03020088 CITY OFCUPERTINO
BUILDING DIVISION PERMIT �GONTRA.CTOR INFO.RMATIQN
/ 'A+., wu3',a A
BUILDING ADDRESS:. HOT WATER INC PERMIT NO.
818 SEPTEMBER DR 088
OWNER'S NAME: 2531 GRACELAND AVE PERMIT ISSUE DATETSAI JUEI-KWEI. AND LI-HUA-L N' 02/21/2003
NE: (650) 298-8494 SANITARY NO. CONTROL N0,
ARCHITECTIBNGINEER: BUILDING PERMIT INFO
- - 0 ELECT PLUMB MECH O
�eoo LICENSED CONTRACTOR'S DECLARATION )±r-n j bDesC II n Ay
`l� I Wreby&from that l am licensed under provisions o(Chapser 9(Commencing 66 y
with Section 7000)of Divisfort 3 ofthe Business and Profession Code,and my licevcis R! {
in 111 fanea dcif 3 � C3(e%2r REPLACE WATER�HEAT Ij'
Z License Clu � 9 l
G Dem Contracts .
55$$? ARCHITECTS rsgbor ATI
I understand my plans shall he used As public mmrM
56 Licensed Pmfesdonal
OWNER-BUILDER DECLARATION
.� F I naso .itis on 11. exempt from M Connano/s e:Any
taw for IK
0 0 whichrfollowing rens,.(Section 7 n L5,Buttner, and Improve,
dem li Code:Any city nr coumy
$ which I%Isu a pe,h re cnnswcn alien nt for such
h patch t m mash any structure
prior=ies Issuance.also requires the applicant for pests to Ole ulgned nammenl
< that he is licensed pursuant othe provision ofthe Communes License Law(Chapea9 Sq.F[.Floor Area $�a1318tion
(commencing with Section 7")of Division 3 of the Busineuand Profminm Code)or
+�33 that Ian is Nm an
exempt mefrod Ne hula for the alleged exemption,Any violationof
Section 7031.5 by any applicant for a perch subjects the applicant to a civil penalty of
not moa than five hundred dollars($50y.
Bi _ Occupancy Typo
❑I,as owner of the property,or my employ=with wages u their sale compensation,
wllldo Newark,and the shucture h nmintended Or offend fonalc(Sec.7614.Business 582
And Professions Code:The Communes Liceme law d=not apply to an owner of5 0 6 - GAS T titre nspec ons
property who bat it ds or Improves thereon,and who does such watt himulf or through his
own employees,provided that such Improvements tie nothoulded arortcnd for Gala It. 507 — FINAL PLUMBING
hmewr,the building or improvement is sold within on ym of ccmpredon,the owner.
builder will have Ne burden of proving Nu he did not build An improve for purpose of
role.).
❑1,as owner of the property,am exclusively contracting with licensed eonbmton to
construct the project(Sec.7014.Business and Prouslom Cade:)The Conmemrs U.
conxe taw does not apply to an owner of property who builds or impmves shaman,trod,
who Contracts for such pmjeces with a csnuactur(U li=med pun eml to lk Conuamon -
License Law.
❑I am exempt under Sm, .B A P C for this recon
Owner Dam' -
WORKERS COMPENSATION DECLARATION
1 hereby afro,under penalty of perjury one of the following declarations:
I have and will maintain a CenlOate of Consent to alFimure for Wmkefa Compere- _
skahm,u pmvldcd for by Section 3700 of the Labor Cod,,for Be,per(b,ance of the
work for which Nis permit is issued.
An and will msinuin WmkeB Compensation Imunnce,u required by Section
3700 of the Labor Code.for the Performance of the wors for which Nis pemtit is iuucd.
My Wmkefs C�s,��"¢soonJo/unms&nim and Poliry number art:
carrier:�'/fx7e /GLA_eL Policy No.: I�T030W
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section lung not Wcumpleted ifthe permit is Worm hundred doltm($100)
or leak)
1 certify that in the p ofermam,of the work for which uh Permit is Issued.l Mall nm
employ any Person In any meaner so AS In become subject in be Workerf'Compew0on
Laws of Celifbmla.Date
Applicant
NOTICE TO APPLICANT:IL after making this camnam of Exemption,you should
become subject to the Worker's Compensation provislona of the labor Code,you must
.,O forthwith comply with Such provisions or this permit sold W Merced revoked.
,z.i a CONSIBUC ION LENDING AGENCY
'Fr fi 1hcmbya11firm Our Nom h amusurection lendin,gatcy for the perfurmena of
ai the work for which this permit Is Issued(Sm.3097,Co.C.)
140 Iander's Name
it,i7. z Lendle.Add.
t)Q I certify Nn 1 have mad Nil application and Bat,that the above Information is
W cornu.I agree to comply with all city and county encourages and sum laws turning to
Q building cunslmc0on,and herebyaorhodn representatives of Nis city to enter upon the
til above-mentioned pmperly for inspection purposes.
��...tt (We)agree to an.indemnify and keep harmless the City of Cupertino against
i.. V1 liabilities,judgments,cases and expenses which may in my my amme lgalnst Said City
In consequence of the
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Da
SOURCE REGULATIONS.,
Re-roofs
Signstun of Appliano'Contnnor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appilant or forum Wilding occupant nom or handle havardoes mamrisl
wggju Mimed by the CuPeNno Municipal CaMU
, aPmr 9.12,and the Health and Stdcty
ode,Section 25532(&)? All roofs shall be inspected prior to any roofing material being installed.
❑Yee o
Will the aPPlicant o utum building oceopsnl use cy.Ipm.nt or dcvlas which If a roof is installed without first obtaining an inspection,I agree to remove
mit ha'mous air com ooduanu u defined by the Bay Area Air Quality Management all new materials for Inspection.
7Distna?
cYea
Ihave mW Ne hoardmmamdals movement;under Chapter 6.95 of the Calling, �% d
le Health fk Solely CDM,Sections 25515,25533 and 25531,1 undemmnd that If the building
oes not currently haw a tenant.that It is my responsibility m notify the upant of Ncqulmmcntswhichmust met prior biuvance or.Cemnnu Oce ,r. SignatureofApplicant Date
�& `y a( All roof coverings to be Class"B"or better
caner or Authorized agarol Dom