00090106CITY OF
CONTRACTOR INFORMATION:
nun.nlNG DIVISION
su{u PERMIT
BUILDING ADDRESS:
I'BRMI'1NO,
OW'NIiR'S N'A'ME
AV
JUST WATER HEATERS
.PUit-ATION000
11,103 WILKINSON
PHONI
].764 NP_F
SAM1ARYNO0/1.)Nr I
CHUANG, PIEWEN
ARCHITIiCUENGINEER: -
11UILDIN'G PERMIT' INFO
(S 1 m 1 293-9901
OLIR's EL, C1' PLUMB MF,CH
1=1 f�l f=1 CI
LICENSED C(INTRAC'IOR'S DECLARAION
+ Job Description
1 herehy utirm that 1 am Iicunscd under pvtvisiann of Chapmr9 (commencing
with Section TWO,( Division 3 of the Business, and Profession Code, and my' license
Lin full force oral6— S L(4ZC1 -
iccnw Clan. Lic. p
_
Dore fj �. �� CJntmnor_ -' ON
�16andet>land n���d 1 (n1�Are�ord.
REPLACE WATERHEATER
ntr pl,�.�n�u
Liomod Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I amempt fano the Contractor's License Law for the
following mason. (Seen 171315 �Isuxin , and 11 f„io, Cole: Any city. county
which mgnlmn u nair m criusuuct, nlmr, impinvo, Aenu1'ob, or repair any drueum
prior to I6 issnanee, at,,) ragnire, the applicant for v¢h period to file a signed nc mural
Sq. Ft. Floor Area
Valuation
that he isgcen,ml pursaaatto the provisiom.ofill commelars Litems Law (Chapter v
(commencing with Section 700th of Division 3 of the Business and Professions Cutlet
o, Nat he i, exempt thcmfr it mod the Ismi, for the alleged exemption. An, violation
of Section 7031.5 by any applicant for a pranit subjects the applicant ro a civil Penalty
APN Number
Occupancyb"ypg
::fnutnume loan rise lmmlreddmUm($500)
01, m owner ol'the properly, in my employees with wager IN Their, sole emr,al..n.
will do the work, and die sticture N nut in cin al or offered for .ale (Sec. 7014.
Business and I'mm, ons Cod, 'Me Connector License law does not appy ut an356
]J038RZej ed Inspections
r of ppennimprove,
my Who lauld, , thereon, and who docs such work himself
or through his own employees imo,ked that such improvement, am mo intended nr
offered for sal.. If, however, the huilding nr intpnrvancnt is sold within one year of
enntplch.n,themwaennn0de will live Ate b edea of proving Atm lie did net loom or
106 — SEWER &• WATER
improve Ito pm,aae rf.mlel.
202 — UNDERFLOOR PLUMBING
O L as owner of the proPeny.ams.cwsively. commeting with Ecenxd contractors in
the (Sec. 7u4. Ruxine., and Pmfic,im s Codc:) The Contractor..
301 — ROUGH PLUMBING
condmm pmjeet
License law docs not apply to an owner of property who bund, or improves thereon,
and who commas for _Inch prnf,cs with a conmmmrW Imensed pursuant to the
302 — TUB & OR SH014ER
Cnnuaemrx Licca c Law.
of amescmptmtdc,See. .B&11C for di, mar ... a
502 — FINAL PLUMBING ENERGY
Owner Date
506 — GAS TEST
WORKER'S COMPENSATION DECLARATION
507 — FINAL PLUMBING
1 hereby affirm anile, penalty if ,,,,y or it following decwmdon..
❑ I have and will n ainmin a ConlEcum of Conran a rcli.iiuore or Wake,%
Compen,rli , as provided bar by Section 3700 of the Lubar Colt, for the
performance of the work for which this permit i, issued.
/O
P. ave and will maintain Worker'. Compensation Insurance as rcyuimd by Seniors
. 7110 of d m Lanni- Code, for' the perfurmance of the work for which this permit Ix
/
l,suud. V ComL�w�o-(�ttttli��un hourumc ntrti<randd Polili'c�y�nn dw1ir, are
OO
Cmrriar�.1N•kJ� Policy NoUCI�Gw_
CERTIFICA'l'IDN OFIENEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(Chis section need not be completed if the permit is for nom hundred dollars
SIM) nr I,s.J
I ccdlfy that in the perfornmner of the work for which Thi, permit is issued. I
,hall not employ any sa,an in any manner m as to become subject to the Workers
_
Campcnwlion Laws of California. Date
Applicant '
NOTICE TO APPLICANT: It, attar making this C'erifcam of Exemption. you should
been emhjen to the Wnrkur', Comperv.:nloo liraTomo the Lubar Code • younue
Ittnhwhb..... lily with tech ....... ora ret Nix permit .hall Ne dccnuwl revoked.
CONS'1 RUCF10N LENDING AGRNCY
I hereby affirm that there is a construction lending agency for the performance
of the work for which this person is issued (ties. 3097, Civ. C.)
Lender., Name
Lender's AJJm,
I cenify that 1 hate mud Nin a,liceion and stem that the alone into rznunion i.
correct. I acme et comply with all city and county ordinances and .rate laws relining
to building combination. and hereby aulhorim mpmscnmtiva of this city incineration
the mltovcramoduned limped, for im, ection purpos,.
(VA) agree to save, inde atify and keep hara lox the City of Cupertino ugainst
-
unl c r wo which may in any way accrue oil ..it
Iiubiliticn, judgnsaa , costs : t
City in cnnncgneace nftho gnunia tf thi mill.
APPLICANT UNDE ND A I. COMPLYWITHALL f{ON-PO�T
SOUR T�It//lint
Issued by: DUIB r1 V
Re -roofs
Signmureo pp t "anor Dam t}Y
AZARDOUS MATERIAL'DISCLOSURE
Will the applicant OF tutom Madding Oct,, it dart or fial haiarduux crclal
Type ofRoof'
n Aclined by he Cupcnino Municipal Cod, Chupm, 212,,1 1 the I Lakh ynJ Safe,
Cafe, Scninn 25531f0'I
0Vet 0 N
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant (it future building :cittpamuse alniprmalorde,;ce,which
If a roof is installed without first obtaining an inspection. I agree to remove
emit harardotnair coatua nuns defined by life Ray Ama Air Quality Mnnagemcnt
DLldm�
all new materials for inspection. Applicant understands and will comply with
Ove• °Nn
all non -point source regulations.
I have read the haramous materials requirements under Chapter 6,95 of the
California Ilealth & Safety CIA , Sectio, 35505.35533 and 25534. 1 understand that
if the building does not coal have a nation. it is my rc,pnmibif ty to notify the
occupant of the requirements which must be stet prior m rcumnce of a Certificate of
Occupancy,
Signature of Applicant Date
All roof coverings to be Class "B" or better
I
owamm Date
undimmed agent
OFFICE