03010175CI'T'Y OF CUPPUMNO
'• as °. `` '
BUILDING DIVISION PERMIT
kXONTRACTOR INFORMATION-
,
8 mLDINGADDRISS:
HOT WATER INC
PERMITNO.
19110 STEVENS CREEK BLVD
OWNER'S NAME:
2531 GRACELAND AVE
APPLICATION SUB DATE
SANTOKH BASI
01/28/2003
IONS:
650)298 -8494
SANITARY NO. CONTROL NO.
ARCHITECT /ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
D CONTRACTOR'S DECLARATION
LIn that
Job Description
1 hereby I
that I am IlTheud u AT provisions of Chapter 9 (commencing
aril
with ccli n]TXNprl Divixion3nl thc0 'r. and Prnlcasio naCade, undmyliccn¢i.c
N21
ea "der .'' �, (,
REPLACE WATER HEATER
I.icenusl at Lie.X
�PdB� ALE ®
Date Cons '
ARCHITECTS DEeLARNTION
1 understand my plans shall M used as public records
1'
JL1I_ �' h 2003
Licensed Pedbsonnal
OWNER- BUILDER DECLARATION
I hereby affirm that 1 am exempt from Tbe Conlnn"r's License Law for be
following m reason. (Section ]131.5. Business and Professions Code Any city or county
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which requires a permit to constroer, alter, improve, demolish, or repair any structure
prior in its issuaom, also requires the applicant for such Motor to file a signed statemcm
that he is licensed pursuant o the provisions of The Contractor's Lice ne Law(Cbapmr 9
Sq. Ft. Floor Area
$S00tion
(commencing with Section AN)(q of Division 3 of the Business and Professions C(wc) or
That he is exempt therefrom and the basis for Tbe alleged exemption. Any violation of
Section 7131.5 by any applicant for a permit subjects The applicant to a civil penalty of
e
Occupancy Type
not are Nan five hundred dollars (f50%
❑ I. as owner of the property, or my employees with wages as their true compensation,
will do the work, and the stmcture, is not intended or o ffered for ask, (Sm.704<, Business
502 —
and Professions Code: The Contractor's License Law does not apply to an owner of
506 - GAS TE uric nspec Ions
property who builds or improves thereon. and who does such work himself or through his
awn employees, provided that such improvements are not intended or offered for sale . If,
507 — FINAL PLUMBING
however. die 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 improve for purpose of
sale.).
❑ 1, as owner of The property, am exclusively convecting with licensed contractors m
t
consumer the project (Sec. ]IH<, Business and Professions CWT:) The Contractors U.
apse Law does not apply to an nwner of property who Wilds or improves Thereon, and ,
who comracu for such projects with a convenor(s) licensed pursuant o the Contractors
License Law.
El L am exempt under Sec. , B & P C for Yemen
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following decillowiens:
❑ I have and will maintain a Cenifcatc of Consent to self-insure for Wurker'eComata-
nation, as provided for by Section 3700 of the Labor Code, for the performance of The
work for which Nis permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
310d) nl the L bur Code, for the performance of the work for which This permit is issued.
My er;.x 'nth cnsal' nsumnc�/tricr and POI' nj,' Wr ��
`
�„ /
'ter. `�• kf^C.1 Pot¢ r.: ^3 3 �i {O
CERTIP CATS OP EXEMPI'1 FROM
WORKERS'
COMPENSATION INSURANCE
(Thin section need not be completed if The permit is for one hundred dollars (310(0
or Icss.)
1 cenify That in The performance of The work for which this permit is issued. I shall not
employ any person in any manner m as to become subject to the Workers Compensatino
laws of California. Data
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject m the Worker's Compensation provisions of the labor Cock, you must
forthwith simply with such provisions or this permit shall be dcemed revoked.
CONSTRUCTION LENDING AGENCY
%
I hereby affirm that diem is a construction lending agency lot the performance of
the work for which this permit is issued (Site. 3097. Cis. C.)
Lenders Name
lender's Address
1 cenify that 1 have read This application and sure that the above maturation is
correct. 1 agree m comply with all city and county ordinances and slate laws relating to
building construction, and hereby authoriea representatives of This city To enter upon the
above - mentioned property Ior inspreion purposes.
(WC) agree set save, indemnify and kith harmless the City of Caliendo)
(We) agree I
liabilities, judgments, casts and expenses which may in any way accroe against said City
id City
in nmscyu ncc of the gunling of This permit.
APPLI UNDERSTANDS AND WILL COMP ,Y W 11 ALL NON -POINT
Issued by: Date
SOU :GULATIONS. 0.J
Re -roofs
Type of Roof
Si sere of Applicanacornvumr Date
HAZARDOUS MATERIALS DI LOSUR.
Will TM applicam or future Wilding occupant store or handle bera mus material
as defined by Ibe Cupenine Municipal Code, Chapter 9. 12. and the Ileallh and Safety
crXk, Srmtan 255321a17
All roofs shall be inspected prior to an roofing material being installed.
pros Na
If a roof is installed without first obtaining an inspection, I agree to remove
Will Thcapplicemorfuwre WildingoccupamuucyuipmcmorJCViccswhkh
emit haXnNous air conmmiwnkS as delired by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑VCS .WAI
No
I have read de ham dons materials requirements under Chaperti 95 of the Califor-
mu I lraIW & Safety Code, Soctinns25505, 25533 and 25534.1 uukrstmN that if the building
does no t end' have u IammT, that it is my m,jim slbilily,, madly the Ta upant d the
mqui t whalomus lbemetpriorto issuanceof.Ccmfiak 'Loup' c'p/ 3
Signature of Applicant Date
All roof coverings to be Class "B" or. better
o I
rorladmrl,edagenT Did I