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02110085 CITY OF CUPER'rINO RUILDfNC DIVISION PERMIT CONTRACT,OR4NFORMATION Eul 0iESSTOKES AV JUST WATER HEATERS INC PERMITN©2110085 OWffETOAhYOSHIAKI AND JOY K TRUST E1764 NATIONAL AVE APPLICAT11J11sPT-3`x2002 1IONIi: (510) 293-9901 SANITARY NO./ / CONTROL NO. ARCHITI=/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECII pKZ 0 � 0 LICENSED CONTRACTOR'S DECLARATION M.P: I trereby alum ma l am Imemard order prusisionsof chapter v(commencing REPLACE WATER �g [ion firs<i with Section 7lUt Division J of Me Business and Professions Code,and my license is Moot Ione and effect. O L� � License,Claes Lue.X p Date s3mvwvv F'=' uJ ARCHITECTS DECLARATION < 1 understand my plans shall W used as pMlic records OyU 3 u Licensed Professional FaOa OWNER-BUILDER DECLARATION Contractor's s u�a.�J 1 hereby allirm Ihm 1 1. exempt from the Contmnoo Littre Lew for the $104 8 w p O following remon.(Section 7113L5,Business and Pmfcswinns Cmlc:Any city or county K m E' which requires a Permit hr construct.alter,improve,demolish.or repair any structure www prior wits issuance,alto requirexthe applicant forxueh Permit it)file a signed memment that hcislirenuua licensedunthe provisions nfthe Convacmw r'sLiccnLawfavirr9 3�6P3t81E'IR�A@B Valuation ag (commencing with Section 70lxq of Division J of the Business and Professions Code)rt y that he is exempt freeborn and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a forrou xuhjects the applicant in a civil Penalty of bUAPNNFTA PLUMBi sJU ENEFL(-46ccupancy Type not more roan five hundred dollars(S50% 506 — GAS TEST 0 1,as owner of the morally,or my employees with wages as their sole compensation, will do the work,and Me structure is not intended fir offered for sale(Sec.70,14,Business and Pmfcssions CWc:The Contractors License law does not apply to an owner or Fllilkl' equire nspections property who Guilds or improves thereon,and whodoessuch work himself or through his ,two employees,proeirlcil thm auch improvements arc not intended or offered for side.If, how eves the building or improvement is sold within one year ofmmpledon,the owner- �tf ILoS© builder will have the burden of proving that he did not Wild or Improve for puryme Lw of I sale.). 0 1,as owner of the property,am exclusively contracting with licensed contractors m NOV 1 9 2002 construct uhc project(Sce.7014.Business and Professions CodcJ The Convacter's Li cense,law docs not apply to an owner of Property who Wilds or improves themun,and who contracts for such projects with a contractnrod licensed pursuant to the Contractor's License Law. BUI DING lam Law. under Sec. .B&PC fm this reason o��./ 0� (VIA Owner Dale WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penally of Perjury one of the following doclarations: 1 have and will maintain a Cenifcafc of Coasmrt Itself matme,for Worker's Compen- sation,as provided for by Section 3700 of the labor Code,for the performance of the work for which Nis permit is issued. 0 1 have and will maintain Workers Compensation Imun ra ,as occurred by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Camcc Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This se,dort std not becnmplmcd if the rcrmit is Pororm hundred dollars(SIIgB less.) 1 certify Nal in the rerlummunce of the work for which this Permit is issued.1 shall not employ any posnn in any manner m as to become subject to the Workers Compensation Laws of California,Dam Amplicant NOTICETO APPLICANT:11.after making this Cenilicam of Exemption.You should become subject to the Worker's Compensation provisions of the labor Code,you must O 0 forthwith comply with such provisions m this permit shall IDI deemed revoked. 2 CONSTRUCTION LENDING AGENCY 'r. .N. I hereby of iren Nat there is a e0nswction lending agency lot the performance of CL7 the work for which this permit is issued(Sec.31N7,Civ.C.) a0 Lder'a Name p z Leacndcis Address ( /jGlkYsi IW' Y` J` i;J 0 1 certify drat I have read this application and state that the above information is U, correct I agree to comply with all city and county ordinances and seem laws relating to DU building construction,and hereby authorim reprmematives of this city to enter Dion the above mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against rliabilities.judgments,cents and exremes which may in any way aucme against said City U z in consequence of the granting of this not L APPLICANT UNDERSTANDS AND WII.1,COMPLY WI'III ALL NON.POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Sommer.orAppucan✓Comma or tam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building receptor store or handle baaandous material as dcti tied by the Cupci ino Municipal Code,Chapter 9,13,and the Health and Safety ,dWLOtho ends,s«tios n 25532125512(a)" All roofs shall be inspected prior to any roofing material being installed. ❑cc Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove mit hasallous air contaminants as defined by the Bay Atex Air Quality Management all new materials for inspection. istri t9 0Yes 0Nu I have mad the hasamom,mamrolsoo,iremems under Chapmr6.95of the Califnt- me health&Safely Codc.Sections 25515,25533 and2553J.1 umlemund then if the building does not currently have a tenant,that it is my msponodulay m nobly the occupant of the requirements which most W mel Prior to issuance of a Cenlfimm of Occupancy. Signature of Applicant Date D 7Owner or mutionved tgcm Date All roof coverings to be Class "B"or better