Loading...
01050173 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDING ADD ..w JUST WATER HEATERS Ijp4eNa. 01:050173 OWNER'S NAZI I:_EE ESTHER _ 1.764 NATIONAL AVE APPLICAr1DNSOTa`23L?^_001 PIIONG ._:(5;10) 29:,.,.9901;;1 SAN[LARY NO. CON[ROL NO. RUILDINO PCRMI'r INPo �reOO ARCHITIiCf/ERGINIiIiR: PLDO ELECT PLUMB NISCH ay 5 N LICENslaucnlvrencTORsD1!cLnlan'nON Job Description O Z— I hercM1y nftirm that I:nn lievnscd under proviriuns nl'Ch:aptcr 9(commcneing wdh Seea'm,,70O)oi Div con 3onite B-in .amt Prafea,nm.Cndn,Bad my Baa -RF_F\I_AGE .,40:,,G,ALL0N IWATER�-HEATER. _ �. Is In hill form and steel.ivi z 6 Ina"Class Lie,a e'o i U Dam Contractor iy 3 u ARCIRYPEr'S DECLARA'T'ION i"u C QJ 1 umdersmad my plans shall M ueerias puhiN mcard, a` Licensed Professional OWNER-HUILDER DECLARATION or 1 hereby affirm thin 1 con eacmpt from the Contractor',Liceae Low for the C ¢ rollowing Icaam,(Section 7011.5.Rashness and Pmfesraa,core:Any city or comity F wl y p r t t construct, n d lt n p y structure 3 pri t : ). r tl I pl l l 1 1 u I y J,atun5c n a. m'tpar,nan,to,pmvso aIthe Ctn,ut Ie Law Ieh.plery Sq. Ft. Floor Area _,__Valuatu die notarial,with Seentn 17(NX))ol Divismn Sof he Rosiness and Proteoians Cn Is) or that he is exempt thcremom and the nasis far me tllcgal esenptimt.Any vinlanon of Section 7031.5 by any applicant fora wood subjects the applicant to a civil pearl, tfnot mare tban five hmrml doill(5500)k APN J"uq�g04.© 00 Occupancy Type , ❑1,as ommer of the property,or any emPlovecs with%ages as their sole compensation. will Jo he work,and the structure is not intended sir offered for sale(Sec.7Oi1. Z❑u i es,and Profession.C«lc:The Contractor s License Lay.'does not apply man 502 — ,F I IgM2irN.l�gppfiM. ENERG V� orasr of property Who builds or Improves thereon.trial wIt,,does such work himself ,,h n. w pl y ' p dedmat. I top ,se t mends: tr -506 —. GAS TEST off I or sale,II It the hailding or arlaosear,arIJ within ime> ' r "am"Iction.the 1 n. wilt1 tire band t froom,III.,he JJ haddlo . 507 :-�FINIdLirvPLUMB'I'NG,/1 ❑I off pen) am estimbelycontracting with licensed ambachars t, Conshont the pial Ill 9ina business JI f._tn Cr 7ThContractor" L.en¢Ww Jon non apply m an in,me,of a nom y woo NdJs or improves rhereone and who comranx for such projects with a ammacbtgsl IiceaseJ pursuwr to the Commemr's License I Is, C lam escmpt under See. .HRPCfnr this rearm {• O/ Owns LateWORKHR'S COMPENSATION ULCLARA'IION Owner hercM1y affirm coder penalty of perPuy one of the t'ollowing declarations: �CI 1 have and will maintain a Certificate of Consent to elf iasu. for Worker's Contpenswion, as provided fur by S¢aon 37010 of the labor Code, for the pc IT.....c of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 37O0 of the LaMar Cole,for the performance of the work for which this permit is ssuedl My Worker's Compw satiun historian currier and Policy number are Carrier: Rdicy Nn: - CCRI'IIICATION 01:EXEMPTION VROM WORKERS' COMPENSATION INSURANCE (This section need not he completed if the permit is for one hundred dollar IS 100).1 less) 1 ccrtily that in the performance of the work for which this permit is issued.1 shall not employ any person in any manner no as to oceanic subject to the Worker: Compensation Laws of Califantit;Dam Applicant NOTICE TO APPLICANT:11:alter making this Cent little of EXeniption,you sho ld been... nobject to l In Wna ker',Conn,avauon"ovkimns in me Inbar Core.Y^u mu"t Q Ibnhwlla comply with such Inovi em or this permit.hull be JcmnN revoked. FCONS'T'RUCTION LENDING AGENCY 1 he.by.0ma mat there is a conamenim lending agency for the performance of the work for which this permit is mond(Sec.3097.Civ.C.) 0. Q 1<nJer's Name , D 7 Lender',Address _ V 1 cmify that 1 have read this application and an.that the aNve informminn is Gu [^r correct.[agree m en.nply with ill city and,army ordinances and state laws mluting C (.i ,saddling canstmaioaoval hereby aumorir.a representatives of th is city to enter firm IN uhnve-nwndinard Pu,inmy ror htgendnI papmel, .r 0. [We)agree to snc, ndmntit,and keep harm]...the CayolCupenino against ^ N liabilitiesjudgnwru,.oats:n,]cgansc,which stay in any way recnic again,said O ',L City in coniopreace of the granting of this.lennif. ^ APPLICANT ONDERS'1'ANDSAND WILL COM PLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Signature of Applicanvcommnor - Drat Re-roofs ITA%\RIIOUS MATERIALS DISCLOSURE Will the applicant or panic building occupant store or handle N,ardl material Type of Roof , as refined try the Cupeninn Municipal Ctrs.Chapter 9.12,and the Health and Safety Cole.Section 25512(:11' El Yes 0N All roofs shall be inspected prior to any roofing material being installed. Win metrp,heratormture N ildingmecrpamn.seeaiapolen,ordc�irr,wmeh If a roof is installed without first obtaining an inspection, I agree to remove nit hemNo.,air corm ain: 1,as all by the tiny Arca Air Quality Afanagemem Dt.tnero Nes 13 No all new materials for inspection. Applicant understands and will comply with all non-point source regulations. 1 have read me hvxrinos materials requirements under Chapter 6.95 of the Cal morin Realm k Saler,Cole.Scedom'_5505,M333 anal 25574.1 understand that it the building does rot eforemly have n board.thin it is my.......mility to notify the ectpanr of the mquiaanents which Trust he stet prior to issuance of Certificate of O"apant, Signature of Applicant Date Owner a aumod,udagem Dare All roof coverings to be Class •B"or better OFFICE