00120051 CITY OF CUPERTINO
nUu:InNG DIVISION PERMIT CONTRACTOR INFORMATION:
' BUILDING ADDRESS: PERMIT NO,
10123 N WOLFE RD JUST WATER HEATERS INC 001.201:J.Lj
OWNERS NAME. APPLICATION Stili DATE
WESTLAND PROJECTS N U 17F,4 NATIONAL AVE 12/08/2000
•. PHONE: SANITARY NO. CONTROL NO.
lSJt�l1 . �—
'im00 ARUII'I'ECAIiNGI WiIiR: HUILDING PERMIT INFO
zFz — HLDG ELECT PLUMB MACH
F2� IJ IJ I=1 1=1
Iheree aoltorIamiicnseeand,,boli i-IColl,m,9fmmmcucin Job Description
FZ.=C� with lull fon]gnl efect. nninftheB:uinuv unci Professions CWe.find mylicemc
nut .Class force and Ill REPLACE 100 GALLON GAS WATER HEATER
g o u Dam clan. Lie..
` 4 u.ul owe Commu'mr
ARCHII'llel"S UIsL'LARATION
I unJcmunJ my plans shall he used as pantie menrJs '
w
ii S p O Licensed Professional
fhat I aIm IexemptlI m the RATION
J= 1 hereby nSee nbm 1 ten exempt ftan the feWoncmr's.:A.,c Law for the
F < following uires a (Smtinn 7031 S.Il.after.,
and P e,dillo li Calc:AnY city or county
FSG whims it,
n permit re cams flicl fiber,imprave,Jcmnli t or repair any almarem
i 3� pone, acereunce,orae n I,tic the:tpp....oI fo...en pe:mll Fil].I.""
.I. "lea. sw¢ment
(comeinnw pSecriot mine pruviaonsonhece Business and Pr Lassies ode) Sq. FL Floor Area Valuation
(commencinggihes vwith Section]INP)ofDivision3of theliminessand Professions
denheiv31.5b anrdmmtme thebavimit thect,dul,hIntiI AnylPenalty
of Senior]n3L5ol anyuneddollForaipermit suMemsthe apPlic:nn muervil penalty
of mit stem than rve handrml soler.ts50xh. APN Number Occupancy Type
01,a%owner of the pmpeny,or my employees with wage,as their sole m:mpcootlon. —
will do the work,and the amour,ix tot Intended or o1b n d Ibr rale(See.7044,
Radial',and Poesoone Gal.:The Contmelo,,License law does not apply to an Required Inspections
orr of e'ppcny Who builds of improvdaemon,and who doe,such work himmif
ilmmgh his own employee.pnwidm Iba,:ucn 1111,101coments are bill inandOd o0 502 — FINAL PLUMBING ENERGY
olTcmd for sale.If,however,the loading nr improvement is field within one year of
nmplemm.the owner-nnlderwilI rbc mcburden ofprovia, lull he did am builder 506 — GAS TEST
mprnva for purpose of sale.). _
01.as owner of rt.am exew.ivel l with license enmeremr,m 507 — FINAL PLUMBING
Property. Ycattai2
nnnwm the does
ran
(See
appl](W,Businowner
and Procity,%sio bl Galea The Contmam'%
License cot:ctnmreply monownerof pmpenycumsolid%orimprovesthemes,
and who mnnmcn for such projects with n umtmeturts)licensed pursuant no the
Com
0J a.e,mi Love
❑1 am cxmnpn under Sec ,6 Ne P C lin this maam
Owner Dom /
WORKER'S COMPENSATION DECLARATION ,
I hereby afhml tinder penalty of perjury one of the following Jeclaratinm
• 0 1 have and will bade min a Crnilintic of Consent to sell-insure for Worker's VV O O
Conlpensation, as provided for by Section 3701 of the Labor Code, for the
puhrtmonee of the xnrk for which Ibis i>Lnnil in ivsucd. '
01 have nd will n ine:in Worker'%L'mopeasuorn Inwnureu,as required by Section
37X1 of the"No CWe,for the pertinmm.ce of the work for which this permit is
sued.My Workers Cmalknvution Imnrmce carrier and Policy reinter are:
Currier: Policy No.:
CRRTIIICAl ION Op EXI NIPI'ION FROM WORKRI2S'
COMPENSATION INSURANCE
I Itis section need not he completed it the permit is For one hundred dollars
ff 1(X)1 or Icss.l
1 mnify that in the perfnmmnce of the x.A for which this permit in issued I
dint no(employ any person in mry manner so as m Deanne xrhicn Io the Workers -
CmaKilmtion Lax,of California.[)am
Applicant
NOTICE.10 APPLICANT:III after making this Cenilicalc of lixcmption,you should
become subject to the Worker's Compemation provisions of the W Wr CWe,you must
O 0 forthwith eon,,Iy with such provisions or Itis Ienah%hull he JecmW revoked,
f7~~' CONSI'RUCI'ION LENDING AGENCY '
C 7 1 hereby,ullinn Ihm there is a comtruction lending ilgency for the pidurrtmnec
cattle work for whill,To semro is rssuW(Sm.3097,Civ.CJ
si Q Leadin's Name
7 z Lender's Acidosis
J O I unify Ihm I have mad this application and amts theme Oda infommtion is
W F.t ..c,l.I "me ,,comply with all city and county ordian o,c,and rune Laws relating
O U in Wilding construction.and hereby authmiicrepmomu,fivmof this city to enmr cpm
F r- the nWve-mettional property for inspection purpne.
(We)agrcrosuve,naeound,l (keep h,nulca the Cityuf Cupertino ageinsl
fn liabilities,judgmems,mets and expenses which may in any way acerae against said
C„) z
City inunnsalncncc til the grania,ol'Ihis ont.
APUBCANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
Signuluteof ApplicanJCnntmctnr Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the appficanior,tamWilding occupant ,am mhaemeIwaNswsmaterial Type of Roof
a.,deflacd by the Cupedino Milowipyl Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)^
CYO" ED No All roofs Shall be inspected prior to any roofing material being installed.
Will the applicant car fuhtc building occupant use quipment or devices w Inch If a roof is installed without first obtaining an inspection. I agree to remove
Iu hw,rJous air cI andn,nm as der cd by the tiny Are,An Quality Muoagcaeol
uismerc all new materials for inspection. Applicant understands and will comply with
❑Yea GNU all non-point source regulations.
I have mad the hammnu.s materials requircmmntx under Chapter 6.95 of the
Culifumiu I Ieulth h Safety Code.Sselions 25505.25533 and 25534.1 mmersmnd Ihat
if the Wilding Aces not currently have a tenant,that it is my responsibility to nmity the
mcnpunl of the mquinmo nts whichnam,,nsn be act priew r I"OrLace ofn Ccaifcam of
Ocempaney. Signature of Applicant Date
Owner or authorized agent Date All roof coverings to be Class"B" or better
OFFICE