02110149 CITY OF CUPERTINO - -,r ^'^ nF---
BUILDING DIVISION PERMIT ;,CONTRACT0RJNF0RMATI0 ,
BURAIj(R48Es6HATTUCK DR JUST WATER HEATERS INC PERMrrNf02110149
orANGbE+7Np:KIM 1764 NATIONAL AVE APPLWATI(1N"213' 2002
DONE: 10 293-9901 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MEED
00 LICENSED CONTRACTOR'S DLCLARA'1'ION fbn
CUF thereby atirmthat l am licensed under provisions of Chapter 9(commencing REPLACE WATER J e [ lion
v, in
with Seclion]ottBnf Division 3 rel the Bndncsaand PndcuionsGde.andmylicensc ix
<„ in 1'n11 rune and effect, (5 0 GALLON GAS)
nK License Class Lic.a
F?�,� Dxtc Contractor
ARCHITECTS DECLARATION
I understand my plans shall the usudas public records
st
NLLa Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License law for the
w OOO following reason.(Section 7031.5,Business and Professions Crede:Any city or county
m!� which requires a permit Or construct,alter,improve,demolish(it repair any structure $750
,;say priorto its issuance.also requires the applicant lit such permit to(ilea signed statement
tE< Nal held.censedpursuannnthe provtaansOfthe ContractnrsLicense Latw(Chapter 9 Sy. Ft. Floor Area Valuation
fe,° (commencing with Section]axn of Division 3 of the Business and Professions Coder or 35615001 . 00
y $
that he h exempt Ihemfrom and R.basis for Ne alleged cumptinn.Any violation of
Section 7131.5 by any applicant for a Permit subjects the applicant u a civil penalty of APN Number Occupancy Type
nnl moreNan five hundred dollars ls500L 502 — FINAL PLUMBING ENERGY
❑ L a a owner of the property.ser my employees with wages as their sole compensation,
will do the work,and the strucma is not intended or offered for sale(Sec.7144.Business 586
and Professions Cock:The Contractor's License law does not apply to an Owner of 5 0 7 — F INAL gee ll pections
property who builds ser improves thereon,and whodnes such work himselfor through his
own employees,provided Nat such inquammenm are not inended oro@red for sale.If.
however.Ne building or improvement is sold within one year orcnmpledon,the owner-
builder will have the burden of proving Nat lin did not build or improve for purpose of
salc.l.
I,as Owner of But p apeny,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)Te Contractor's Li-
u law does not apply to an owner of properly who builds or improves rummm,and.
who comom s for such projects with a conlraclnr(s)licensed pursuant to the Contractors eff
License Law.
1 tom ezempl under Sec. .B tit P C for this of seta vett
Owner Date WORKER'SCOMP17NSATIONDECLARATION DEC 1 2X002
1 hereby affirm under Penally of perjury one of the following declarations
T have and will maintain a Certificate or Consent)self insure for Worker's Compcn- g 011 Ir'T. IA1�
caW tion,as provided for by Section 3700 of the Labor C dc,lot performanceB
of the U 4LYnYN
work for which Nis Permit is issued.
1 have and will maintain Worker's Compensation Insurance,ses required by Section
I'00 of W Taber Csde,for Ne performance of Be work for which this Permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Cartier: Policy Na:
CERTIFICATE OP F.KEMPr10N FROM WORKERS'
COMPENSATION INSURANCE
(this suction need not be completed ifft Permit is fnronc hundred dollars(blot))
or less.)
1 ccnify ohm in the performance of the work for which this Permit is issued.1 shall not
employ any Noun in any manner so as In become subject 10 the Workers Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,me,making this Cenit3cme of Exemption,you should
become subject to the Worker's Compensation provisions of the Jahn Ode.you must
O Z forthwith comply with such provisions or this Permit Shull be deemed revoked.
ZO CONS'FRUCf10N LEN DING AGENCY r
pI hereby al firm that there is a pmurectlnn lending agency for the Performance of nn
W? the work for which this pis issued(Sec.3097.Civ.C.)
W n /1
Lenders Name
Lls Isnder'a Address
U O I minify that 1 have read this application and sum that the aline information is
D. r correct.l agree to comply with all city and county oudinamces and state laws relating it)
0U building construction,and hereby authorin rePmmumoves Of thus City to enter upon the
,r W alawomentioned property for inspection purposes.
,r CL (We)agree to save,indemnity and keep harmless the City of Cupertino against
D,, Iiahilitica,judgencnm.costs and expenses which may in any way accrue against said City
U in consequence of the granting of ON permit.
�--� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POIM' Issued by:S Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicentlCoulmrou oar
HAZARDOUS S MATERIAprot sl morhandl Type of Roof
Will Nc applicant orfuwrc building oacupam stare nr handle hararduus material
as defined by the Cupertino Municipal Code,Chapter 9.12.and the health and Safely
ode, 0Yr,z5532(a>'' All roofs shall be inspected prior to any roofing material being installed.
❑Yes ❑No
Will thea Event or future building l.eu ret use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
pp g pa aAirQ
mit hvallous air amtamittamx as defined by the Bay Arca Air Quality Management all new materials for inspection.
In
istrict?
❑Yes ❑No
I have mad the h000dous materials rcquiremcnta under Chapter/.95 of the Califon
il leaks!,Safety Code,Sections 25515.25533 and 25534.1 umkrld Wl if the Itudding
es not currently haus a tenant,that it is my resrymsihility to nnely ole occupant or Ne
,mmoremsWhichmostbemmp;mtukssuance'IfaCcnmcale'IfQcgpancp. Signature of Applicant Date
wner ser agmmixee agent Dale All roof coverings to be Class "B"or better