02040078 . CITY OF CUPERTINO - - -
BUILDING DMSION PERMIT I .COWRACTOR"INFOE2MNITON .
BUILDNG ADDRESS: PERMR N0.
COFIELD DR JUST WATER HEATERS INC 02040079
.
OWNER'S.NAME APPLICATION SUB DATE
f ' SALLY .LAUTEN 1764 NATIONAL AVE 04/16/2002
PHONE
SANITARY NO, CONTROL NO.
(510) 293-9901
ARCHITECl/ENGINEER: ! BUILDNG PERMIT INFO
ou BLDG ELECT PLUMB MECH
< LICENSa .
ilaad� R'S DECLARAn0i I hcrcbyaIlrm themensunder previsions of Chapter.9(comymencin
g' lab Description
m
REPLACE WATER HEATER.
is in full force and'cHen.
OL Limma Clasz Lic.a
Dae. Contractor
-•LL u0 G ARCHITECTS DECLARATION
us 5 1.alraand my plans shall be used as public mambst
x o O Licmuld Professmml
OWNER-BUILDER DECLARATION
I hems)affirm that I am exempt four the Contvcmr's License Law for the
following masa.(Seniors 70313,Business and Professions,Code:Any city or county yC 7 2 5
F h which requires a Permit to essentialolter,impulse,demolish,or repair my structure
3$
or to its issua .160 requite the applicant for such samnitto file.signed statement.. ..
_ _._
. . ._ ._.. .. .. Y..�_ .._.-`..
ird
tholbe ii lam.MSection70 ep 't oim3oContrxtWsLtanttlAwumsC de) ..,( Sg�p2��j�jf7r a , - Valuation
(com enE NSepum 7000)9!Di,lion3ofthe eupnus and Profnvons Code) -'i3 S'TrU.U'1 i �a., tI �[( ,)'�•
or Jim he v exempt atc¢fulm end the basis for the allegedexempiion.Any violation
-:a;. on 7031.5 v mydreddollforoSW). zvbjccutheopplicamtoativllpenalry-
01..1. of bepiatMreaaaldemploy). 502�N�rL PLUMBIN ENERG)PccupancyType
❑L d ods ew'm-.e progeny,tx my is F.,cu with wngca Te theifsole compensmion, _
-tris q Bi a,drk:vd dial-odc: e C nal imenamd tar eRLaw due,a.,apply 704x;' ,c�<
trial of antl Professions itch o The Contractor's and w Law does not apply to en 507 - FINAL Pffi�dlhffi'�d�IIfdspectioiis
owner of t his ow em builds or improves thereon.,rad who does sues work aduado
mself
ofero It his Fal}, provided Natp h improvements wirc rantintended -_- . .._ _. ._...._. ___....
..offtted fo I if however the Wilding o pavemem is uW wMm oa year f ,l: 'l., . ,'1•'* C: ._..
aampin en,the owner bustler wdl hove the burden of proving insist,d c nm Wild.,
'
improve for purpose of tale.).
-.___.___.._-.—_.__._.__... wilhlicnvcd mntnnors - ____......_.._.___._...__....__-_,..__......... -..._.__.. ,'O-_....._.__-._.._
C ❑Lrs owmcrofthe PropenY am exclusively contracting t p _,._._.-.._.._....._.......___.._.._._... lll'�_::<i,i".P.:f^. ".-
_? emsuvn Ill.projact(Sec.7044.Business and Profusions Cade:)The Contract
._r ' License law does nota 1 to an owner of `-d.=°] - -" D:J:?iP
apply proprrty who bullas v'm ulvu....du,
who uevtnus.fa such po)cu th oouactv(s)1,»....n purauani so die. .__.__ .. __ __ _ ............
Contianofa Licenu law � "`e -_ ..-......._.. ..._ __
,f am caunq trader Sea. '.7 iB kPCfa did,moon F0NA� ®
❑I
awar .Dia
:;n r' ' WORKER3 COMPENSATION DECLARATION
i- _ MAY
ns L O OoOs1
O 1 ( C
- e 1 hate aRan a do pr;mlty of a l ry one f thfollowing declwtiov--
❑ 1 Aeve stall :�Ill•moniiini'Cenifiasm'or Coa..' to self-insure for Worker's
Comp<maion;-vs-previded (tar by-Section-3700-of tic- abor'Cale,-for BUILDING
perfase
t".
of the wwk for wNeh 0u permit u issU
ued.,'
O I hays and`d•ill mainuin,Wmker iComperiv�ian losur,nce,jai fequired by Section
3700'of'the labor Cade for sM peifonrnmee of Ne,work for which
N s Famous{a
issued.My Workmi Complication Ins ranee arnerb,dd Policy numberarc ,er •v,
__ _
♦ �_._...
_
tZ
Carrick 4.1 IfPoi.. h .. . . 1. '„ .� . .� .. . :.f ., ., 'nI (i.'. ._....
s CERTIFICATION OF EKEMMONFROM,WORKERS
` fh COMPENSATION INSURANCE
..7,.5 (This'secitun`need Wt becofnplamd if the Perms,is for me hundred dollars
WWI or less.)
Ic.certifythanmy par perfo a oflhe as
piehmtapc' tits usaia.7
Com ration Laws of Ca6fumi,.Dae.' "'L""'"-""° -to)he Workcra -
shall not employ anY.pason In any manner so as to become rub)ect ,,,.f. v
A&'ant '..• .•
!Ncome slTOAPPLICAa11 It.lker,aRttmaking artion P CeN mo of Exam tied.ybuumuM ,^:'i.. J'0 " ""' -"
z Obecomeh comi to tie Wvkei s Cbmpensbtion Provisions of she labor Code;you muss
Torah th comply lh s--provuiom or Nn patent zhal be deemed k d.
a� to I,tl n P CONSTRUCTION LENDING AGENCY1
- -
WF" I he by affoi M t there is a c tuact J ng ageary fen the perfommnad //�� // C_�VW�— , I n •IL.b
fNe wokfa h'n this perm tit d(Sec 3097-C C) .t� /�/)/LfL[iC, -
�:Q 'Lenders Neme'w.,.__._ ._ ....._._.. .._. .____ _.._..__ � 1. -_..._ ..... .-- __.___
Lead * AM
V 0 at r application tt ion is
1 ttn fy to c I navy mad thiIIIitydco and sure that the daboveslat information aion is
W-E,e cobuildnagreeto tempt)wiNallcity.4ricoumyordinances andslatelowserbi�on
1-7 tab.1lovegmnilread rT.7ieimby'anahonxe reprtsenutivas B(Niacity to enter upon
�. L'T she aba_sx-nemioagd at ad nor impl%etion puryosey,:_y,_„„-- ..._,.
^',L (Wejagicau,eve,Indemnify and keep harmless the Cityof Cupeu;no a gain
h' lubililies,judgmenu,ensu,b upcnxs witich,mey in'any way acme,gaima u;d
UlZr Citynconrequence of the)mag of thispermt ”'^”
_ APPL7CA�t,U1 91st LlSPSAXID\fiL4 C0\1PLV lvjj'j{ALL NONPOL r
sovacE'REGu AnDNss r:::,' Issued by: Date
Sipmv of Apel cmUCenaev 1 Dat Re-IOOfS
+ XA2ARDOUS MATERIALSDISCLOSURE f "
'"7 Will tk applicant or(curt Wilding g a pant save or local herudous m tarsal
• Type of Roof. .. _ -
ddeRned by the Cupenim Municipal Code.Chapter 9 12 and Ne H<ahh d Safery - 4 - -'
Cade Smi..23532(0 t : h.. in Tr Fk S' b'', 'i t ")(. t' a&� ,-t i: .
.;t ❑Ys . . tONo ! p 'iC b t1�'A y
All roofs shall be inspected prior.to any.roofing material,being.install ed.
_..
b',. Wll the applcantorfumabulangea p a qupmentod f ea him If a roof is installed without firs ob ainmg an mspection,�I a""e6 to Fiero
emit haxardo s cmtatmnanu u d f ed b}Ne Bay Arta Ai Quid y Man g'mc t . gr VC
Dlamn , r .,,-all.new ins ecn9nt Applicant understands.and will-comply with
❑Yrs l ' ONo .. ,� _ - P _,...
r, y t r. all non-point source regulations '
1 ha a read he hazardous rimerials regmrtmmu'urker Chapter fi.93 of Ne '
CN fern s H Ith h Safety,Code.Sections 25505,27533 and 25534.1 understand Nat
iflartart of
reinotpnendy hsvcoss W.twtislimy ms."of Cart
za ant a(Ne u
p icy iremmu loch moss sm n poor s tssuana of Cmdaete bf
_.Signature.of Applicant._ _._. . . . . .-- .Date:
own nwhrued vgcm r J+ 1 Dae All roof coverings to be Class"B"or better
r _
-OFFICE