02110114CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION
BU1 I1S V
JUST WATER HEATERS INC
PERM IT N02110114
DIWOIDE NyANT VIEW CONVALESCENT H
S1764 NATIONAL AVE
APPLICATT11"4!B1Wd 2002
T
ZONE:
(510)293-9901
SANITARY NO.CONTROL. NO,
ARCHITECTIENGINEF.R:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I herchy altirm that l am licensed under previsions of Chapter 9 (rommeneing
REPLACE WATER Ift8W90'rANK &
with Seclinn 9gk1 of Division 3 of the Business and Professions Code, and my licenm is
inmllforce andeffecl.
HOT WATER BOILER
License Class I.M.g
�''����®
Dam Contractor
ARCHITECT'S DECLARATION
I understand my plans shall he used as public records
MAY 1 4 2003
Licensed Procedural
OWNER-BUILDER DECLARATION
1 herchy nllirm that I am exempt Irnm the Conuuctnix License Law lin de
BUILDING
reason. (Section 7031.5. Business and Professions Code: Any city (it county
which requires a permit to construct, alter, improve, demolish, or repair any structure
$14000
prior to iu issuance. also requires the applicant for such Permit o rile a signed statement
that he is licensed pursuant to the provisions of the Coutranmk License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 740of Division 3 of the Business and Professinns Code) nr
34229044.00
that he is exempt therefrum end the basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
P Y YP
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
m mo, the. five hundred dollars ($N)0).
301 - ROUGH PLUMBI
G
❑ I, mower of the property, or my employees with wages as their seta compensation,
3133 ReT381
T
thin ns
will do the work, and the srmcwm is not intended or offered for sale (Sec. ]BM, BusinessgW
and Professions Coale: The Contractor's License law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for ash, If,
304 - ROUGH )✓s �,
505 — FINAL ELECTRICAL
however, the building or improvement is mW within one year of completion, the owner-
5O7 — FINAL PLUMBING
builder will have the burden of proving Nat he did not build or improve for purpose of
sale')'
508 - FINAL MECHANICAL
❑ I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7 d , Business and Professions CmM:)The Convector's Li-
.
cense Taw does not apply to an owner of progeny who builds or improves themon, and
who Comment for such projects with a contracmr(M licensed pursuant o the Contncmr's
License Law.
❑ 1 am exempt under Sec. . B & P C for this rcmnn
,
WORKER'S COMPENSATION DECLARATION
I
1 hereby a fhm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Contem to self-insum for Worker's Compere
tioo, u provided for by Section 371) of the labor Code, for the performance of the
1wricDI
rk for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance, es required by Section
(X1 of the Labor Code, for the performance of the work for which Ibis permit is issued.
y Worker's Co n,cnmlion Insurance carrier and Policy number art:
rtier: Policy No.:
CERTIFICATE OF EX EM PfION FROM WORKERS'
COMPENSATION INSURANCE
(This section need nal W completed it the permit is formic hundred dollars 15100)
or loss)
1 cervi fy that in the performance of the work for which this permit is issued. I shall not
employ any person in any manner se as to become subject o the Worlmos Compensation
Laws of Califomia. Dare
Applicant
NOTICE TO APPLICANT: If, after making this Ceniticate of Exemption, you should
become subject us the Worker's Compensation provisions of the Labor Code, you mus
forthwith comply with such provisions or this permit shall he deemed revoked.
CONSTRUCTION LENDING AGENCY
/1
I hereby alarm that there is a construction lending agency for performance of
the ..,it for which this permit is issued (Sea. 309], Civ. C)
Lender's Name
Lender's Address
I Canny Nat I have read this application and sum that the above information is
comet. I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby amhnrm, mpre_senmtives of this City to enter upon the
above mentioned pmpeny for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities. judgments. costs and expenses which may in any way acerae against mid City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL, NON-POINT
Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Type of Roof
Signatureof ApplicaRDam
HAZARDOUS
US MATE RIALS DISCLOSURE
or handle
Will the applicant or future building oc,
r 9.1 Health and
Chapter
as defined by the Cupertino Municipal Cosle, Chapter 9.12, and the Health and Safety
code, Section 25532nd?
All roofs shall be inspected
to any roofing material being installed.❑Yes
0N
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
mit hazardous air contaminants Its derined by the Bay Arta Air Quality Management
all new materials for inspection.
DWrier?
0W C] No
I have read the hammous materials requirements under Chapter 6,95 of the Call for-
ria lhealth &Safety Couto. Sections 255/5, 25513 and 25534.1 undcrsund Our ifthe holding
does not currently haus a tenant, that it is my responsibility to amity the occupant of Ne
rcquimments which must Mmet prior ser issuance of a cemBcae of wcupmwe
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner umn,edagent
ora Dale