02090158 clBUOF
DDIVISION
I PERMIT CONTRACTOR INFORMATION:
LD ,n±DD'18ffGGLE AVE WATER HEATERS ONLY PeRMITOgv�0g9001115g8
3'Tlf91`(3IMF:DEIGHTTON 970 E. MAIN ST, SUITE 200 APPLICV!gjS2y c002
PHONE: (415) 566-2209 SANITARY NO. CONTROL NO,
O O O ARCHITEC iENGINEER: BUILDING PERMIT INFO
z❑ BLDG ELECT PLUMB MECH
6 r-- U I— L=.1 L_-:]
z�y= LICENSED CONTRACTOR'S DECLARATION g REPLACE WATER HdAbi+�F P
I hereby affirm that 1 am licensed under provisions of Cha ter 9 mommencin Crl tion
Fy�w with Section700n)of Divivam3 ofthe Business and
dPPrromssions Code,and my license f�
SYR is in(ul force arr _1 V5 ,7
/G
d re0 i U License la Lic.p ✓ / /aJ YY (f V3 j /a�/SYk
Dae Cummmn
¢_.00 ARCHITECTSDECLAR TION OC
a y I Professional
my plans shall be axed us Public records T 0 8 2002
iE a p O Licenced Professional
o E.� OWNER-BUILDER DECLARATION 1, 1
so 1 bemby aRrm IM1a 1 am exempt from the Contractor's Lt...Lsw for the
BUILDING�g�D��
F < following....(Section 9031.5,Business and Pcotbssions Cada Any city or county 67 7 0 O
E F❑ which requires a permit to consumer.shoe improve,demolish,or repair any structure
�3$ -primmits,' also restores the applicant for such p<rmtto file asgned statement.
thbt ere t}Isensd pu a ft0 the p_ sionz of the Conuacmrs Laeme Taw(CImpmr9 ``.�kl e Valuation
momme c givIh Sect ,701Xu. f Division 3 of the Business peri Pmfia'sone Code) C 1, \ 1 1L�\s..'i 0l)
or mai he is 2aempi Therefrom arta Ne basis for the Alegal ekerrom.Any wistim
-of Section 7031.5 by any appliesta for a permit subjects dam applicant to a cine Penalty
of Type
;of not mom Nan five hundred do an(S50)(1). Af'N
01,asoWnor ofthe o,arm Ir thwa mebso!ecum tion, 506 - GAS TEST
Props Y Yemp yeeswi gesm penin
will dome'work;aad'Ih Code:no Is noYiamndW Or License
Law for sale apply
toaa,- "- --------
•owner ss'property Who
Calc:The Contractor License Law s such
not apply m an nspec[ions`•` " • '
owner ofpropertyhim ow Who loreds or improves provided
that
such improvements
who encs m n work intended
or
lf
or through hie own employees,provided that sucM1 impmvcmenrs are not imm�ded or
---------
'Completion,
Co option stheewIf.Howevowner-Wn.ilder
l havethe burden vemem n s that
within'oneyear of ,•II V::`v' r,r.-n
m
improve
the owner-builder will have the burden of proving @aI M1e did not buil)or
improve for purpose of seleJ.
r _,--_._..__.__
the
_ _ p E as owner.facim (Sm.7 am Business
contracting with CWlicensed The Coacmrs m _ _(]'•i lUt•'C''\is.
constr- - - Licensee)Law
does
n f5a.'LOLL owner o and Presorry who
Code:)The improves
theroi s
and-who
Law d«s nut apply m an owner of property who builds or impmvcs thereon,
5 = .and who somans for- .pmjeers.with a.conucmrtsl.Iicenud.pursmnLo.he. ...._.__._..._._ . ............clic.
C mcmYs License Law.
❑1 am axe In un der Sec '` .B&PCT this reason .t'I'. t )-:�"'�i'O❑
r Data
ti%t1,,eno c WORKER S COMPENSATION DECLARATION -
'I'laureby aRrm under prnalty of pep ry,nine of the following declarations-❑ I have and'will'malmain'd Ccoificale of Cdneent'to self-insure for Worker s
Compenaaion.-m ro
pvidN
for by Section 370D of-,ha Labor Crdq for the
- -- _ Performance of ihe'work for which this permit is issucdi,Is,.
`1$4 have andvill maruinWorkcr's Coniper,alion 1 m 1 inquirxdbySoaom
p700 of[be Labor Cal fial(ther pedurrounce of the-work'ficar which.thismot is
.. dMyW k t 1 ,�ancc carrier andPolicy number am
Carr s �'doli YNn ��J
1 •Ch,j,F C CONPOFEXEMPT)AA WORKHRS1
MPENINSURANCE
.t
TION I ...
""'(Thirsenion'rieednoi ticcomPlciaJ i(me permit Le for one hmulrce Dollars ,list,Ar 7,`'Ii716L. sPl ...ss( ,5111 C_✓l�'U'
+(Slfhp or to
_u.,.,. n.,.�... -. ..... .......care. . .....,
-dia Icertify,ltr t in pen any hr d'f which u d to t Worke I -
�s. _ .- m ..� 1•_ 1 sl, 1 iwJl l!Iry .'
C ml m employ Laws
at on m,D nano us to hesitant,suh)ea to the Workcn'
CnmPemainn Lows o(Cali forma.Doc
_ ._. ___....._ _ .._ .. ___ecce
„ 'mpking lh 'CmiO<ambfE emPt o You should
_ _ .. ..
NOTICE s','Il ss " ' ,•
hccmneh xomvd Me such pr Cortins or ti is pmvie m�or the Calla Code,you must
u .
00 forifiwitn comply with such provisions or this permit shall be deemed mvukcJ. '
_.
F,;VJ c' ICUNSTRUCTION LENDINGAGENCV ', ' J " -R`I : 'r0
1 h reby_Rrm that there n a oaomnl i lending agency fo the pe f rtes ce -•L,' _ r •P+
�;r �ofdre wok! tich lhspemtsssueJlS i09TCive CI
------__ .,____.,..,., ,
a`
Leader's Addres
loi 1
U1'0 .•lcenify Iha l have rind this appli<aion and store that the above information is
W;Fs 'rarest.I agree to comply with all city and county ordinances and,state laws relating
0eu uilding carotmltion)mod hereby iahurite mposedmtives oflhis citYto enter upon
therebshave-inemioned property for Impaction pwyoseS,,,..
-41 IWO agmc m.save:indemnify and keep harmless the City of Cupcoino against
lin habilities,judgmems,costs snit expenses which may in any way accrue aloins,said
V Z City inconmq eaceofth g Ing of this pc t.
'.\PRLICA VI'UNU RS IAJDS' LL COMP YWITH\ELK N:POI Issued by; Date
SOUItCE'REGULATWNS. s
Signature of ApplicanVCammct " ' ;j-"" ' ,',,,,I rc;�}} Re-roofs
t` NAZ\RDO MATERIALS DISCLOSURE '
ill the applicam or future bolding occupant store or hanJle bawrdosammnad _ T f-Rf
as denied by to Cupertino Municipal Cod Chapter912,all the Health and Safety yPe.Ooo
Cod s imo 5532(x) I r 'liar e I' Iv ;.ti l yti,r;� 'f!1 t '�'ti} ,,
❑Y<a " t + t ....All roofs.shall be.tnspected prior.to.any.roofing material.being.installed._
.
Will thenal 'SIT •-
.... m.._- e 'ry -
I ., DP revert err furore boilers IYSC meat or devices which •
Wilding he
e9mP If a roof is ms[alledl'wlthout firs[obtaining an'mspec[ion;I'agr8e`to remove
emitict? us air conmminanu a4 Defined ny'Ihe Pay Area AirQmlity htanagemem ,
okraec all new materials for inspection. Applicant understands and_ will comply with._
❑Y ;e-n� -' '-' .l all non-point source re ulatBm$
1 have sad'the hdzaduus.tramdalz rcgmrcmrnts rosier Chapter 6.95 of the
California Health&Sel'ety Code.Sections15505.25533 and 35536.1 nndeound that
rflhe bu ld g does nor c rrently l a e a mount that it is my rt pons b llY to notify the
c 6t f the req re m h h muco be t p to issuance of Certificate of
Oce Pa lice
Signature of plicant Date
f Tanen raea_ag<t "'Dat All roof coverings to be Class `B" or'better
F..
....::r, n..�...•-.•iti= _' . ., _.... _.m _ . _ _ .,,. __ ... .... .- -- " -OFFICE