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,
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BUILDING PIeRMI'I INFO
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LDG ELECT PLUMB MCC11
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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