02040012 -CITY OF CUPERTINO
BUILDING DIVISION. PERMIT CONTRACTOR INFORMATION:
i BUILDING ADDRESS: PERMIT NO.
10440 STOKES AV HOT WATER INC 02040012
' OWNER'S NAME: APPLICATION SUB DATE
, .OKUBO 'EDWARD K AND JUDY S 2531 GRACELAND AVE 04/02/2002
PHONE: SANITARY NO, CONTROL NO.
(650) 298-8494
0 0 0 ARCHITECT/ENGINEER: BUILDING PERMIT INFO
to BLDG ELECT PLUMB MECH
y U n L= 1-3 C__7
8 m i . LICENSED CONTRACTOR'S DECLARATION Job Description
i z y I hereby affirm that I am licensed under provisions of Chapter 9(commencing
int isith Section]U�an>mhron3anbeBa,me„ ad roeayon;Ca dmyBreose REPLACE WATER HEATER.
SmX� hm renfomc 1, t lI/ Vl/Y/A 1\l
a w� cen,e cla„ ur.a
a O y ,Doc Crecmr
CHITECT'S DEC
RLARA O
,g ..:.1 undersand or,plans shall be used as public records
i R o z Lircnxd Pndcssinnul - -
-a��,a : OWNER-BUILDERscramrim he RATION
Thereby affirm that 1 1. exempt from the Contiamr's License Law for the
following rthson.(Semon]0315.Business and Professions Cade:Any city or county- $500
E Owhich q pc t r n w talter-mpros<,demolish,or repair any stunum
1 Pim ur its'. 1 y ' tl Ppfcanl lar such permit to file.signedatalemenl.
thil} I c ,N y n tM1 p sof the Comracmh L anti Law(CM1apttt9 -
Icnn ncngx;itnsnl ]Of10)ofD...too3oftheBusncssaoilNfesaon,Code) .;'l ',1'T32S®4�` rs�ri,(, y':'tIif'M Valuation
ar Ban he is seenth'umrtfmin and the bast for the alleged eurnpit n.Any violation
-of Section 7031.5 by any applicant for a permit subjects the applicant to v civil penalty
of hotmomthanfivehundreddauars(s5oo). 502APNIft*AL PLUMB IN ENERGYOccupancyType
❑1,as owner of the propcny,or my engsl.,m,with writes as their sole mmpen,mlon,
-will-do theworkfand the structure is not intended or offered for sale(Sec.7614;
tBb,iness an d'Professions Cade:The Cvrowelm s License Law does not apply u.vis 507 - FINAL PIAOryIB 16JOspeetions"
owner of propcny Who builds or improves thereon and who docs such work himself
or thmugh his own cmpinyeee,provided that mch improvement.,art at intended or _ „__.
yffn le far sale.If.haweven the ll hove d er burden
a sulci within one uild of -----
ompinion,tM1e waerbuilJer,will have the burdrn of proving that he did not build or
"
Improve litr ryupnse of sale.).
❑l,as owner propcn&am cxduzivelycnntractin8 with licensed contractors to ,_ _...._. _
- /�. ■ J . .
instruct Law
project(Seo, m a,Business and Professions ids or The Contractor's FINP'ai IsE® �r '13
License Law dm,nm vpply m an owner of propcny who Wilds or improves Ihercon.
and who c....cis for such.projeca with..commrouhd licensed......I to Ne.. .. .. _._ ._ _. __. ._ ... ...._.._ .._ ....t___..._.. .
contractors License Law. _ ........... ..... -._-__ ....._ .-_ .
O l not exempt under Sce ,B&P C for this reason JUN 19 2002 'h '
Own Dred
WORKER'S COMPENSATION DECLARATION
•• Ihereby affirm under penahyofperjury one ofthe following declma,ions: BUILDING
❑ 1 have and will maintain`n Ccnificam of Consent tis self-insure for Worker's
Compensation. as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this Permit is issued.
O 1 have and will maintain worker's Compensation Insurance,es obtained by Section
37fq of th`Litho,Cti for he perform c of theee,work
(�ffaaar which�thghis per(rnitt is
Cam11-Tp . orAeraC,rgfrtnmto YolicYN : l'J q oq(.(2 - ._ ...,_ .1 _ _ .. _ - r - . _. _._.
'.,r,.CERTIFICATION OF EXEM"ION PROM;WORKERS'1" '*•� ?� (Q, l e- Y
COMPENSATION INSURANCE''
'i' (Thr,wa on rad not he cnmpl<¢d f the permn s far one hundred dollen ' ! s": l. .
(5109)or less.)
I enify that in me perfornsance of th lk f 1 rah this rmit s issued I - - - _- - • -„�. - J•` _ _- --
shall not employ any person in any manner so is,to become speubject to the Workers
Compensationlnwsof Caliltfmia,'Dam' -
..Applicant ... .. - ._ ._... ._
.ov, -
INOTICETOAPPLICANT:If,ritm,ranking this Cenificmeof Exemption.you should
liccome subject to the Worker's Compensation pi 'eiohs of the Labor Code,you must
Z Q forthwith comply with such provisions or this permit shall bedecmed revoked. .I
. . .. ._ _... . _ ... ”- ..
M a '- r CONSTRUCTION LENDING AGENCY I'
a'> 1 hereby affirm that thirre is a construction lending ager y for the performance -
,.., of the work far which this permit is issued(See.3097,C .CI
Q Lender's Name. -.•.' •.. •.•.... .. v_..-
=.Z Lenders Address I,
V •,1 certify taut 1 have red this application and state that the above information is
fi,'•p. coirtct.I agree to comPlY wi h all city and county ordinances and atom laws relating
O V m building conalraclion.and hereby arhorim representatives of thl.Ccity to enter upon
(r] the above-mentioned propcny for lnsper ion purposes. _ ,_
F,.0.I f We)agree io sive;indemnify and keep harmless,the Ony of Cupertino against
N' liabilities,judgment,costa end especres is Inch may in any way accrue.gaunt mid
City nconsequcnc2 of th gram. of this perinit "'"
APp4(C7(R.pNDL VDS qND WILL COMELY WITH ALL'NOgPOINT
5o R .d:n tl' - c '1 I el Issued by: Date
. sign fur cont tb ... Date Re-roofs .
SU0.E
handle hemNous material Type of Roof
HAZARDOUS MATERIALS DISCLO
W 11 hepCu,n o future bolding tic pant store r
as d f ed by tM1 3 pen M aWl Cad Chapter 9.12.and the Health and Safety ,
eaa set 2ss32(n) ., "• ( .:'..Ifj,
❑Ye, - t rvo All"roofs shall be in$'c' d-prior-to any.roofing material bei g.installed.
Will the applicem f thing occupant use equipment or devices which If a roof is installed without first obtaining an inspection;I agree to remove
emit harandom,ser mmaminants as defined by the Bay Area Am Quality Management
dcl'❑s Yec all new materials for inspection. Applicant understands and will comply,with
Dist . y p _ •• _ -
r all non-point'source regulations.
1 have d the hazard 'material regiob aam t uridei Chapmr 6.95'of the
Cillfamia Health&safety Code,Sections 25505,25533 and 25534.1 undersand that
Ifni W'Ia1h
t<u rely have a mnant Nlit' yrcp -'bl'ty to notify the - . . '. _. . . . .. ... .. .. _. ... .-_ _ - .. ..
acupontrthathmust h met poor io as a ce f a Cenificme of
g pp Si nature of A licant Date
ii cra _Date Al] roof coverings to be Class B"or better
OFFICE