03020098 ctTY of cUPERTmo C0NTRACTOR INFORTVIATION.
BUILDING DIVISION PERMIT � ym .a, ,i A�E�SE"Yt.. Ca�+iv ?akc<5s
PERMIT NO.
BUILDING ADDRESS: JUST WATER HEATERS INC
1154 FERMITi55ue*3020098
G ER's NAME: 1764 NATIONAL AVE
YING MOY SANITARY NO. N0.
(510) 293-9901
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
pZ LICENSED CONfRACO)WS DECLARATION Job DeScrl 1 p �t�l
O 1 hcrthy.flim,Ihal l am Itcenud under pmNslons of Chapwr 9(commencing "FIN F... 'five,
with Secthn7OnOWDividon3 of the Business and Profession,Code,and my license is ®®®II Mel '
Mfull tmceand effect.
REPLACE WATER HEATER APR 1 5 2003
teens Llcen,e Clua Lk.g
ARCHI
oQ contractor (40 GALLON GAS)
Dam plan
DECLARATION
i 1 utrdcrsund my phos ahs11 W used u public recnrN
'a LicensedPmreaiaNl I3UILMNG
iD OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors License Law fat the -
31.5,Business and Pmfeosiona Code:Any city or county
ZQ� following motor.(Section 70
$ which requires a permit m construct.elrer,Improve,demolish,or repair my structure
prior it)in,Issuance.also mquirtsthe.PPOunt fanuchpermiuo Ole asigned statement Sq.Ft.Floor Area Valuation
tharM is licensed pursoam la the Prevision,of the Communes vxnseLaw(Chapter 9
sC� (commencing with Section 7000)of Division 3 of the Bisirmsa sed Pm(minn,Ctme7 fir
a Nn be U emmpt drmfmm and the,bub for the alleged I-1010 Any violation of
Section 7031.5 by any applicant fm•Permit subjects the applicant 10 a civil penalty of APN Number Occ n Type
Out,ort than five hundred dollen(ML -
❑I,uowner of Ne propeny,mmY cmPloyw with wguuthelr wktmmpenulion, 3
6926003
wllldo the work,and lheswclum b not ntended oroRcmd Intosh,(Sec.7D14,Business Required Inspections
and Promulons Code:The Commutes Lim.caw docs not apply to an owrmr of 502 '— FINAL , PLUMBING ENERGY
property who Wllda mimpmvea rbercon.and who does.uchwmk himself orthrough his
own employers.provided that such improvements rte not Intended m offered for sale.if, SO6 - GAS TEST
however.the building or improvement Is sold within man YOU of completion''he owner-
builder will have Ute human of proving dant he did not Wild or Improve for purpose or 507 - FINAL PLUMBING
sale.).
❑1,a owner of the intensely,am,doslvely contracting with licensed convenors to
wn,wn
the project(Sec.7014,Business and Pmfessiom Code:)The O ncelcrora U-
come Law does not apply man oven of Property who Wiles or improv,Ammon,and.
who comment for uch projects with a con=10r(s)licensed pursuant to the Contractor's
License Law. ,B k P C for this modernjounI an e.empr under See.
merDem - -
WORKER'S COMPENSAnON DECLARATION
J1 hereby affirm under porgy of perjury oro of thefollowing declantionK
r/ I lave end will maintains Cerlacale of Consent m self-boomfar WorkersComport-
,don•u Provided fm by Section 3700 Of the Lab,Code.fm the Performance of me .
wait for which this permit is island.
❑1 have and will maintain workers Compensation luursnce,a retrained by Section
3700 of site L um-Code.for can PQTolritaneC of the work for which this permit is issued. ,
My Wofte.Compensation hnmarme carie,and Policy number are:
Cannot•. Policy No.: i
CERTIFICATE OF EKEM"ON FROM WORKERS'
COMPENSATION INSURANCE
(This sectionrmctimneeco,pleted lDW Prmrir b reform hundred dalba($101) -
__ of leu)_._
1 eemfy Net In the perfotmuKe of Ne work for which Nit permit ts loved.I dull not -
employ any peon.in any,anrmr an as W become subject to the Workers Compensation .
Laws of California.Date
Applicant _
NOTICE TO APPLICANT:If,after making this Cool Cate of Exemption,you should
become wbjeci to the Workers Compensation provisions Of the LsWr Code,you must
Z fo,,wilh comply with such provisions of this permit hall be deemed revoked.
Z q CONSTRUCTION LENDING AGENCY
1 hemhY.Birn dant then b•eouwdimt lending agency fm tlm 1mHormamx of
a> sire work for which this permit Is Wood(See.3097,Civ.C.)
W QLenders Name
a Lender's Addres,
V1 certify that I hue read this pplication and sera that the above information is v
L4 E" coral.i agree to comply with all city and county ordinances and sem laws relating m
0 U building const gree in.n.,indnd bmnifya d keep
harmltivewf Nb dr to entero age Ne
n7 .hove-mentianad property far Wpection pugwes.
(We)agree m ssve,indemnify and keep hannku the Clry of Cupertino id City
i..� IAA Ilroliltlu.7udgments.costs sod narcoses which may In any way accmc Iinst
Pinst old City -
t„)z, in comemome,of rite gnarling of data permlL Date
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
REGULATIONS.
Re-roofs '
Signature of AppliunUContrutor Dam Type of Roof
HAZARDOUS MATERIALS DISCLOSURE `7P
will the applicant or future building Occupant store or handle hauardous matedat
I
darned by the Cupertino Municipal Code.Chapter 9.12•and the HCsidl and Safely -
de,Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes ON.
If a roof is installed without firs[obtaining an inspection,I agree to remove
Will the applicant or future Wilding Occupant we equipment or devices which '
mit hazardous air ro murnants u defirmd by the Bay Arta Air Quality Management all new materials for inspection.
❑Yes ❑No
I ban mm Ne alumnus materials mquimments under Chapter 6.95 of the Col lor-
nHealdtdrSafetyCode,SecWm 25515,25533 and 25531.1 undersand Natif We Wilding
ura not currently have a,nank that It is my respomibility In notify rW ucupanr of the
quirements which must W met prior to lnuurcoefa Canlrcam of Occupancy. Signature Of Applicant Date
All roof coverings to be Class"B"or better
Owner or wrboris0 agent Oate