03090023CI'1�1 OF CUPER'fINO
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BUILDING DIVISION PERMIT
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CONTRACTnR INFORMATION =.
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BUILDING ADDRESS:
HOT WATER INC
PERMIT"903090023
.R'S NAME:
2531 GRACELAND AVE
PERMrr Issue DATE
NE:
(650)298-8494
SANITARY NO. CONTROL NO.
ARCHITECfIENGINEER:
BUILDING PERMIT INFO
,.
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACnOR'SDECLARATION
Job Description
1 affirm that I em licensed under provixiom of Chapter 9 (commencing
p
o.70
with Section Divlxion5of the Business and Profeasians Codc, entl mylicenti is
ndOfof
L¢enlw Crux and err Lic.N 4 Z six,
WATER HEATER
DateCummctor
FINALE®
A CHITEJ DECLARA ON
1 understand my plana shell W used as public records
SEP 15 2003
Licensed Profcasional
OWNER -BUILDER DECLARATION
1 hereby aHlrm that I am exempt from the, Contractor's License Law for IW
following re mn. (Section 7131.5, Business and Prefesiom Code: Any city or county
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Which rtyuir a Permit to construct, elect, improve, demnstructstructureL
lixh, or repair any se
• •
prior to its issi onec, alm meant. the applicant fonuch Permit m file a signed movement
that he islicensed Pusuan90 the provisions of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7") of Division 3 of the Busincm and Prurrasiam Cade) or
that he la exempt thaefmm and We basis for the alleged exemption. Any violation of
35928004.00
Number
Occupancy T
p y ype
Section 7031.5 by a, applicant ver a panni a Objects the applicant m a civil pcnalq of
not more Nen free hundred delta. ($500).
_APN ----- —
- —
❑ I, as owner of the property, or my employees with wages as their sole compensation,
502 - FINAL� �j I c FRGY
will do the work, and the structure is not inrendcd or Offered Waste (Sec. 7094, Business
Proresions Code:
and The Convector's License law does not apply m en owner of
property who builds or improves thereon, and who doesauch work himselror through his
506 - GAS TES
own employees, provided that such improvements are not intended moRered formic, If,
507 PLUMBING.
however, Ne building or improvement is sold within one year of completion, the owner
-.FINAL
builder will have the burden of proving that k did not Wild or Improve for purpose of
sale,).
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7W, Business and Professions Code:) The Contractor's Li.
cense law does not pply to an Owner of property who Wilda or improves themon, and
who contracts for such projects with a conwcmr(s) licensed pursuant o Ik Contractor's
,
License Law.
❑ I am exempt under Sec. , B k P C for this moon
er Data
WORKER'S COMPENSATION DECLARATION
_.. ... .. _.-_
I hereby eRiorn under penalty of perjury one of tk following declarations:
I have and will meinuine CcniOnm of Consent no tiff-imurt Camper.far. WoCompc
_.
action, u provided for by Section 3700 of the labor Code, far the performance of ft
_. ..
work for which Nis pennu is ixxucd.
❑ I have and will maintain Worker's Compensation Insurance, asmyumed by Section
of the work for which issued.
3700 of the Labor Codc, for the pe((rit
y Workcr'sC onifffoy9oogrreemance Rth/s�rmit3s
MY'canior and Policy
aERS'
EtsTIPICA FEXEMPI'ION FROMW
COMPENSATION INSURANCE
(This section need not k completed if IW Permit is form= hundred dollars ISI0f0
or lest)
1 unify that in the Performance of the work for which this permit is issued, I shall not
employ any p. a in any manner an az to Wcomc subject o the Worker!Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: IL after making this Ccnifieave of Exemption, you should
become mhjen to the Worker i Compensation previsions of ore Labor Cede, you mum
foMwith comply with such previsions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm out there is a construction lending agency for the performance of
the wart for which this permit Is issued (Sec. 3097. Civ. C.)
Lenders Name
Larder's Address
I certify that 1 have read this application and slow that the above information is
correct. 1 agree to comply with all city and county ordinances and amts laws relating to
building construction, and hereby andamire hapreseneaeivesof this city to enter upon thc
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
Hatt itiea, Judgments, casts and expenses which may in any way accrue against mid City
in conmenence, of the grants ng of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCEREGU 0�J o+ 03
I/
Signature of Appli m/Co trmmr I Data
Re -roofs
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or ruwre Wilding occupied at= or handle hazardous material
,
az Outlined by the Cupenino Municipal ode. Chapter 9.12, and the Health and Safety
c.So 25532(.)7
All roofs shall be inspected to any roofing material being installed.
❑ Y. y. u
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future Wilding occupant use equipment or devices which
R hazardous air contaminants as JclpcJ by IM Bay Area Air Quality Mmagcmcnt
all new materials for inspection.
suict7/
❑ Yca
I have mad the baardnuemamrials reyuiremens under Chapmr6.95 of the Collar.
'
n do Safety Co@, Sectium 355(15,15533 and 25534.1 understmd dyad the building
Once not currently have a resent, that it is my responsibility to unify tk acepam of dee
reyuncmcmx which,mun met poi aiamarecoracemraam ora ver. O
Signature of Applicant Date
All roof coverings to be Class "B” or better
O
wrier Or aalhoriin agent D m
eCITY OF
cUPER,TINO
t
CITY OF CUPERTINO
WATER HEATER
PERMIT APPLICATION FORM ��� 3
APN # 2 J `� — 0-
o v
Water Heater/ Vent
Date: O O3
PPERMITFEE
Plumbing Permit Issuance
PLUMBING
Building Address:
Energy
BUILDING
BUSLIC
Business License
BUILDING
Owner's Name:
% 0 jtgiZr
Phone
OP�2)
Contractor: Phon
�/� Wi4i,2� SNL
&P
Licen e #:
Contact: Phon
:'
Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect ❑
Plumb
Mech ❑
Job Description:
W 7�t. IZ�cGx/JG�i/h/s'�v�
Residential Commercial ❑
Cost of Project: 6�
Strapped ❑ On Platform ❑ Bonded
❑
New Location ❑ Re lacement
Qty. iff \
Appligaple 1 Fee ID
Fee Description
Fee Group
BPWHEATER
Water Heater/ Vent
BUILDING
PPERMITFEE
Plumbing Permit Issuance
PLUMBING
BENERGY
Energy
BUILDING
BUSLIC
Business License
BUILDING