02110044 CITY OF CUPERTINO
BUILDING DlVISBAN PERMIT CONTRACTOR INFORMATION:
eu19)2446iEsSILVER OAK LA JUST WATER HEATERS INC PERMIT NO 2 110 04 4
221,,63
QWfr- ANSOO-YANG AND YING S 1764 NATIONAL AVE APPLICATIPl15NUTP2002
IONIi: 510 2 9 3-9 9 01 SANITARY NO./ / CONTROL NO.
ARCI31TfiGT/IiNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECi1
x00 LICENSED CONTRACTOR'S DECLARATION p
e�F I hereby anirm mad am eeenred ander prnnirnma..r enapmrv(anmmand"g REPLACE WATERAc1yUon
azw wile Scninn]Ixxry of Uivixion3nf tc Businca and Profeasinnsendc.and mYli,rnseis
G« rullrnmaand Off'" (40 GALLON GAS)
OZ�}I_ Limmuclass Lic.M
-W Dam Commer
ARCHITECT'S DECLARATION
s a I undmitand my plans shall he used ase public records
Oyu
o
i3v.G Llccnsad Pour,siowl
Hu.0< OWNER-RUILDER DECLARATION
I hcrcby allirm that I am exempt from the Cnmramor's Liccnsc Law❑r the
ca caa 0 ldllnwing rasort.(Section 7031.5.Busiacsx and Prorcssinms Gine:Any city or county
which rtq.ims a permit to construct.alter,improve,demnlixh,(ir¢pair any Aructure $632
prior to its issuance,also requires me applicant for such Femur it)rile a signed dawoom
t?< that he is licensed pursuant to the provisions offficContractor's I.imnw Law(Chapmr9 Sq. Ft. Floor Area Valuation
(Communeingwith Section 7(Xx))ofDivishrn3onhennsines.andPrnreamom,Contain 34249015 . 00
y $
that he is exempt Ihc¢fmm and me bats fur the alleged eacmhtion.Any violation of
Section 7031.5 by.ny applicant for apermit subjects the applicant to a civil penalty of APN Number Occupancy Type
not team than Ove hundred doll...($S B. 502 - FINAL PLUMBI G ENERGY
I,a owner f the property,of my employees with wages as their sale compensation,
will do the work,and the sometime is not intended or offered for sale(Sm.704x,Business 5136
and Professions Code:The Contractors License Law dors not apply to an owner of 507 - FINAL Q}�Qgiections
property who builds m improves Braman,and who does such work himself or Ihmugh his
sen employees,provided that such improvements arc not intended oroRered for sale.If.
however.me building or improvement is sold within one year of completion,the owner.
builder will have the burden of proving that he did not build or improv,for purpose of
rale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the pmjecl(Sec.7044.Businem and Professions Code:)The Contractor's Li- l'�� tr��p a}� rl f�
nulawdoesnotapplytoanOwner of property who Wilds or improves thmmon,and Ir 11�.I be9 Lox.l�
who contracts for such projects wit a contractor(s)licensed pu,manl tot he Contmam'r 11�.1 E
Licence Law.
❑1 am esempt under Sec. .B&P C for this reason
Dwner Date NOV 18 2002
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally or perjury one of the following Jmlantion e BUILDING.I�D I�G
I have and will maintain a Cmiifcam of Consent o acl6Uinsun,for Worker's Cmohen-
ration,as provided for by Section 3700 of the labor Cash.for he perlormance of the
work for which Ibis permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
3701 of to Labor Gyle,for me performance of Inc work for which this Permit Is issued.
My Worker's Compensation Insurance carrier and Policy number art:
Carrier: Policy No,:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mus section need not he completed if IM Permit is for one hundred dollars(S I(xp
,it less)
I acidly that in the herliumarrm of the work for which this permit is issued,I shall not
employ any Person in any manner so as to become subject o the Workers'Compensation
Laws of California.Dam
Applicata
NOricE TO APPLICANT:IL at let making this Card licam of Exemption,you should
became subject to the Worker's Compensation provisions of the Labe Code,you must
OO forthwith comply with such provisions or this Permit shall M deemed revoked,
z CONSTRUCTION LENDING AGENCY
E-t I hereby allirm that them is a construction lending agency l or the Performance rf
ya 7 the workfor which this permit is issued(Sm.3017.Civ,C.)
WQ Lrrvts Name
0. Lenders Address
V 0 I certify that I have read this application and state that the above information is I�r�,TU�I/LL
W P correct.I agree to comply with all city and county ordinances and slate laws relating to /
enter
QU building
(We).,etion.ave hereby
dcmnifhorircepreantedvcse City
ofytoertinorymmc
W above-mentioned property for inspection purposes.
(WC)amen m sant,indemnify and kith nay in a the City of againino against
N in
Of
uang expenses whicn may in any way eccme ngainsl rail City
U zA consequence of DE RSTAND this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONPOINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of Applic..VC,,nvaclnr Date
I IA]ARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant rr future building occupant store or bandle hatmdous material
his defined by Ib.Cupenino Municipal Code.Chapter 9.12.and the Htalth and Safety
GNc.SeedYesnn 25532001 ON. All roofs shall be inspected prior to any roofing material being installed.
❑
LWill the applicant or future building Occupant use equipmcm or devices which If a roof is installed without first obtaining an inspection, 1 agree to remove
ot hazardous air contamiwntx ax defined by the Bay Arca Air Quality Management all new materials for inspection.
District!
❑Yes C:1 NO
I have mad the hazardous maerialsmrylrammm under Chepmf6.95 of the Califon
nia Health&Safcty Code,scemms25505,25533 and 25534.1 understand that If the building
docs not currently have a motor,that it is my responsibility to notify the occupant of the
mgnirement,,which Most beMCI primit)aaananraccrdreaenrampanmy. Signature of Applicant Dale
Owner or anlbmircd agent Dale All roof coverings to be Class "B" or better