02090103.. CITY; OF'CUPERTINO
S.
r..
CONTRACTOR INFORMATION:
.i:'.,LBUILmNG DIVISION PERMIT
,BUILDING ADDRESS:
PERMIT NO.
:11755 SEVEN SPRINGS P
JUST WATER HEATERS INC
02090103
1TWTE AND CATHY C
-
1764 NATIONAL AVE
APPLICATION SUB DATE
09/17/2002
PHONE: -
(510)293-9901
SANITARY NO. CONTROL NO.
zp ARCHITECT/ENGINEER:. f _ _
BUILDING PERMIT INFO
„
BLDG ELECT PLUMB MECH
w'
i LICENSED CONTRACTOR'S DECLARATION
Job Description
affirm tat Iamlicensed under provisions ofChapter 9(commencing
,aton
REPLACE WATER HEATER
aIhembv
with Se 76M) of Division 3 of the Businessand Professions Code. and my license
s In full force and effect
(5 0 GALLON GAS)
Uccnsc Class' Lic. M
Date Commmm
ARCHITECTS DECLARATION
.1 s 1 understand my plans shall he used as public records
Licensed Y_rofessi... I
- ' OWNER -BUILDER DECLARATION
firm shat I "aesnopt from the Cofucmr's License law forte
'r 1 herb, afm m
< following rcason.'(Section 7031.5. Business and Professions Cale: Any city or county
O which requires a permit to cons mi alter, improve. demolish, of repair any s na mm
-- - - -- -'
m .,do, W it, issaaw, also eM.io,,dW sp,lic,aa fur' such .it 1P Ble a s geed suanmm
- tM1a1M1e IgpSedpursue a drpmvi. a,sofdxConvacmrzLaenxlnwlChapmr9
p , ,Sq: Ft, Floor-Area,r,, 1 -�.,
Valuation
(comrrsm g lh Sect ]IXlO) fD' isiunJof the Business and Professions Code)
{'t„!, 1 ;.t, s 1+"% E. a'33
br Ihoi heir esempi thertfrom and the basis for the allegnl eaemPtion. Any vmlation
6S39.4 On
-of Sco i.7031-.5 h,.., appli,.Al for o permit subjects the applic.00 -11- .. penalty-
APN Number
Occupancy Type
,.inntmoremnnc<ehundroddolloossmT
........:
pi, as ownerof the property. or my employees with wages as their sole compensation.
502 -
5 06 - GAS TESTRe aired Inspections;,
q p
willdothe work: and 't o suacmrc'isram intended or.6 ed'far sato fse<: 7aur
Law docs to
Buimnis'ond' Professions Code: The Com iewr's License not apply an
owner of pomsmy Who Wilds or improves thereon. and who Jas such work himself
507 - FINAL PLUMBING
.ortrough his own employees, provided ma such improvements are not intended or
J._ _ _
._. _.... .. ..__. _ _ _ . _-__ _ -
..__... _. ... _.._.... . ... ........ .. ....... ....- .. -.
torr sme IL hdwdvcr, the building or urdenivement n sold within one year of
J ' improvtion, the will have the burden of proving Iha he did nm build or
*,oropa
usaf alder
improve for puryox o(sale.l.
❑n a.fthePSec.7 I la contracting i;hodenxde to
I'
Comms.
ones t th p n (Sec ]0a4' Business d f<. Code ) to '.
Irk p /J� 1�p3
II `I O... � la
mpr ves reon.
Uanx (saw Ames not apply m ao ownerof ac.r1r who builds m improves thereon.
es property
i; _.and who.commns.Por. such Projects.with acommvmrlsl.licenud.pursmns.m the
P...
._.._____.___._.__._____.___.._.____. ___..... .-_.._._....._._._.. ...... __.... __,._.__. _..._... ....._..... _.
C ndano', License Law.,
❑lam exempt under Sec.':B&PCfonhis moon
OCT'b-3'2tlb2'
Owner Dae
- I •; "',; WORKER'S COMPENSATION DECLARATION
Iherohy afim, under penalty of. perjury ore of, J,e followingdeckmaimm:
pp 1 1
pUILDS �'
0 1 ha c and 'will maimain a'C<rti0cate of Conxp m self -in .mfe for Worker's
je Coin anion, as provided for by Section 3]00 of the labor Cede, for the
perfonnoixc of the work for which this permit is issued..
.
s',
I h o e and will maim Worker's Ctim t 1 sumnc< by Sgecrop
this I,
in which this peffnit is
3000 Ode, for Inq lMrfinmanee
3 the wdPolicy
- rr numb
issued. MY Wo k<r.-Co pc_ t I supnce rand Policy number are: a
rker
. My Worker
-_ - _ _ ..............
,,,, .o „
_
Crt P6ltry N,,
,r
s,
°.: CERTIPICA'IION OF EXEMPTION FROM P'ORKLRS't -','
')' sir+ ••'s sI
COMPF,NSATION INS URmNCE _ ..
_._.......
.._. .__.. _. _.__�___._ ___.._.___-__. _ - . ._...._
•(•�
_...
(Th `looms need not he u, nplded f IM1< t' G r one hundred dollars
(Sl M.m 1111.1 „
..'j, Ic Ifylh'n on the pert n of lh kr' `h ch th pc t "'und.I
,. •(i; I.I' sl .:..jl.,..., 'sl" '...
, hall not employ any pc n n any manner w as In beinpe subject td the Worker .
Compenaatm Laws of Cul lfyrn , Dam.
- Applicant
01 1
n' you suld 1
oNOTICE TO APPLICANT If. utter making fi Ccrrficwt E pI ho
Z N k t: C pcnsat p n lithe labor Calc you x:
1 e Inc;
eih
,
., (ooh c ply h Pru' s or Ib. pc m t 'hall be deemed revoked
_. _ _ _.- _ - -
Ji -Q CONS ONLENDING AGENCY
- t lending f Ih perfunn
1 hereby ff rte th mereis
I, I
N
the work for tissued J09]Ci, CC.)
which thispe . tS )
li
.. .__. _. ....
hders Namn
Z Ismer'. Addreis'
0 I ossify% that l have read this application and state that the above information is
Fs '.correct, I agree to mmply,waft all city and county ordinances and state laws riming
IS mbuildingconswnion; and hereby imhorire npcsoattives eftbis city menses upon
q'the above-inentioned no,cny for inspection purposes.
agree is save. indemnify and keep harmless the Cnyof Cupcnnm.g.iao
,(N'el
rn liabilities, judgment,, casts and u,amses which may in any way a"Con against said
z City in cbnsequnia df the granting f This "out -
City CANT UNUCRSTANDS'ANDWILLCOMPLYWITHALLNON-POINT`
IsSUedb Date
by:I
SOURCE REOUCATIONS. -'•. +� '
,,:
Re -roofs
ofAmlficanVContmp,m v, -.. : .'. ,Pate:'':
HAZARDOUS MATERIALS DISCLOSURE
Will thepprcz t future Wilding cup at it rha al hotindous mate' I
.Type Of ROOF
SEctmed by Ne Cupertino Municipal Code Chapter 912. and theHealth and Salty
(. ., sit ly A 4 sl
<•.
Cod Sds 255)_(1
o ( �N<,Ai'laal+.lp=.
ve.All
roofSrshall be mspected.pnor.to.any roofing material being installed....-.... .
_
'wnme,ppi future build money devices rich
If is installed'witbout first obtaining an inspection Pagree to remove
t g ,s pment
emth rdo air conlandustas asde0ned by the Bay Aica Air Quality Management
D -
a roof
all new materials for inspection. Applicant understands and will comply with
t t
03 a °No t .
I all non -point source regulations..,,.,
F j. I
,1 huve rerthe hazardous mvterials requirements under Chapter 6.95 of Ami
Cattleman Health&Safety Cat,,Sections25505.25533 and 25534: 1 understand that
iftn
wich atenant. temp lnay ro...cc bllity tonficalefy
ccu,eiildingeoesnotcunen
f
mcupam of the requiremen¢ which muss be ten prior m iesmnce of 6 Cmifcata of
o<<awn<Yd, ,., .:. ',
..Signature of Applicant..... _ .. ..... .._.. Date
All roof coverings to be Class "B” or better'
ownnor aalnoaaeaogapt .. Dare.
-o
OFFICE