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02110043 CITY OF CUPF.WHNO ;�'-' x v n ®a 6".'- 5 BUILDING 131VI51(IN PERMIT CONTRACTOR INFGIRMATI®N '2 '.f IZI,.':'. a ra:4ES^ BU19)21rJA1)I9U!9VOSS AV JUST WATER HEATERS INC PERMIT N©2110043 c6 QwrBAMRY JOYCE E TRUSTEE 1764 NATIONAL AVE APPLICATTII'llU 32002 IONIi: 510 293-9901 SANITARY NO. CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 �00 LICENSED CONTRACTOR'S DECLARATION ]� p <u P 1 botchy affirm that 1 am licensed under provisions of Chapmr,9(commencing REPLACE WATER H Alf on �< with Section 70NpofDivm..3of Ne naircaand Professions Grde,and my ficcnsc is in full force aoil euett (40 GALLON GAS) License Class Lic.N @y— Dau: Conuacuu <nm— ARCHITECTS DECLARATION C z< 1 understand my plans shall k used as public records d OyU asi30 Licensee Phimseienri t-•u "� OWNER-BUILDER DECLARATION As M e i 1 hereby alarm that 1 am exempt from the Comncbsra License Law for the w r p 0 following reason.(Section 7831 5,Busincas and Pmfcssions Code:Any city or county A.x m� which requires a vormit,n consruct,alter.improve,demolish.or repair any structure $699 wsae poor In its issuance.alsu,equirm the applicant fnrsuch perminn file a signed smmment $=i< Affithe is licensed pursuant to the poonsionsifififfe,Connector's Licered E.Aw(Chaptorit Sq. Ft. Floor Area Valuation yt-$ (commencing with Section 7gy))(It Diviaion3oftheIffunessoneProfessionsCode)or 34229001 . 00 y .. that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant In,a Permit subject,the applicant t...ivil penalty of APN Number Occupancy Type not more than five hundred dollars($500). 502 - FINAL PLUMBI G ENERGY ❑ La,owner of the property,or my employees with wages a their Auto compensation, will do Ne work,and the structure is not intended or offered for sale(Sec.714,1,Business �t*Ad. R and Professions Code:no Contractors License Law done.not apply to an owner of 507 — FINAL V yv)gZ�1,y CC[IOUS property who builds or improves thereon,and who does such work himself or through his man employees.provided that such improvements ac not intended or offered for sale,If. however,the building or improvement is sold within one year of completion,the owner, builder will have the burden of proving Nat he did not huiId or improve for purpose of sale.). I,as owner of the Property,am exclusively comruting with licensed contractors to construct Nees not (Sec.7844,wnerofroprtywho builds ee:)Thc Comractor'snd � censelawctsfnmapply eanownerofprolanwhobuildstarimprovesCotton,and IS••It`i1S LIe-9 who coronets for such projects with a cnmranor(s)licensed pursuant to the Contractors License law. ,� a:�n�Q�(1Q ❑I am exempt under Sec. .B&P C for this reason I4 !, `J LSJUG P. Owner Date a1 Tr _✓/ SNI Wm under Sharyof ijur,on UEme RATION \� I hereby affirm under penalty of perjury one of Ne following tlalantions: B I have and will maintain a Cenifinse of Consent sel6iau d for Wonket'x Coni sation,a Provided for by Section 3701 of the labor Coale.for the portormaxe of.k work for which Nis permit is issued. ❑I have and will maintain Workers Compensation Insurance.a r uimd by Section 3700 of Ne Iabur C,tle,for Nc performance of the work for which this Permit is issued. My Worker's Compensation Insurance carrier and Policy number art: Carrier: Policy Nn.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE j This section need nm Mcompleled if the permit is for one hundred dollars al Its)) nr Icss.l I certify that in the Performance of the work for which this permit is issued,I shall not employ any ponam in any manner so as pa become subject to the Workers Compensation Laws of Calan nia.Date ApPlicam NOTICE TO APPLICANT:IL after making this Ccnifcxm of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Q O forthwith comply with such provisions or this Permit sholl k deemed mvnked. z y CONSTRUCT ION LENDING AGENCY {�+ I hereby marm that there is a construction lending agency tot the pmoomanw rel fyi are work for wh ich this Perm it is issued(See.31N7,Civ.C.) W Q Lao ors Name Z lc J Address t i ��- t..l 1 agree that 1 have read thirty and county and slam Nm the above iw nrelatinn is {✓ti (~ cnncn.lagrec to comply with all rchyaffor repolynNinesol and smm)enter upon the V abovbuilde-geutioned snared hcmhy action yp rposes, mlws of Nls city to cnmr upon Nc W above-(We)are to sa y for inspection an keep mi tY (We)agree to cavo,indemnify and keep hay in a Nc City ri CuPensts against U fA inconseque consequence of the costs and of this Pe mit. rosy in any way accroc Against said City U z APPLI quNT U DERST NDS this permit. .r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONPOINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signature o(ApplicarmCnatractor Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will theapplicantor future building Occupant store 9.1orandhandle hazardousmamma)Safety Ide.See by the Cupertino Municipal Coale,Chapter 9.12,and tk IicalN and Safety Code.See 25532(a)7 All roofs shall be inspected prior to an roofing material being Installed. ❑res C]No P P Y g g Will the applicamnrfumrcbuilding nccupa tuseequipmentordeviceswhich If a roof is installed without first obtaining an inspection, I agree to remove mil haaallous air contaminants a defined by the Bay Ana Air Quality Management all new materials for inspection. i,oncR❑Yes ❑Nu I have mad Ne h i andous materials requirements under Chapter 6.95 of d4 Califor- e Health&Safety Code.Sauna 733(15,23333 and 25531.1 underwnd Nm if the Wilding oes not currently haw a tenam.Nat it is my responsibility m noddy the nacuPam of she Naimmenei which must k met prior to issuance of a Cenifcatc of occupancy. Signature of Applicant Dale 0.nor m..Ih.ritsdagent Data All roof coverings to be Class "B" or better