02030141 TY OF
CIBUILDING DIVIISSIIONN� PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10282 TERRY WY JUST WATER HEATERS INC 02030141
OWNER'S NAME: APPLICATION SyB DATE
JOE WING G AND KIT F ET AL 1764 NATIONAL AVE 03/25/ 2002
HONE: (510) 293-9901 SANITARY NO. CONTROL NO.
nO O ARCHITECT/ NGINEER: BUILDING PERMIT INFO
s w C BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
6 v, I hereby affirm that I am licensed under provisions of Chapmf 9(commencing Job Description
'yCm win,Seet..7000)afDi,iai.b3anb,Bmina.,.anePmfd,irmvCode.andmylicerm REPLACE 2 WATER HEATERS .
'am htll fame and effect. (40 GALLON EACH) FINAL
E®
ie 6 is inLicefull
Came Lic.b
O n O Date Canaan a
130, ARCHITECT'S DECLARATION
u O¢ I undemend m hall be use) public record.,
my as pu
r APR 15 2002
i as p O Licensed Professional
e OWNER-BUILDER DECLARATION
^_ I hereby u1Brm that]am ao,nnn from the Commcmis License Low forth,
t=za following remain.(Section 7031.5.Business and Professions Code:Any city or county _ Bgig
F O which req a Permit t c onduIt improve.demolish or rept r any structureYV�LD ��I
a, 0 prop t w also theapplicant for such permit to Gla a signed statement_ - - __.. __. _.
that q p'licensed p lauein to the mvisions of the Contractors License Law(Chapter v
(commencingth Section 711(0) f Division J of the Business an Profe sions Crate) t\'•"'?'t' Sq -Ft.iFloor Area„ f 5 1 r p, Valuation
or that he is xempt thcrefrbm and the basis for the alleged eanppti&c Any violation t •'y v c; i n l J o\ v�s _
of Section 4031:5 by any applicant for a permit subjects rise applicant to a civil Penalty
of not more than five hundred dollars($5«p. APN Number11
1
't- Occupancy Type
01,us owner of the property,or my employees with wages as their sole compensation, S02 — FINAL. PLUMRTNL PINERGY
will do the work.and Ne awctura if not intended or offered for sale(Sec.71134,'
Business and Professions CWe:The Contractor:,License Law does not apply to an 506 — GAS TESRequired Inspections-- '
owner of propcny Who builds or improves thereon,and who docs such work himself ,
or through his own employes,provided that such improvements am not intended or 507 - FINAL PLUMBING
"offered for sale:lC howeveT.the Wilding lir improvement is sold withinond"year of - """""_....__.._._.._. . -__...__ ._-_-. ._ .._ ___-._..
iompletion.the ownerbuilder will have the burden of proving Nat he did not build or
mprove for purpose of Gale.).
.._... ._ .. .._..__. Cl
._ ____ _
co L us owner pr the pmpc.7, ausiness a contmctiog with licensede Contractor's m .11 construct the project(Sec.71.i Business and Professions Code)The Gmtmaom, .
License Low don oat apply man owner of property who builds or improves t to she
_and.who contracts for.such projects. .- u.contmnor(s)licensed pursuant to she. _
-
Contractors am axe License Law.
- ❑I em exempt undci Sec. � ';B&P C for this
_ (),an,, . Bite
= ..
WORKER'S COMPENSATION DECLARATION
I
A •t 1 hereby affirm under penalty of perjury one of the following declarations:
i 0 1 have and will maintain a Certificate of Consent to self-inmm for Worker's
p Compensation, as provided IDr by Section 3700 of the Labor Code, for the
_ performance of the work for which this permit is issued.
°I have end will'mainuln Worker's Compensation Insurance,as required by Section
37W of he Lobos CWe,for the performance of the work for which this pcnNt is
issued.My Workers ComMnsatian Insurance easier and Policy number me:
r ._ ...- .-
Cacti f 1}./ p [ s PAIicy No '.
CERTIFICATION OP E%EMFTION FROM WORKERS"f" �" - a •4 I`t- 15° 6°l l l!t
'COMPENSATION INSURANCE
"
-it(This section need oat be eomplcted if the permit is for one hundred dollar tk
(SI00)or less.).
1 ri fy;hat in the perf ret ce n the ort for which u ct sh s sued 1 I� i
shall not employ any of California.
any manner so az m become subject to Nc Workers'
Compensation' Lvws o-California.Date
Applic
NOTICE TOAPi die WeT IL after making this C<niGcate of Exemption.yoq should . . t
0 Q becomeh'comp y the Workers Compensation Permit shaof the Labor raveled.d.must
forthwith'comply with such previsions or this permit shall be decreed rtvoked.
CONSTRUCTION LENDING AGENCY
> I heieby affirm that there is a construction lending agency for the performance "'s
W u..t of Nc ancokforwhich this permit iissued(S c 3097 CCJ ... _ .. ..___._.._. ._ .. .. .. .. .....
a,Q Lind Name'
Lenders Add curt
I cagey that I have read this itcity
and on any store tom the above maws relati n CiJ/ Vl• (\,1N�n
W E.,
correct I Wildingagree to comor comply with all ant and county ordinances and state laws refuting
0 V to,.mv-mentisedproperty hereby inspection '"'
repreumativn of Nis city to carer upon
� W the ebovumentioncd property for mspcnionpuryoacs
y liabilities,
0. Wefagrcc to save,my and keep homeless the C of Cupertino against �/1 f. �`tti
. jodgmenta coats ad
,, which may in any way acemem sa
.,ain't
i n of this
d •^�
SOURCE
OURCE REGUL HOTS:DS AND WILLCOMPLY WITH ALL NON-POINT ' !
soulicEREGULAnoNs: ^';.'" �. - " Issued by: Date
slgnawrq of ApprcemICnntractnr.. "'...""•" .. Date" Re-roofs
HAZARDOUS MATERIALSDISCLOSURE Wit the pplicant or fumrt Wilding ovelijimin mort or handle hiscrdent roacensd .,Type Of.Roof _ -. __ _ -
as Jcf ed by theC pan o Municipal'pal Chapter9.12,and theHealth d Safety, - -
CWcSano 255)1.) - - \ •. .
❑Y: 7th ;I I I; ,"All roofs shall be inspected prior to_anyroof ng material,being installed, .
Will the pplicam in-,,tbuilding p t eequip e t devices which If a roof is installed,without first obtaining an inspection,'h agree to remove
cm t"b icardous a r mamm unit as def ed by N B y A A Quality M gbmcm
Clinics? all_new materials for inspection. Applicant understands and w_ ill comply with
°Y °" all non-point source regulations.
lM1a,e read'he haaalloua materials regmmmrnu under Chapter.6951of the
California Health'&Safety Code.Sections 25505:2553]and 25534.I understand that
-if the.Wi lding does not currently have a tenant.that it is my respansibilfly to notify the" -
occdpant of the requirementswhichinusbbe'met prior io issuance of a C,nifcate of
Occupancy..-' -
..
(' f Signature of Applicant Date
owner orauthori,ed agent " -' D,tn. All roof coverings to be Class "B" or better' .
._
t, .. .. —.-- - - -
ea.•. t t _ . ' OFFICE
, .. 1 . . -_. _ �,_ ... ._. . - i ., • . ... - • fir. ,