00110095 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
11.742 TRINITY SPRING CT JUST WATER HEATERS INC 00110095
OWNER'S NAME APPIACA'I'[ON Still DAf11
SWENSUN ,JOHN F AND BETH 01 1754 NATIONAL AVE 17./I7/2000
PHONE: (510) 293-9901 TROI.SANITARY NO. CONNO.
O a L ARCIII'f1iC'IYI?NGINf?I?R: ICHLDING PERNIH INI O
W OO❑ IILDG IfAiC'I' PLUMB MIiCH
FEW
6N
m LICENSED CONTRACTOR'S DECLARATION 106 DeSCfIIJ000
O1 herchy at imu
_ flat 1 am licensed under previsions of Chapter 9(commencing
with Sreian]IXMII of Divi,ion�of rhellusinnsand ProfusionsCod,.andmylicense
Y ] in in full hire,and'Iron.
a G Littnsc Cl;,,, Le.#
-
n 3 a D:,m can,mnir REPLACE 50 GALL GAS WATER HEATER
ARCHI'IECI"S DECLARATION
Ca g I understand my plans Quill be u.sal as public record,
�N
w a O O
Licensed Pndosiowl
Oat I an,c'eu t from
DECLARATION
I hereby xl Oren thus I 1 emmpt tram the Cessions Co Liannc law for the
C R which y ler ,I 7031 , anti ro Professions Any city nutty
ca D writ., I 1 It C I I 'It tl denulish.tar relator any so licome
a3$ pnuhanno is suu uv.oLo regi n-Otv uPl l'wnu I pe iuo I I 'b J.t roam
(comate cingwJpunuannolhcpmvisioM-3lithe nnorsl.inenmhav,iomCar4 Sy. FL Floor Area Valuation
(commencing ling wish Smion](gull of llivi'inn 3 lithe Amines unJ Pmfesions G,Jr)
or that he is exempt therefrom and the heti,for rhe alleged conniption.Any violation
of Section 7031.5 by any applicant for u Wmait subjects the upplump to a civil Penalty
of not more than five hundred dollars f$500). APN Number Occup' 1 i - e
El 1, ndnbc Pmpurya my cmpluy<c with wags as 1heii w,le eompen...lion. '
will do theLxirk,and the edunure is not intruded or chert.,inr sale(Sec.1044. 366c�117.13f.�
Bes,and Pndc,,i al,Gyle:'rhe Cammctor'Q License Law does nit apply u,u s ' 'K aired Inspections
r of propery Who builds or improves mm
eun.and who does such work him>df
it through his awn empli provided that such improvements are.,if I omi or
offered for sale,If.however.the Wilding or Improvement is sold within one year if 50'r' — FINAL PLUMBING ENERGY
completion,the owner-builder will have the burden of proving that he did not buildor
Inmrove for purimm of sale.). 506 — GAS TEST
❑I,as owne,A ria Properly,a.,. ,clu,i,el.c....ru ling will,rtaea.ul comm,,....la 507 — FINAL PLUMBING
,glmrl the ptnjcct ter,.704.Il„sines,and Prof..was Cndc!1 The Canmuhn's
i n
ieense law din•,ren apply to an owner el pro,ny who builds m improves therein.
and who contractsfor such pmjtt¢with a romumogsl pursuant the
Commemes Lieense Ina.
❑hamexempt under ser. .licensed1&P c for this reason
Owner ote
D
WONKER'S COM "rte A9lON DECLARATION
I hereby nitinn under l,enalkyol'licrjurvoloot the following declarations: ) I
O 1 have and will maintain a Certificate of Consent to self-insum for 0.orker'% Q
Compen,alion, as provided for by Section 37M of the IaMn Code, for the
per earminec of the work for xhich,his permit is inmN.
❑1 have and will maintain Wmkur's G....Namdon Imuran..,as required by Section
37110 of the l.ahor Code,fur the perbnuarec of,he wo.k tar which this pcnnil Is
issued.My Worker's Compensation Insurance carrier and Policy number ars:
Cartier: Policy Nu: I
CI?R I'119CATION OP EXEMPTION MOM WORKERS' 1
COMPENSATION INSURANCE
(Thi, eaion need no,be completed it the permit Is fur ane hundred dollar _
($100)ar Icso I
1 eerily that In the perinnnance N the work lin which thi,peon;,Is mood.1 '
,hull no,employ any Person in any nt r so as ,hil subject m the Workers'
Cnnpenvtinn Lm,of Coldomim.Dam u
Applicant
NOTICETO APPLICANT:If,after making this Ccr i ieate of Exemption,you should
Icfome subject m the Workers Compensation provisions of the Lahor C de,you must
O Q forthwith comply with such Provhiuoa or Ihis permit dint;he dee nod rrvoked,
{ r
ZI CONS9RUC'fION TIT
NDINO AGENCY
C1 hereby aftinn the,theca is a con,wctian lending agency far the Mdorinunw
.(,he work for which(his Permit is iswcd(Sic.3097,Co.C.)
L ❑ Lender's Name
7 Lender',Address
U O 1 certify thin I hose mad this uppllrvi at and vac that the aMnc information is
W, Hnen.I nonce to comply want all city rad county ordinances end'fmc laws nela0ng
O I,1 oat hnildingnaIntel nn.nmnatchynn,hanve ripm,nmlives el'n Ilk ehy iteater apart
r ty ,hc abovo-mealia led progeny lo,inspecron,purpa.eu. .
F d (We)agree It,save.indemnity; d keep hunnless the Cilyuf C.,rono agrinn
y Ratifies.)udgmenv.«Qts and expenses xhich may in any way accrue agains,.said
U 7 Cory.in...nscyuese of the orandng of this pcnnil.
APPLICANT UNDERFI'ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REOULA'DONS. y'
Slgnulua nl Applecan/Commnlo, Roe Re-roofs
I IAZARI)OUS MATERIALS DISCLOSURE
Will oneapplicant or future haddmg occupant case or handle hacadoas material Type of Roof
as defined by the Cupmmm MunmiPtd Gale.Chapter 9.12,..,[,he Health and Safny
CWc.Section 15532(.1]
❑Yea 0 N All roofs shall be inspected prior to any roofing material being installed.
Will theappiicant er future but ding occupant use c,mlonem of devices which If a roof'is installed without first obtaining an inspection, I agree to remove
emit hn'eardius air continni nems n,defined by the Huy Arca Air Qunlhy Manager rof
. Di'tdnr all new materials for inspection. Applicant understands and will comply with
El Y" 11No all non-point source regulations.
1 have real the hazardous di requirements under Chapter 695 o1'the
Culifomia Health k Safety Clete,Seniors,25505.35533 and 15534.1 understand that
ifthe Molding docs not offeedy have a tenure.,be,i,i,my rcspm.ihiliy m notify the
oceupum of the requirements which must he met prior u,i.....,ee of n Cmlficuc of
°rear i Signature of Applicant Date
Owne..,fault id„d agent - Dxa All roof coverings to be Class "B”or better
OFFICE