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01040108 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: HU ILIA NO ADDH:RSS: PERMIT NO. WATERIL71:3el STOKES AV JUST HEATER INC 010410108 OW'NIiR'S NAME AP'P'LICATION SUB DA's. V 04/20/2001 �IONE: SAM LARY NO. CONTROL NO, o 0 z AkCfIITECI'RS\GINF.F.H: BUILDING PIeRMI'I INFO Ore 0� F!-, LDG ELECT PLUMB MCC11 yd z P,,, 1.- ay zS N LICENSED CONTRACTOR'S DECLARATION Job Description 0 Z a 1 hereby affirm that l am limmed under provision,of Chapter (commencing with Sell i70o(col'Ie on 3ofthe llusuae„and Prol'unmm Caxle,and my lie <x C-? is in fall force and effect i,i _ en. •. SM c a Liecn.ecm.. Uw.9 REPLACE 40 GALLON GAS WATER HEATER. w Dalc Cunramur 3 a y ARCHI'I'ECr'S DECLARATION ON I undemmnd my par,shall be Irsed u,public leads Limewd Pa,fcs,aumI �' t3WNl?ILIHIII.DIiR DECLARATION 6.to I concise affirm Thal 1 am exiend from the Contractor's License law lir the L:L1, fnlluwing rt (Section 70315,Badav,vandmfe P ,> co n,Code:A,city m unty •'S 0 which re,carea c a permit to construct,all,l,ln:ItmvC,demnlid..tr spam any,lmcu[e c.CS= primum its ceseance.rborl to lhepowimlicanlfneC or..... License I,m•J,minmem than❑mider,unpndnmtlmme pmwi,roll,Fnnne the lrac,ne,ucalhse4hwfc,Cole) Sq. FL Floor Area Valuation .c Ill he is wish Suction om and Division 9 nl the Ileged ex and ion,ProAmon kinin. of Ihm he i,31.5 b,Therefrom anJ,he breis lith the alleged exemption.Any violmion 8 4 2 of fct dame th n iv hundred doll lira permit whjee,x thu uPPlieun to a civil pvmhy 'effect mom man owe nandred ennat,(ssofl. APN Number Occupancy ype ❑I.E, erofthe propeny,n inployee with wages ts their win mmpnrovtion. will do the work,card the s mctohe b not intended or offered for sale(Sec.TMJ. - ^ 7 0A 11.s „amt Prnre,.ion,Cane.The Contractor's Liccne Law aces m,l Ilody:nR air equired Inspections owner of property Who build,or impnm'e,Ih omm.and who does uch sunk It ell car through his own employee,.provided mat such improvement,are not intended or 502 — FINAL PLUMBING ENERGY offered for sale.It,however,the budding o mpn Cat Is sold within o e year of completion,the owncrCuilder rill have the burden of proving thin he did not hold or 506 — GAS TEST imprnw for pamis,of,ule.l. ❑1,a,owner of the pml'ert,ran exclusively contracting with licensed contractors to 507 — FINAL PLUMBING m....ret the Project(Sec.7044,1...and Prulesionn Code:I The Cnnruse...', License law does not apply to an owner of popery who Builds or improves thelium. Emil who contracts for such protects whh a contractor(,(licensed pursuant to the Commcmr's Linen-Law. ❑1 mn exceed under Sm. .B k PC lir Phis rcuwn qt Owner Dme RI �-ith LFri WORKER'S COMPENSATION DECLARATION -'11-Y "{/ I nemby oflirm under penalty of perjury toe of the fidlmring declaration,: JAN 0 7 tie I have and will n aim:dm n a Cenilice of Con,eal In w161nxm'e fororkm w ', 2002 Cnn.peroutim. an provided for by Section 371X1 of doe Labor Code. for the perromnmce of the work tiro which this Perack is i-wit. ❑1lmvc and will maintain Worker',Compensmion Insurance,as reyvimd by Section BUILDING 3700 of he Linn.Code,fur tui pem,rao c of Inc—A for drill Ihi,penult is toed.My Worker',Cnnhlhemmimn Insurance eerier End Policy homier an: Currier: Policy No.: CERTIFICATION OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section neN act M arnpleud if the pemm,is for-toe hundred dollua ISI WI car Ics.l , I certify that In the Iserform:nru of the work for which this cierair is issued,I shall not employ airy ptrom In any manner,o a,to beconro subject u)the Wnd.ecs' Compcmmlun law.of eahfmmia.Date Applicant NFrICE'I O APPLICAN 1':IL abler n,kthg this Ceniicate of E,ctnplion.you should Z become.innea ` to the Workers Compensation pissins al the labor Gale,you u. Q fonhwirh comply with such Pm o. n rannhi,I,n.nic vhull Ix Acu:ncA ruvnkcJ. FCONSTRUCTION LENDING AGENCY ai 1 hereby atlimh thin There is o constiuldin.lending agency for tireperl'onarna of the work for which this Wmhil is issued(Sec.3197.Civ.C.) Q Lender's Nunle .1. Z Lender's Address U C l certify lhm l Lave run(this uppl'm,d i and Bowl:nm in,nbnve lot onnmion i, rat t,,,t 'move,.1 agree rah comply with all city and county ordinoncm and nam law,Mlaling Q (� cal building anxruc:Ion,and herebyuulhorim ropoenmive,of ml,City its care,upon } the above-nuentioncd prnpeny sur m,pectimt purpmer. (We)agree costive.mcd,maify and keep hrrmlcs.hc Cayof Cupenim,again. Z liabilities,Judgnmncs,amu arta expennc winch nay in u:ty w-sty came:hg:rn.a,:hid V Z City in mon,mucom of the granting of this permit. SAPPLICA PIT OURCE RL'GUIERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date scalrbue of APPllcantUom.aro, Dme Re-roofs HA%ARDOUS MATERIALS DISCLOSURE Will the ap,licmnor forum buildingnccapanl pore in handle htmed!.us contend Type of Roof de defined by the C'upmtino Municipal Coda Clocao,9.12,and the Health and Sutcty Cevdn.Seetioa 25532(a)'! ` E3 Y0, °No All roofs shall be inspected prior to any roofing material being installed. - winmeapphcamoflinure buildingomricamuse cnuipmen,ordevices which If a roof is installed without first obtaining an inspection, I agree to remove �- t I nvmdomsur contalano :,m,defnodby Inc nny Alen Ah Quality Mattagemem trice all new materials for inspection. Applicant understands and will comply with t °`'e, 0N all non-point source regulations. I have read,he haemdou,memnmis re9airemenls under Cnapmr 6.95 of the Cullfomin Ilcdln k Sulay Code,Scelinm 25505,25533 and 25534.1 nndcnlmhd Ihot if be building doe,alt:currently bavc a fern(, he,it i,Illy"'ponxlhllay toItntily the occupant of the requiremenu which most M mel prior cat issuance of a Certificate of Oc.... fly, Signature of Applicant - Date owner„rambni,edngen, Doe All roof coverings to be Class •`B'• or better OFFICE