03020094 CITY OF CUPERTINO a'� r+<a�: '.mw <* „x:kk�Fwr'tie^ a i•s=up;,`.1
BUILDING DIVISION 0 p R T,C" WINF?Q ATIQN
BUILDING ADDRESS: JUST WATER HEATERS INC . PERMIT NO.
7983 WOODLARK
RR'SNAME: 1764 NATIONAL AVE PERMIT ISSUE DATE
THOMAS HERBERT E JR AND LOIS A 02/24/2003
NB: (510) 293-9901 SANITARY NO, CONTROL NO.
ARCHITECTMNOINBER: BUIIDINO PERMIT INFO
It ELECT PLUMB MECH
�00 LICENSED CONTRACTOR'S DECLARATION
-
M��ly 1 hereby amort that I am licensed under provision of Chapter 9(Commencing Job Description
with Sxmdo70110)of Dbidon 3.1'the Budnueand Profo sloru Code,end my license is
in Em forte and
License REPLACE WATER HEATER
oIb ut LIc.N FINALE®
[[ Dam Comtrutm (4 0 GALLON GAS)
ARCHITECTS DECLARATION
1 undersand my plans shW he meth u public menrds - MAR 10 2003
k c Licensed Professional -
OW NSR-BUILDER DECLARATION p
<E 1 thereby affirm that 1 em exempt from mn
m the Coetors Liunse Law for the BUILDING
not following mann.(Section 70013.Buslness and Professions Code:Any city or county
$ which mqu'm••permit In emaroeL alcor,sup.,demolish,Or rePair soy stmetum
prior to is lasuence,dsu requiresthe applicant formch permit to El.A signed$%element
{?txxF< Net he is licensed pursuant mthe provisions of heConnactorsLlttvclaw(Chapter 9 Sq.Ft.Floor Area Valuation
C3a (commencing with Section 700M of Division 3 of the Business and professions Code)of $1129 -
3 that he is exempt thumfrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit objects the applicant to a civil penalty of APN Number Occupancy
not mom Nen nAs hundred dollars(M).
Tyl�
01,As Ower ofthe property,or my employ¢with wages As theirsole compensation, 36203026 . 00
wllldo tho.mic. rad themucmmis not ntended or offered furule(sm.7044,Business �pp�3��p�{(�g��
and professions Code:The Contractors Limine law does not apply ro an owner of 502 . — FINAL FL'UMB INU cftRGY
property who bullds or improms thermal,and who donumh work himselror through his
own employees,provided that such improvements am not Intended rronemd for ask.If, 506 — GAS TEST -
however,the building or improvement Is sold within one you ofmotnedon.Na owner.
Wilder will he"the burden of proving that he did not build or improve for purpose of 507 — FINAL . PLUMBING
ale.).
❑1.as Owner of the property,am excluaively contracting with licensed eomeacton to
construct the project(Sec.70u,Business and profession Code:)The Contractors U.
cease law does not apply to an owner of property who builds or improves Nem¢.And,
who contracts fm such projects with•eonuumr(a)licensed pursuant in the Contractors
License Law.
❑I am exempt under S.C. .B k P C for this mason
nor Date
WORKER'S COMPENSATION DECLARATION
I hereby 4111no under ponsky of perjury oro of the following deelantlons: -
IMAsandwildforbyneCeninnmoftheLabrCodenumfinerformaCompen- '
13700
an, r pro h this
for mi Sectioniu3]00 of the labor Code,for the performance of the
k for which Na permit Is Issued.1 have end will maintain Workers Compensation Insurance,u required by Section
of the labor Code,rot ih performance of tiro work for which Nis permit It Issued.Workers Compensation Insurance omier end Policy number art:
rier. Policy Noce "
CERTIFICATE OP EKEMP71ON FROM WORKERS
COMPENSATION INSURANCE -
(Otis sectio neeg not beeompleted if the permit ltforonc hundred dollars($100)
or kLL)
1 sonify that In the performance of the work for which this permit it issued.I Mall not
employ any person In any mannerm as to become subject to lh Workers'Compenutlon
Lawsof California.Dem
Applicant
NOTICE TO APPLICANT If.after making this Ccni(icam of Excmpion,You ahold
become subject to the Woher'B Compensation provisions Or Ne Labor Conde,YOU mutt
.J O forthwith Comply with tach MASIOn or this permit shall be deemed revoker.
CONSTRUCTION LENDING AOENCY
�4
J-+ 1larobyef(um that Nem as emuUuelirn lending agenry,for the performance of
ai
the work for which this permit is issued(Sec.3097,Civ.C.) _
W Q Lenders Name -
UZ LendersAdtimss
fJ Q I Certify Net I lure rad Nisty and coup and sats this And
shove m mlWon it
W U boiled.I agree m comply with all ally and county ordinances end cam hew mining to
Q(� building construction.and hereby tuthorlmmpressnu0vrs of this clay menter Upon the
W ahovc(We)agree
properly for W Indemnify
an keep ha
(We)agree to cove,And expenses
end keep hay In m the Clay ru Cupertino against
i—ty Ihbllitiss,judgments,the gracing eepcnsecmit. may in anywysmuc gdnn cold City
L) APPLICANT UNDERSTANDSof IAIND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS,
91tafRe-roofs
HAZARDOUS
Signature of ApplinDam
HAZARDOO US MATERIALS DISCLOSURE Type of Roof
Will Ne a Cupent or m,(Muni Wilding e.Chapter
nom or hurdle Health
asd Stedsi
At deEnd by the Cupertino Municipal Code,Chepmr 9.11,aM the HnIN seri Safely
lDbuic,?
de,Section 13331(e)7 All roofs shall be inspected prior to any roofing material being installed.
�Tcs ON.
Will the Applicant or future building occupsn,use equipment or dMges which If a roof is installed without first obtaining an inspection,I agree to remove
it huamnus elf conummmis as dolmod by the Bay Amo Air Quality Management all new materials for inspection.
❑Yes 0 N
I have mad the heuN,ws materials requirements under Chapter 6.95 of the Califor.
Health A,Safety Code,Scedon 75305.15533 and 35534.1 umlemund NU lNm building
es not currently haw A mrwt,Wt It u my responsibility in mdfy dm occupat or the
uirements which must he met pdor of immee of Ccni0cate of occupancy, Signature Of Applicant Date
Owner onuthorived agent Date All roof coverings to be Class uBu or better _