03010026 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRACTOR INFORMATION:
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BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT No.
10883 SWEET OAK ST 03010026
OWNER'S NAME: 1764 NATIONAL AVE APPLICATION SUB DATE
STUPECKY HAROLD E AND MILDRE 01/07/2003
'�. IONE: (510) 293-9901 SANITARY NO. CONTROL NO.
ARCHITECT!ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�Op LICENSED CONnsedorOR'SDExiomof hip Job Description
ON
ZP I hereby alum that 1 am licensed under provisions of Chapter 9(commencing �+ �,,pp�� 2D
<% wifellfeth mn]ggBnf Division 3nf the Business anJ Pndescinna CnJe,anJ my license is REPLACE WATER HEATER Irl®
F,Ovdi in full force onJ cflcct.
Tap DoLicwns.claaa Contractor
(40 GALLON GAS) 14 ZOOS
02— Daw lac.N tar
ARCHITECTS DECLARATION JAN
Yiy s I understand my plans Nall be used as public records
KOyU
til a W I.Icenxd Pnt'essinnn
OWNER-BUILDERexempDECLARAI Contractor's
ontr ON BUILDING
I hereby.flea Nal 1 1. exempt lata the Cessions Code:
License: nylaw lou the
lin 00 which ire mater.(Section]onstr Businessandmpr Professions Ca lc:Any city of county
w$� which requires;a PCril m mm�am,alter,improve,demolish,or repair any nacwre
r 2< prior In its issuance,also requires the applicant for such permit to file a signed stannum
gp5 that he islicensed pummnuo the provisionsofthe Contractor's License law(Chapter9 Sq. Ft. Floor Area Valuation
(commencing with Section 70xdof Divixkm3 ofthe Businessand professions Cnde)ar $660
Nat he is exempt therefrom and the basis far the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penally of APN Number Oe
not more Nan five hundred dollars(1510). ccu PanC Y'►YP
01,as owner of Ne propeny,or my employees with wages ss their sale compewtion, 32651034 . 00
will do Ne work,and the aWcture is not intended muffered outside(Sae.9144,Busiuras g�
and Professions Cork:The Caromm Dr's License law does not apply m an owner of 502 - FINAL FrL e .'R RGY
property who builds or improves thereon,and who deessuch work himaelfor through his 506 - GAS TEST
own employees,provided duration improvements arc not intended or offered for sale.If,
however,the building or improvement is sold within one year of eampletion,Ne owner.
builder will have the burden of proving Nat W did not Wild or improve for purpose of 507 - FINAL PLUMBING
sale.).
❑1,as owner of the progeny,am exclusively contracting with liccuued contractors to
construct the prancer(Sec.7014,Business and Professions Code:)The Contractor's Li.
canoe law does not apply to an owner of Propeny who Wilds or improves thereon,and
who contracts for such pmjeclo with a contmctor(s)licensed pursuant to the Contractor's
License Law.
❑ I sin exempt under Sec. B 4 P C for this ressnn
Owner Data
in WORKER'S COMPENSATION DECLARATION
1 hereby affir under penalty of perjury one of the following declarations:
I have and will mainloin a Cerificam of Consent to self-insure for Worker's Camped.
cation,as provided for by Section 3701 of the LaWr Code,for the perfoumanae of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as inquired by Section
3700 of the labor Code,for the performana of dw work for which this peril is issued.
My Worker's Compensation Insurance contact and Policy number are:
Comet:. Policy Nn.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mus acedon need not he completed if IM Peril is for one hundred dollars u 100)
nr less.)
1 certify that in the perfnrance of the work for which this Permit is issued.I shall not
employ any person in any manner sat as to become subject to the Workers'Compensation
Laws of California,Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should
We...subject to the Worker's Ciderammum provisions of the LaWr Code,you marl
O Z forthwith comply with such provisions or this petit shall he deemed residue,
z O CONSTRUCTION LENDING AGENCY
P `�' l hereby affirm that there is a construction lending agency lav the performance of
04 ?,t the work for youth this Permit is issued(See301 Civ.C.)
1140 Lender's Nam.
Z Lender's Address
O 0 1 unify that 1 have mad this application and slow that the aWvc information is
U. F correct.1 agree a comply with all city and county ordinances and safe laws relating to
0Ubuilding construction,and hereby authorize represearfaes of this city to enter rpm the
W shove-mentioned property for inspection purposes.
CL (We)agree In save,indemnify and keep harmless the City of Cupcnino against
r(n liabilities,judgments,costs and expenses which may in any way accrue against at City
U Z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS,
Re-roofs
Signature of APPlicoO Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future building e,Chapter
note of handle haramoanmaterial
as defined by the Cupertino Municipal Gide,Chafer Y.R.and the Health and Safety
,AELCadC,Sccti255321a)'!
to ON.
All roofs shall be inspected prior to any roofing material being installed.
❑Yes
1 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
mil haramous air contaminants as defined by the Bay Area Air Quality Management all new materials for Inspection.
Dimdcf!
❑Yes No
1 have re ad the hazamoas materials recomm rdsunderChapter6.95oftheCalifor-
at.Health a Safety Code.Sectimu 25515.25533 and 25534,1 understand that if the Wilding
utas not currently haw a moans,that it is my mopeamihiliry In notify IW racuPant of the
requirements which must the met prior to issuance of a Ccniticam of Occupancy. Signature Of Applicant Date
Owner or eamndxed agent Dam All roof coverings to be Class"B" or better