01060121 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
19934 WHEATON DR WATER HEATERS ONLY 01060121
OWNER'S NAME: APPLICATION SUB DATE
HUANG CHANG-LUNG 500 AIRPORT BLV 06/21/2001
,• PHONE: SANITARY NO. CONTROL NO.
(415) 349-3747
q 0 z0 ARCHIT ICUENGI,NEER: BUILDING PERMIT INFO
kL"w BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR dunderp DecuoAT1oN Job Description
O ln H G I hereby effinn that 1 am licensed under Provisions of Chapter.t(commencing
f_Fm shofllf demodefect. on3ofmrBusinmandRofcssionxCodc.andmyliccnu REPLACE 40 GAL GAS WATER HEATER.
as m to< is in full tome and effort.
—m m a Licenu Class Lie,x
at LL O Dam S DECLARATION ARCHITECT'S DECLARATION
�='O� I underhand my plans shall be useJ as public rtcmras
s�<E
In o O Licensed Yrofexzional
oil Oat I am exempt m DECLARATION s
I hereby affirm that 1 am exempt from the Contractor License law for the
{_?s' following UiMsreason.Pamir
70313,Business and vefdemolsh,or Any city or county $700
8 s❑ which requirex a permit m constmn,ober,improve.demolish,or repair any structure '7
to r- prior to it,'i'viciam.r1o.'e'uniciffic.plifirmn1 rl permit Ifilettaill.rdsmndmit, - ... ..-- -
�� maz by Ive 'ptnn,Nt&tlwpn rho . ftI C t for I' U (Chaptar9 I O2 ea I Valuation
h.r.
Uemmeer g w m smf ann'a the b4.. �IO h fie,•( 0.,..tT:.;,>,,�'(r?'`.
or that io is 31.5 b therefrom and or basis for the cts ed exemplar.Beanoto Any violation
of Section 7W L5 by any applicant for a permit subjects me applicant m m civil pcmhy
of not motrthan file hundred amlat.(SSW). 502AFNP,1�f#jkgr PLUMBIN ENERGY Occupancy Type
01.as owner of the property,or my employees width wag.as But.sole compensation, 506 - GAS TEST
will'do the work:mul the structure isnot intended or offered for sale(Sm:9044,- t - -
B63indas and Professions Code:The Conmactor's Lice se law does not apply m am 507 - FINAL PLBIAq} 1WCDrlspections- "
owner or property who builds or improves thereon.and who does such work himself ,
or through his own employees.provided that such improvements ue not intended or __._ „ __, _ .,
'offered for kala.If.however,the building or improvement is sold within ooh ycer of - - - - --- - ' - I-.h -
completion.me owner-builder will have ate burden of proving that he did not build or
improve for purpose of san).
- _.._ .
❑1 asmvner ofthe property,am Budavely commangwith licensedd:)Th Contract ro + /�
License the prefect(Sm.Ito a oomer oBusinesand PrAproperty
w ons Code)The improves
trocar a
License law does not apply won owner th proPrrty who Wilds o mproves thereon,
and who contracts fix such Pralttm wnh a cantractar(s).bcenud.pursuam to the
Cmmrocmh License law
❑I am exempt under Sec. B&P C for thisonsun
Owl . , Date -........
WORKER'S COMPENSATION DECLARATION
!• 1 hereby affirm under penalty of perlury,otie f,he following declaretiom:
❑ 1 have and will maintain a Certificate of Consent to sd6insum for Worker's
_ Compensation. as,provided for by Section 37W-orf the Labor Code. for the
performance of the work for which this permit is issued.I .
❑1 have and will himaii in Wbrkcr'a Compencatimn Insurince,at'required by Sietion
_ 37W of thc'Whor Code,fur the performance of the work far which this pem+it is
issued.My Werkrls Compodulden Insurance darner and Policy number ate:
Came s lir . t`+•PoIcy No:.... -
+ !CERTIFICATION OF.EXEMPTION FROM WORKERS','
'
... COMPENSATION INSURANCE' _._.._ -------- _._r___..__ .__..
1 (This action need not be cnmpined d the Fiction is for one hundrtd dollar
151WI let .)
1 cent(,tM1ut in the rforinanc c ••.
r... ..
y pe epf the work lb cishie ibis permit is tsar id l I` .....y ,;��,4.'C q� s'
tCmin nm employ,any penam'in any nunirr w as ab bu'omc wbject lo'thi war ids' Fj
Compensation Laws o/Catifomio.Date''
.
Applicant.+NOTiCET
OAPPLtICANTkc Cn
C� 0
h Id
fordwith comply w4. ch provisions or this limit shall be clesumdmarked,0 _
rN. 1 - "-,'CONSTRUCTION LENDING AGENCY "'"
I hereby uflom thm there 4..s admouniction lending agency for the perfrioniance .I1
of Lir '
W � w«k roeLender's Name# Amice pj fat
Lendelaana(ser.e3Wm.7.ec.l -
Zis Address t ,. , , . . .'D Ii:'s.!+":1C+I
U,C) , s
1mildly that 1 n. d broadly
th Application nd ,are v s of isinformation —
' Ira vl 6 to comply,with all city and c myordinancesW.tt laws relating
W wWilding' c n w<uon a dl+ him"o p u Tuve of this city to m pan
91t 'he M t oil P nyf speer p R^ .
L IWdagree sosavet and expenses
Ameph mayinthe City of Cupcnmo against
Vi Citie to co ry consequence
casts and enpenses whmh may m any way accme against said
V z Cityin!ANT UND ofthe grantingml Nis L CON"'
SOURCE REOCLTIONSNDSANO WILLCOMTLY WITH ALL NON-POINT
SOURCE REcuLAnonsl' Issued by: Date
Signaturt orArpficenoconmarmr. ... ,,Data Re-roofs
HAZARDOUS SIATERIAL.Si DISCLOSURE ,
waime anpti2ani a ratan nauaing«cupant score o<n:mdle naratdons matrdal. Type of Roof
as defined by the Cupertino Municipal Cal,Chapmr 9.12,mad the Health and Safety _
Code.Smtion 25532U)1, .,. .'" J�,- :.,q:.l'..cf. l . . 1 . . .�,
All • if
., „f•, oofs.shallbe.inspected.priorto,any_roofing.materialbeing-installed.._
Will theApplicant farm,building c pam,useeq pm At or tee Ineswhich' If a roof is installed'without first obtaining an inspection,�I agree to remove
.
e i,h d contaminants as dcfi ed by the Bay Are.A U fry Maoag in
n t ict. all new.materials for inspection. Applicant understands and will comply with
Oyes - ON. all non-point source regulations;
1 hove uod the haaardlous materials requlrmants under Chapmr 695 ofthe
California Health&Safety Coda Smtiuns25505.2553Jand25534.I undrmandthaq
if the building does not currently have a tenant that a L my nesponsibility w nsni(y thq; +
amupatn bf the requirements which must be met prior to L,uantt cf a Certificate of
"pa"`y' Signature of Applicant Date
All roof coverings to be Class "B" or better
Owaer or aummimcl,front, Da
:,4 f
.;.L. .. . ..._ ., - OFFICE - . . .. . . . . ..