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CONTRACTOR INFORMATION:
NG DIVISION
PERMIT
BUILDING ADDRESS:
PERMIT NO,
10113 SENATE WY
JUST WATER HEATERS INC
02090109
cF6'g1V8'?b GERALDINE M
1764 NATIONAL AVE
APPLICATION
PHONE:
SANITARY NO. CONTROL NO.
(510)293-9901
ARCHITECT/ENGINEER: !
BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
r_I
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby alErm that l am licensedinder providmisof Chapter 9(commnrcing
REPLACE WATER HEATER
with Section 7000) of Divi on 3 of rhe Business and Professions Code, and my license
is in mu fnrcesrb<Ireet.'r
(40 GALLON GAS)
License Class Li,. a
Date Contractor
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from rhe Contractor's License law for the
following reason. (Section 703 L5, Business and Professions Coda: Any city or county
o m
which req irts a pe t t construct. alter, improve, demolish. or repay any swemrc
pnorm is ssuarca I r� rhe epplicmtflat such permum file 4 so sh"p e09.
_ _ ._ ...
that lips lhbfdyurua'rggbdhe bmvimons of the Co.wnoisLcenr law lCh prer9
(Ir meriq rig wish Sect ]000) f Division l -fNe ��usiaypgd Profession Code)
w r ,So.fPt FlowrAregg�� S I Valuation
% _ { 114 1 , {T i l..I L JP. A'. o }' .J A{ � .: #. � .s±:
6S3047
or that heexempt do. him Ne hasit for rhe alid;ed eission . Any violation32
-af Station 9031.5 by any applicant for a permit auh'a, ,the applicant m a civil penahy-;
-no
APN Number
prbwi Occupancy Type
:of aot mere than five hundred dollars (5501.
❑I, at owner of the property, or my employees with wages mthci, sole compensation,
502 - FINAL
ENERGY
- 506 - GAS TESTRe Ins -' "" `' l:
--.illakimo the work; andOneo -'
ssot
feredLaw
not intended Lice
doe
Basin&i and'Peofexsions Calve: The Contractor's License Law does not apply m en
e: The C se apply to ai
uired ecti6ns''',
q p
owner, of property Who builds or improves thereon, and who does such work himself
507 - FINAL PLUMBING
or through his own employees. Presided nonsuch mprovemem, are not intended or
., __ . ,._ _.. _......_ _....._. _ ....
offered Tor isle the bread m improvement r sold one year of
but hewithin
wnerwevei,
completion, the awncr Wilder will have the burden of proving but he did not build or,
t
impress for purpose of aaleJ.
i
.co I,uawncr ofdet Property, am with licensedcommissionCor ronto
.i'i
(Sec. Business d Professions Code 1 The Convenor's
(Sec 7044 Bunn s and property
construct the does who thereon,
La do s o d t n`own�T f n who Wilds or
wh cunvac8 far such Prolaas nh a m trictiagal 1 cnaud Pursuant m_PPY P a Y PCor
1--.,•_-.r.,7 fLl ( Lt'o'
^•_and
ConLice
s i L unitS
Ives
❑1 me 1.rgpr rNer3a B&PCfurthaarexmnO net "'�tSORICERS
Dii
COMPENSATION DECLARATION
I 1herebye0irmuMerpenalty of penury one of the following dalamuons: -
�
❑ I hive-and'will maintain''S'CeniOcam of (unseat to self -in ... c for Workeis
Compensation, as provided for by Section 3700 of the Labor Cade, for the
Perform ei o/ the work for which this pemut is Issued.
❑ 1 have sad will m i ta o Wofker•s Compeiwd Ins'um . as ,required by Section
3700 briar' WWF Code; for the performance of she work'for which this Pewit is
'
'ss h MyW kei. Comp<n anon lnsumncarrierendP Icy mbar are,
Cmrtle�s' < 'yi,q.I Policy Nor ,, t--—�.•
F 'Tars,),): 4i.'.I r�y.�I rrI hr lrl,r
}ill,`�ti1s.lFi
' \I'(:iERTiFICATION OP.EXEMPTION FROM WORKER3�';`
' 'h''� a -I' ' " ""
n, _Ili .y 31`1:
14 fOMPENSATION INSURANCE°
ti:" 111,11 (!2
seedo'o nkdnm ae ktimplemdif the pewit is for one hundred dollars
IS 100) or less) r
"t Icertty BiaPG the ped rmS ce aftW wo kfo-hick this permit is use)
shah obi employ any person m any man as to become suM1ject to the Work<cs
Cum monism . 1)
...yo
NOTICE TO APPLICANT If, after mak this Ceri(eme of semtion -lib lJ
p
became sublen to the Workeis Compensation psosissom or LaborC!',you must
7onbwhhcoriipywidi such provisions or this permit shall W deemedrevoked. '
_.. _.. _._ ._. ... _ _ ....
- _ ...._._.
it rs" ' CONSTRUCTION LENDING AGENCY `
.... ...-.,..__. .__ _.. ....__.
D P
:aeon waon lanai..
hat or, ag n y f ;be beff i t,
' 1 h by'aPow th
f in w k forwhich thk pewit is issued (Six 3097 Ci C)
-Lumill
-4-�--�--.-._ __... _. ...._ .. .. _ _ .
Lender Address " _o
l � ,v/�'�_` In', r. lirti:'I
n t 1 c mfy that I have read this application and scam that theabove information is
�
recr I gree to comply th all city and county rdirmw and state laws relating
t Wilding constraodtnand hereby authorize repreaen}it rs fit city to enter upon
the abovcmenrioned pmpeny for inspection purposes.,,. _
jW j ojre m save:'indemnify'aad kelp harmled rhe Cary of doNruno against
liabilities, judgments, casts aN expenses which my in any way accrue ag?inn said
City in consequence of the q fang of onit pc 'n `
APPLICANT UNDERSTANDS' AND WILL COMPLY WITH ALL NON -POINT'
I q ,
Issued by; Date
SDYMCB REGULATIONS f ..
Re -roofs
Signmjreof ApplacaMContrwior', . f rt Dat }
• HAZARDOUS' MATERIALS DISCLOSURE
W0l the applicant or Nae building occupant stamorlonlle tivarlim material
-
.Type OT' ROOF •�,.•�_-.�•••+•--.-•-.-
, asdefrul by, the Cupertino Municipal Code. Chapter912 and the Health and Safety
Code $at on3 S32(e) 11t
''T'7 Yek't.�a• t s,.IbJiIONb 'rl;
_ I 71 - p `y,'I'Ti r•i
' } • I( ' $ i 4 s)1 1Ir %u ..1I F,iS A
.'!
_ - ;,
'Will applicant or future building occupant useequipment devices witch
_ _All roofs shall be ins ected. rior.to an roofin materlal-being installed,,._._... _..
P P Y g
.._.. ..
If a roof is installed 'without first obtaining an Tnspection�4 ageee,to remove
emit hazardous nit comm rants to def ed by the Bay A. Ali Q al'ty Manag end
Damct ,, ;'
all new materials forinspection. ,understand, and will comply with, .
❑sea=' •, ,I —ON.1. No I - -
- ,�Applicant
all non -point source regulations.. r= ;,i., `
_
,. 1 have, rad tha hamrdous materials requirements under Chapter, 6.93'of she
, ,I,,v
, Califomia Hevha&Safety'Coide,Sections25505.35533a 85534. I undeamndthat
_
'af sae thre at is triY
of;ticeupan� bf the requiremenu which miiss a! met prior m immanynof a Cenificam of
xroaf the requirementsw ich musbe issuance
°rupancy"'"'
Date,.
_Signature_ofApplicant ._.. .. _.___...._ _
All roof coverings to be Class `iB" or better , r.. _
0 rcr or amhoriud agent ) Dam -
I'
OFFICE .-. ._.. _ _.... .._.... _. ..... ...