
t
sr
wch Projects with o nmvunorts7.licensed puraum m the
_and who commcts hi, a v.....
Z
_.. _.. _ . .. ... ... .. ...
La
law. 1
pt Linde
❑ 1 am ex<mPt under Sm. "' . B & P C for this am car
01 am exempt
o
Date
FINALED
- WORKER'S COMPENSATION DECLARATION
' I hereby affirm under penalty of perjOq one of the following deelamtions:
OCT 1 2001
p 1 have and will maintain o Ccnificmc of Conieni m .selbin.am for Worker's1
Compensation, as provided for by Section 37M of the LajW1 CWe, for the
performance of the worA far xhich Nis permi} is issud. •
BUILDING
❑ 1 have and will contain Worker's Cnmpensmiun Inaurnnce, as .,,aired by Section
37W of the Labor Code, for the performance of the work for which this p .it is
" issued. My Workcr's Compenmtivn Insurance ca.ic_and Policy number an:
Cam r ,.. Policy Na.;
CERTIFICATION OF EXEMPTION FROMV WORKERS'
-
-,.,.. I, .. COMPENSATION INSURANCEi,r;:..,'.
_. .-..-..._. ._-_. ._ _. ._.... __..-.. ._... ... ......._. ...-._... ..... ... _ _
" This seation need not be completed if the Permit is for once hundred dollars
'
ISI W) or I<ss.)
certify IM1 t in he peadmonams, cifffie somh fear which hispe 't is issued. I
_ 1
shall not employ any Person y manner so asto became subject to theWorkers
C,mmun,ilint Laws of CI"f Data
Applicant .: ... .. :.
.. ... ... ..
NOTICETO APPLICANT: If. after making this C<nificate of Exemption. You should
become.subject m the Warace, Compensation previsions of the Lon, Code, you most
fonhwilh comply with such Pm,i ma m this permit shall be decimal revoked.
CONSTRUCTION LENDING AGENCY,
I hereby affirm that them n ro a onarbion helm ing a'g<my fw the Performance
'
s
n(the wad for which this permit is ixwed 15ec. 309]. Civ. CJ .. ..
.. __. ... .. ._ - _..
^�
Lender's Name - __ .,._. .._ .... ... ... -.....
Z
Lender's Addrecc
.- n
1,mime that I have rtad Shia application W orae that the above information is
correct. I agree to, comply with all city and ,army ordinances and pa y laws relating
C.%
ices of lhis,ity mercer upon
rebuilding consvaed
W
rhe above .,barred propertyo m,ectom purposes.
p
nd for ify arile
(iGz
and keep W against
Wel agree to ave. indemnify and Iccp h rales the
to save,
an City of com against
liabilities, jutlg costs and expenses which may in any way accrue again. said
,f Q
Z
coca,
thegainingngD thin permit."
APPLICANTULATIOTANDSANDN'ILL COMPLY WITH ALL 'NON -POINT
NTUNDER
APPLICANT
Issued by: VVVV Dale
y'
SOURCE REGULATIONS..
Re -roofs
'
Signmme of A,pIi.mJComm<mr .. .Date
_HAZARDOUS
MATERIALS DISCLOSURE
will the applicant or future building ocempam store of handle havrdous.medal
.. Type of Roof. .... .... -.. .
m defined by the .Cupertino Munnd,al Code. Chapter 9.11, and the Health and Safety
CWe, Section 25532W1^,s - •, ,•r1.'s'^r
: ❑Yc,-, - Cl No, .:,' "_.,.��.. -; J'-
roofs shall be inspected.prior to.any roofing material_ being, installed. ..
. _',' ,.
Will the applicant or future building occupant use cgaiPmantord<vmeawhich
.-All
If a roof is installed'without first obtaining an inspection; I agree to remove
emit horhrdous air contaminants as defined by the Bay Area Air Quality Management
-
allpew,materials for inspection. understands, and will comply with
Di ... let?
❑vea - 12No -'
_Applicant
all non -point source regulations.,
1
1 have'rcW rhe Woodova materials requirements under Chapter 6.95 of the
California Health & Safety Code. Sections 25505.25533 and 25534. 1 understand thatif
he building docs not ,Dandy have a nmam, that it is ,ay mipt milaility to notify the
occupant of the rc,uircmcros ishich'inusi ne and prior In issuance of a Cerificam of
Occupancy' I -
Signature of Applicant - _ Datet. - .. .
All roof coverings to be Class "B" or better
owner nr,rrn tined agent Dam
OFFICE