02120057 CITY OF CUPEW11Np
BUILDING DIVISIONR'I
PERMIT C0NTRACTONFORMATION:
oda wk. 2
BUILDING ADDRESS: JUST WATER HEATERS INC PERMITNO,
20580 VALLEY GREEN DR 02120057
.OWNER'S NAME: 1764 NATIONAL AVE APPLICATION SUB DATE.
GEORGE K. SALON AND SPA 12/13/2002
orONE: 51 O 2 93—9 9 01 SANITARY NO. CONTROL NO.
ARCI IITECrIENGINEE.R: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
oee� l� 0 0 0
Lroo LICPNS[DCONnsed under
OrproviCons ofCON
I hereby qof tont 1 nm of the
under ndProonx ofsCode,ry(commencing Job Description
with Section]IXMB of Division J rf the Business and Professions Code,and my license is
io lupin eandeffect, REPLACE WATER HEATER
z' Licence class Lie.a (5 0 GALLON GAS)
For❑ Dam TS DECLARATION QQ� As 0.11 LOTS DECLARATION
��eZ� lundcrsand my pions Nall he used es public rtcnNs
FAQ Licenacd Professional
DWNIiR-BUILDER DECLARATION
y Y I hereby Atirm that 1 um exempt from the Contractor's License Law for the
i a o O following reason.(Section 7031.5.Business and Prnfcssinns Car:Any city ase county
$ which requires a permit u,cataract,alter,improve,demolish,or repair any structure
FI„ priu to its issuance.also requires the applicant for such Permit it) a signed statement
ppmm< that he is licensed pursuant nthe provisions ofthe Contractors License Law(&pwr9 Sq. Ft. Floor Area Valuation
y+F$ (commencing with Section)gg1)of Division 3 of the Business and Prnfcssinns Cade)or _ $777
— Nat he H exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of limber Occupancy Type
not more than rive hundred dollars(s50 ). r0 4 . r O p y yp
p I.as owrmr of the property,or my employees with wage as their rale compenWicn, .ss�4
will do the wok.and the swarure is not intended or offered for sale ft.*7§d/,Bu 1i esti` g�, (, ,,
and Professions Cram:The Contractor's Lic Ira} does I apply m A! win of" — INAL Y'L �eZ'"LSl f;i(GY
prspcnywhohuildsmill les thercn a doe chs khimrelfonE all is
own cmployces,providcd that such imp emenu even tmmndedorolferedTB�axle. L t�o6 — S TEST
however,Ne Wilding or improvement is Id within one year f comfit(��a`fIIIppjdtto
builder will have the humero of proving or inty}fulps 'r NAL PLUMBING
cam.).
CO] 1,es owner of the property,am eaclas ly contnni with contractors to
contract she project(Sec.7844,Business i Cade: c Conraetm's Li-
clean Law does not apply m an owner of p n uilds or improves theme .and
who contracts for such projects with a comractroho licensed pursuant to the Conractor's
License Law.
p lam exempt under Sec. ,B&PC for Nis mien
Owner Date
WORKER.$COMPENSATION DECLARATION
1 hereby a0i.under penalty of perjury one of the following decimations:
p I have and will maintain a Cenifcare of Consen to.selGinsum for Worker's Compen.
satian ns providcJ fur by Sminn 3]W of the Tabor Crdc,(nr the perfmmad.of the
work for which chaperon is issued.
p 1 have and will maintain Worker's Compensation Insurance,as acquired by Section
3700of Or Labor Codc,far the performance of the work far which this permit is issued. -p ,N
My Workers Compensation Insurance carter and Policy number are: �V
Cartier: Polity Ism: �
CERTIFICATE EXEMPTION M WOF SATIONINSURANCE NPROORKERS'
OMOF
CNSUR
cons seldom need nm becomplerd irthe lcrmit is mr-unc hundred dollars nI W)
nr leas.)
I certify that in the performance of The work for which this permit is issued,I shall not
employ any grown in any manner an ono become subject o the Workers'Compensation
Laws of caGfomia.Dam
Applicata
NOTICE:TO APPLICANT:11.alter making this Cenilicem oIEsemptime,you should
become subject to the Worker'Compensation provisions of the Labor Code,you must
O z forthwith comply with such provisions or this permit shall be deemed marked.
z CONSTRUCTION LENDING AGENCY
N+ I herebywhich this
Nat Nercivcnn(See. 10 lending7,cagency fm the performance of
pi ► the work for which this permit is issued(See.31097,Civ.C.)
R1 Lender's Name ._
z Lender's Address
U O 1 certify dal 1 have read this application and state that the above information is
IL H correct.1 agree to comply with all city and county ordinances and state laws relating to
O U building construction,and hereby immorive mpmacnadona,of this city to enter upon the
n7 abnvcmemioned property for inspection purposes.
C (We)egme rose..i ndenni fy and keep harmless the City(If Cupertino against
V) liabilifirs.judgments,costs and expenses which may in any way acerae against aid City
U z in consequence of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:S4U�k6 Date
SOURCE REGULATIONS.
Re-roofs
Signature IdApplicargCondrichor Dam
HAZARDOUS MATERIALSdinRIDISCLOSURE Type of Roof
Will theapplicantuse Muni building te.Chapter 9.1ore 2,and
the
Health
md material
as defined by the Cupertino Municipal Cade.Chapter 4.12,anJ the Nealth and Safety
afe.Sec den 2ss)2(a)P All roofs shall be inspected prior to an roofing material beim
❑Yea polo P p � y g g installed.
Will the applicant or future building a:cupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
mit bxardnus air contaminants as derincd by be Bay Arca Air Orality Management all new materials for inspection.
t District]
❑Yes 0 N
1 have read the havamnus materials requirements under Chapter 6.95 of the Califon
ria Heald&Safety Cale,Sections 25505.15513 and 35531.1 understand that iflM Wilding
dins nal carcmly have a mmol Our it is my resp namility m ami 11 me cecupam of Oc
requlmmems which mast he met'Hill III is...of a Cendicam of Occupancy. Signature of Applicant Date
Owneror amhorimd agent Dam All roof coverings to be Class rBr Or better