03030102CITY OF CUPERTINOe`
BUILDING DIVISION PERMIT
Om tACTOWINFIORMAT QIV
0UILDING ADDRESS:
JUST WATER HEATERS INC
PERMITNO. '
OWNER'
1764 NATIONAL AVE
PERMIT LS
IE:
(510)293-9901
SANITARY OL NO.
ARCHITECDENOINEER:
BUILDING PERMIT INFO
BLDG ELECT ' PLUMB MECH
l� C=
LICENSED CONTRACTOR'S DECLARATION
1 hemhy apirre that lam licensed under pmvWpns of Chapter 9 (commencing
.lob Descrlptl
wish Secllon 7glU)ofDlvision Sof the Budnessand Profculnm Code. and mylicenu is
1 IV A L E D
u«nlseec sdeGeL` Lag
REPLACE WATER HEATERS -
Dam cent"`"`
(40: GALLON GAS) MAR 19 2003
ARCHITECTS DECLARATION
1 understand my plana shall he used As public records
BUILDING
Luerumd Po'r�ona'
OWNER-BUILDER BUILDER DECLARATION
1 hereby .(Boor I am exempt from the Contractor's Law (Dolle
: Any c county
following muna 7031.4 Business and nm Code: Any clay
on
nr mpdr any atromuro
w, do s
permit re cnmtme4 alar, Improve,
which requires permit t
poor m its issuance, h permit t a hapten l
for such permit m Ole • Law
also requires .pions
nProfe,w(,Code)r9
Sq. Ft. Floor Area
Valuation
conedp o (Chapter
he is 00epmw.isanermeheBusi ass or
Section Division r of lM Business and
(cat
and theof
t on Any atoo
Net he Ian exempt Nerofrom and the baa for the alleged c.,emptlon, Any violatlm of
he 1, exempt
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects du applicant to a civil penalty of
not mem Nen Rw hmxmRd doll. (SSO
1, an owner ofthe property. or my employ= with wages As their solo compensation,
34249007,
will do the work, and destruction is not intended oroffered formic (Sec. 7W.Busionis
Required Inspections
And Profession. Code: The Coauncmra License Low does, not apply m an owner of
property h. bulld.m Impose., unworn. andwhodoce.uchwnrk Mmselforduougl his
502 - FINAL PLUMBING ENERGY
awn employees, provided that such improvements sae not Intended m offered forcers. If,
TEST
lon. Ne owr-
bronvm. Lie building or imp nvement a gold within one year of eempler.
SO6 — GAS
builderwillMeretheburdenofprovingWtMdidortbuildaimproe,fm purpose of
507 - FINAL PLUMBING
"to.).
❑ 1, as owner of the propeny, am excrugivcly contracting with licensed contractors In
construct Ne pmjen (Sec. 70x4. Business and Promotions Code:) The Com acter's LI-
,
came law docs not apply to an owner of pmpenY who builds or improve Neman. am
- -
whocontractsfor such projects whir a con"clons) licensed pursuam to the Comram e.
License Law.
❑ I am exempt under See. . B ILP C for this moon
Owner Dau
'
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury oneof the following declaradnm:
low and will maintain a CenlEceu of Consent to self-Insuro for Worker's Compere
salon, as provided for by Section 3700 of the labor Code. for de perform.. of be
work for which this permit is Issued.
❑ 1 law and will maintain Wolters Compensation Insurance. As requirel by Semon
3700 OHM labor Code, for the performance of Ne work for which thispennit i. bound.
My workers Compensation Ingoessm: esMO, and Policy number au:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Tia uce ln_n need not hecompleud iNhe permit Is foronehundrtAdollan (SIM)
.
or Ica.)
-
I cenify that In the performance of OR, work for which this permit Is Issued, l shall not
'•' ' ^ ^' ° ----- -- -- -_.__ _._—. ,. —,._..—..�._—.,__ _
employ any person In any manner n As in become subjcct to the Workers' Compensation
Laws of California. Dau
Applicant
NOTICE TO APPLICANT: If, after making this Oeni0esu of Exemption. you should
become subject to Use Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be decmod Revoked.
'
CONSTRUCTION LENDING AOENCV
I lu,mby thi vel dere a a construction lending sur Nc performance m
)
3
' Ne work Ian which this permit i. issued (Sec. J09'1, Civ. C.1
which .)
/�
tandem Name
lander'. Addmo
I cenify Nal 1 haw mad this application and sum Nu the above information Is
o conecL. l agree to comply with all city and county ordimnceund gore laws Retailing to
building construction, and hereby amhorime mpmmnmivea of this city m enter upon the
.hove-mennmad property for Impaction purposes.
(We) agree to an, indemnify and keep harmless the City of cupenlno against
i llabllides,judgmenu. costs and expenses which may In any way acerae against aid City
mcon 1 his rmit.
APPL CART UNDEm nof the RSTANDSof IAND WILL COMPLY WITH ALL NON-POINT
Issued by: Date
SOURCE REGULATIONS.
Re-roofs
a of Roof
Type
Signature of App0nHAZARDO °ite
HAZARDOUSMATERIALS
occ pentgo or
Wilkie appellant or (alum Wilding aecupantuoro or handle hoallousmatenJ
sa de0nod by Qe Cupeni RomeCode. Chapter 9,11, and the Health and Safely
rade. Section 25532037
All roofs shall be inspected prior to any roofing material being installed.
❑Yes ❑No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant ugo equipment or devices which
It ha%Arming air ccmuminams as defined by the Bay Arta Air Quality Management
all new materials for inspection.
mim7
❑Yes [3 No
Ieqnim
,
I he. mal the hunmouc materials requimmonts under Chapter 6.95 of the Celifor-
liculth&Safely Code, Sections 35505,25533 and! d25534, I understand low If he building
es not cuncnlly hew a anon. Not II Is my responsibility m nudl'y the occupant of the
uiremenu which must be met prior On issuance his Cerdfcam of Occupancy,
Signature of Applicant Date
All roof coverings to be Class "B" or better -
Owner, or authorized agent Date