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02120095 CITY OF CUPEWFINO -" 'BUILDING DIVISION PERMIT CONTRACTORINFORMATION:. lw .x . w- a�y __ xrsuy .tom BUILDING ADDRESS: JUST WATER HEATERS INC PERMITNO. 21607 VILLA MARIA CT OWNER'S NAME: 1764 NATIONAL AVE APPLICATION SUB DATE YEH YUSUNG W AND CHI 12/26/2002 (DONE: (510) 293-9901 SANITARY NO. CONTROL NO. ARCIUTF.0(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 �o Zp LICENSED CONTRACTOR'S DECLARATION m u P 1 hereby affirm that I an licensed under provisions of Chapter 9(commencing Job Description with Section]000oof Division Sof Ne Busmessand Protestors Cnde,and mylicemeem in full force and effect. REPLACE WATER HEATER qg l.ieensc claxa ue.a OZ�, Dal Conraram (75 GALLON GAS) ££� ARCHITECTS DECLARATION C1understand my plansshall be usedas public records npyV FLLOt; Licensed Pmfossionai g OWNER-BUILDER I BUILDER DECLARATION nF 1 nasoereby.Sect that 1 1. cBusin from the Casions o License Law for the p o which ire requires 4 (S=t 71n1 5,Business and improve. demolish. Code:Any city of county a' $ which requires a pemst ha umswm,alter,improve.demolish, file repair any structure prior m its i lice used p also harpoons the the applicant for such permit w files signet summem (commislicensed puremnt mthcprovisions sion of the d,bror's License Law m(Chapter 9 Sq. F[. Floor Arca Valuation (commencing with Sectlnn7lkkl)uf Dlvisinn3ol the Business nnU Pmfeaslnns Code)or $1675 y $ Na(he is exempt there(rmn and the basis for the alleged exemption.Any violation of Section 7031.3 by any applicant for a Permit subjects the applicanfto a civil Penalty of APN Number Occupancy Type not more than fin hundred dollars 1550% 3 5623064 . 00 ❑I,as owner of the propcny,or my employees with wagem their sole coo eniation, will do the work,and the shucwm is no(intended os offered for In(See7844,Business $�pp�y� [sy�p ��,1��p�,, and Professions Code:The Commutes License Law does not apply to an owner of 502 — FINAL YLwt�i eY�7V tRGY property who builds or improves thereon,and who does such work himselfor through his Own employees,provided that uch improvements art not intended or offered for sole.If, 506 — GAS TEST however.the building or improvement is Mid within One year of completion.the owner. builder will have the burden of proving that he did not build or improve for purpose of 507 - FINAL PLUMBING sale.). ❑1.as owner of Ne progeny,am exclusively emardi ing with licensed contractors to construct the project(Sec.7044,Business and Professiom Code:)The Comracmfs Li cense Law does not apply to an owner of property who builds or improves thereon,and L'@� �� who contracts for such projects with a contracmr(s)licensed pursuant N o the Contractor's r 13 License Law. ❑I am exempt under Sec. .B@PC for reason .lAN .O 3 2003 Owner Doc WORKER'S COMPENSATION DECLARATION 1 hereby aBirm under penalty of perjury one of the following declarations: BUILDING I have and will mai main a Cenilicam of Consent to self-i nsure for Worker's Compcn- 7c, inn as provided for by Section 7700 of the Labor Code,for the peRonnamea or the rk for which his Permit is issued. I have and will maintain Worker's Compensation Insuranceas required by Section fk1of the Ichor Calc,for the perfnrmanccof Ne work for which this Pchmit is issued. y Worker's Compensation Insurance carrier and Policy number are: rtier: Policy Na: _ CERTIPICATE OF EX EM MON FROM WORKERS' COMPENSATION INSURANCE This:ectilm need nut be completed ifuse permit is(orae hundred dollars(5100) Or less.) 1 ecnify Not in the p ummaanec of the work for which this Permit is issued,1 shall not employ any person in any manner an as in become subject to the Woders'Compemation Laws of California.Date Applicant NOTICE TO APPLICANT:IL after making his Ccnificam of Exemption,you should become subject to the Worker's Compemation provisions of the Labor Code,you must O Z forthwith comply with such provisions or this Permit shall be deemed revoked, Z O CONSTRUCTION LENDING AGENCY [-+ I hereby alarm that there is a construction lending agency lin the Performance of aiti the work for which this permit is ironed(Sec.3047.Cis.Q W Q Lender's Name :D z lendeis Address V O 1 certify that I have read this application and state inat the above information is L IGYV�. C4 F correct.I agree to comply with all city and county ordinances and state laws relating to QU building construction.and hereby authnrim mprcsenmtives ofthis city to enter upon the Ualcove-memloned property for inspection purposesuJ . (We)agree to save,indemnify and keep harmless the City of Cupertino against Cary liabilities.judgments,costs and expenses which may in any way accroc against said City V Z to consequence of the 6ronfngof this permi t. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs HAZARDOUS Signature of ApplicaDoc HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant Or m)future building e,Chapter entre or handle Health addSafrmaterial m Ucfincd by the Cupeninn Municipal Code,Chapter 4.12,and the Ilcallh send Safely IMLCM..Seaton 255321.)] All roofs shall be inspected prior to an roofing material beim Installed. ❑Yes ONO P P Y g g 'l Will the applicant or furore building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove (mit handous air contaminants as defined by the Bay Area Air Qual fly Management all new materials for inspection. District? [:1 Yea 0N I have mad the haaardous materials requirements under Chapmr695 of the Califor. nia Health S Safety COak.SeetO.25505,25533 and 255M.lundcrsund and ifthe building does not currently have a mount,that it is my resphmibility in mildly the Occupant of out mgofrements which must he met prim to issumn of a certificate of Occupancy. Signature of Applicant Date Owner orauthorieedagent Date All roof coverings to be Class"B" or better CITY OF CUPEWFINO -" 'BUILDING DIVISION PERMIT CONTRACTORINFORMATION:. lw .x . w- a�y __ xrsuy .tom BUILDING ADDRESS: JUST WATER HEATERS INC PERMITNO. 21607 VILLA MARIA CT OWNER'S NAME: 1764 NATIONAL AVE APPLICATION SUB DATE YEH YUSUNG W AND CHI 12/26/2002 (DONE: (510) 293-9901 SANITARY NO. CONTROL NO. ARCIUTF.0(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 �o Zp LICENSED CONTRACTOR'S DECLARATION m u P 1 hereby affirm that I an licensed under provisions of Chapter 9(commencing Job Description with Section]000oof Division Sof Ne Busmessand Protestors Cnde,and mylicemeem in full force and effect. REPLACE WATER HEATER qg l.ieensc claxa ue.a OZ�, Dal Conraram (75 GALLON GAS) ££� ARCHITECTS DECLARATION C1understand my plansshall be usedas public records npyV FLLOt; Licensed Pmfossionai g OWNER-BUILDER I BUILDER DECLARATION nF 1 nasoereby.Sect that 1 1. cBusin from the Casions o License Law for the p o which ire requires 4 (S=t 71n1 5,Business and improve. demolish. Code:Any city of county a' $ which requires a pemst ha umswm,alter,improve.demolish, file repair any structure prior m its i lice used p also harpoons the the applicant for such permit w files signet summem (commislicensed puremnt mthcprovisions sion of the d,bror's License Law m(Chapter 9 Sq. F[. Floor Arca Valuation (commencing with Sectlnn7lkkl)uf Dlvisinn3ol the Business nnU Pmfeaslnns Code)or $1675 y $ Na(he is exempt there(rmn and the basis for the alleged exemption.Any violation of Section 7031.3 by any applicant for a Permit subjects the applicanfto a civil Penalty of APN Number Occupancy Type not more than fin hundred dollars 1550% 3 5623064 . 00 ❑I,as owner of the propcny,or my employees with wagem their sole coo eniation, will do the work,and the shucwm is no(intended os offered for In(See7844,Business $�pp�y� [sy�p ��,1��p�,, and Professions Code:The Commutes License Law does not apply to an owner of 502 — FINAL YLwt�i eY�7V tRGY property who builds or improves thereon,and who does such work himselfor through his Own employees,provided that uch improvements art not intended or offered for sole.If, 506 — GAS TEST however.the building or improvement is Mid within One year of completion.the owner. builder will have the burden of proving that he did not build or improve for purpose of 507 - FINAL PLUMBING sale.). ❑1.as owner of Ne progeny,am exclusively emardi ing with licensed contractors to construct the project(Sec.7044,Business and Professiom Code:)The Comracmfs Li cense Law does not apply to an owner of property who builds or improves thereon,and L'@� �� who contracts for such projects with a contracmr(s)licensed pursuant N o the Contractor's r 13 License Law. ❑I am exempt under Sec. .B@PC for reason .lAN .O 3 2003 Owner Doc WORKER'S COMPENSATION DECLARATION 1 hereby aBirm under penalty of perjury one of the following declarations: BUILDING I have and will mai main a Cenilicam of Consent to self-i nsure for Worker's Compcn- 7c, inn as provided for by Section 7700 of the Labor Code,for the peRonnamea or the rk for which his Permit is issued. I have and will maintain Worker's Compensation Insuranceas required by Section fk1of the Ichor Calc,for the perfnrmanccof Ne work for which this Pchmit is issued. y Worker's Compensation Insurance carrier and Policy number are: rtier: Policy Na: _ CERTIPICATE OF EX EM MON FROM WORKERS' COMPENSATION INSURANCE This:ectilm need nut be completed ifuse permit is(orae hundred dollars(5100) Or less.) 1 ecnify Not in the p ummaanec of the work for which this Permit is issued,1 shall not employ any person in any manner an as in become subject to the Woders'Compemation Laws of California.Date Applicant NOTICE TO APPLICANT:IL after making his Ccnificam of Exemption,you should become subject to the Worker's Compemation provisions of the Labor Code,you must O Z forthwith comply with such provisions or this Permit shall be deemed revoked, Z O CONSTRUCTION LENDING AGENCY [-+ I hereby alarm that there is a construction lending agency lin the Performance of aiti the work for which this permit is ironed(Sec.3047.Cis.Q W Q Lender's Name :D z lendeis Address V O 1 certify that I have read this application and state inat the above information is L IGYV�. C4 F correct.I agree to comply with all city and county ordinances and state laws relating to QU building construction.and hereby authnrim mprcsenmtives ofthis city to enter upon the Ualcove-memloned property for inspection purposesuJ . (We)agree to save,indemnify and keep harmless the City of Cupertino against Cary liabilities.judgments,costs and expenses which may in any way accroc against said City V Z to consequence of the 6ronfngof this permi t. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs HAZARDOUS Signature of ApplicaDoc HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant Or m)future building e,Chapter entre or handle Health addSafrmaterial m Ucfincd by the Cupeninn Municipal Code,Chapter 4.12,and the Ilcallh send Safely IMLCM..Seaton 255321.)] All roofs shall be inspected prior to an roofing material beim Installed. ❑Yes ONO P P Y g g 'l Will the applicant or furore building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove (mit handous air contaminants as defined by the Bay Area Air Qual fly Management all new materials for inspection. District? [:1 Yea 0N I have mad the haaardous materials requirements under Chapmr695 of the Califor. nia Health S Safety COak.SeetO.25505,25533 and 255M.lundcrsund and ifthe building does not currently have a mount,that it is my resphmibility in mildly the Occupant of out mgofrements which must he met prim to issumn of a certificate of Occupancy. Signature of Applicant Date Owner orauthorieedagent Date All roof coverings to be Class"B" or better