02120059 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION ',.
BU I LDING A DDR ESS: JUST WATER HEATERS INC PERMIT NO.
7940 WOODLARK WY 02120069
OWNER'S NAME: 1764 NATIONAL AVE APPLICATION SUB DATE
MICHAEL LEE 12/16/2002
IONIi:
(510) 293-9901 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
Op LICENSED CONTRACT'OR'S DECLARATION
F I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
with Section 700(hof Divislnn Sof me Bminessand Professions Cole.and my license is
<,„ in fallfnneandeffro. REPLACE WATER HEATER.
a= License Class Lie.. FINALED
04;0 Dal Contractor (40 GALLON ' GAS)
�o U ION
I understand my pinm shall he meed'public records
JAN 16 2003
ca c.1-
Licensed PmfcsslnnBl
OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the BUILDING
m_❑0 following reason.(Section 71111.5,Business and Professions Code:Any city orcnunry
u k$� which acquires a petmif m Construct,Blair,improve,demolish,or repair any structure
wa prior in its issuance.also requires the applicant for sub Permit o file a signed statement
6 that he is licensed lammamlothe provisions of meChia�lmsLicense Law(Chapter9 Sq. Ft. Floor Area Valuation
M (commencing with Section 7lXXgofDivision 3ofthe Business and Professions Code)or $600
W�.. than he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any aPPlicanl for a permit subjects the applicant o a civil Penally of APN Number Occupancy Type
not more man eve hundred dodars(S5BB). 36204044 . 00 P Y YP
❑I,a owner of the property,or my employee with wages ss their sale compensation,
will do the work,and me slmclnte is not intended or offered for sale(Sec.70,14,Business
and Professions Code:The Contractor's License law doe not apply to an owner of 502 — FINAL
C'Ti 1VC.Se 'R RGY
property who Indictor improve thereon,and who does such work himselfor mmugh his
ovarimpoyee,prosdded Out such impmvemenHam notimmndedoro!feared Annie.If. 506 — GAS TEST
however,me building or improvement is sold wiminane yesrofcompletion.theowner. SO7 — FINAL PLUMBING
builder will have the burden of proving that he did not build or improve for purpose of
sal.).
❑1,as owner of me property,am exclusively contracting with licensed contractors to
construct the lumber(Sec.70al Business and Professions Code.)The Contractors Li.
cense law does not apply to an owner of property who builds or improves themon,and
who contracts for such projects with a constraints)licensed pursuant in the Contractor's
License Low.
❑I am eaemplumler Sec. ,B&PCfermiimason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury one of the following declarations:
I have and will maintain a Cenibcale of CnnsenOo self-insure for Worker's Compere
salion,a provide)fm by Section 3]IXI of the labor Code,for the performance of the
work for which this Permit is issued.
1 have and will maintain Worker's Compensation Insurance.M acquired by Section
114)of the Labor Code,fnr the pesformence of me work for which this proor is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE.OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thisscetilm incaution Mcompiceid if the permit is(Drone hundmd dollars(SI(a)I
nr tea.)
I certiry Our in the Performance of the work far which this Permit is issued,I Nall not
employ any person in any manner m as no become subject o the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject os the Worker's Compensation provisions of the Lmor Code,you mus
OO forthwith comply with such provisions or this Permit shall he deemed revoked.
z y CONSTRUCTION LENDING AGENCY
[-+ I hereby affirm mut there is a construction lending agency for performance of
ai the work for which this Nord is issued(Sce.3197,Civ.C.)
W Lender's Name o
Uz Lender's ABdress
U Q 1 certify mat I have read this application y o ream that me above Information misting is
W U cortem,l agree m comply with all city and army oudives of and slate laws relating e
0 U amovenmentio ed pm rty herthyection purposes.rsesenulives of this city menmr upon the
W aMrvr(We)
to save Rt inspectionbean
(We)egme m save,indemnify and kceP harmless me City of against against
Iiabilitiea dice o the costsand expereas
of Permit, may in any way creme against said City
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signmum of APPlicaDateHAZARDO
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will
theapplicant or futureoccupantsacraor handle momentous material
az defined by the Carsnn Municipal Coe.Chapter 9.12,and the Health
and Sefcry
rnde.se[tiitn 15532(a)? All roofs shall be inspected prior to an roofing material being installed.
❑Yes ON. P P � Y g g
Will the applicant or future building uccupanl use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
Fit haeardnus air contaminants as defined by the Bay Area Air Quality Management all new materials for Inspection.
District?
D Ycs 0N
1 have m:al me bnowdous bramrials requirements under Chapter 6.95 of me Califon
nix Health&Sahely Calc,Sections 255(15,2533 and 25534.1 understand mm if the building
does not currently haw a mount,that in is my resrymsihility m notify be occupant of me
requirements which must be mit prof to issuance of a CeniOcam of Occupancy. Signature of Applicant Date
Owner nr authorized agent Date All roof coverings to be Class nBn or better