03010166 CITY OF CUPERTINO _
ItUI1.nINf,DIVISION PERMIT CONTRACTOR INF,ORMATIONr
BU ILO]NG ADDRESS: HOT WATER INC PERMITNO.
22543 WOODRIDGE CT 03010166
OWNER'SNAME: 2531 GRACELAND AVE APPLICATION SUB DAI'E
MAU CHENG-I AND TZU-TING 01/28/2003
IONS: (650) 298-8494 SANITARY NO. CONTROL.NO.
ARCH]UECr/ENGINIiER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MUCH
°wFoo LICENSED CONnsedunOrproviConsof hap JobDescri tion C
m� ON
u u 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commandos P Irl NA L E
�¢m with cel n70(XI)nf DivisinnJ of NC Rusi 1ciddPromsomesQWe.and mylicenx is
g<s info( card J`t y REPLACE WATER HEATER
FN4 Lice Lic.N
�' m Comractnf �- MAR 2 4 2003
�14g� ARCHITECT'S .A AI'1 N
oto rstand my plans shall he used as public records
if 0 Licensed l'rafeatured BUILDING
OWNER-BUILDER DECLARATION
e R� E 1 hereby affirm that I am exempt from the Contractor's License Law for the
ii:p0 fallowing reason.(Section 7031.5,B actress
and Professions Code Any city or county
$ which requires a permit ,,construct,a1Nr.impmve,Jemnlish,or repair any im time
prior or its issuance,also requited the applicanl for such fourth to rile a signed statement ,,ts
m< that he is licensed pursuant to the provisions of the Commcror's License Law(Chapter 9 Sq. Ft. Floor Area $vratt0tlon
tcommencing with Section 7000)of Division 3 of the Business and Professions Code)m
Nal he is exempt therefrom and be basis for Ne alleged cacreptinn.Any violation of
Section 7031.5 by any applicant for a permit subject be applicanl to a civil penalty of
not more Nan Bre hundred dollars(550(1). B Occupancy Type
D 1,as owner of the property,or my employees with wages as their snle compensation,
will do the work,and the structure is not intended or offered for sale(See. Business 502 — FINA
and Professions Code;The Commcrar's License Law does not apply to an owner of 506 — GAS TE elgwre nspec Ions
pmpeny who builds m improves themon.and who dura such work himselfor bought his
own employees.provided that such improvement arc not ntended or offered for sale.If. 507 — FINAL PLUMBING
however,the building or impro ent is sold within one year of completion,be owner.
builder will have the burden of proving for he did not build or improve for purpose of
aale L
❑1,as owner of Be prhi am exclusively contracting with licensed contractors to
construct the pm$m(Sec.704,Business and Professions Code:)The Contractor's Li-
cense law does not apply to an owner of property who builds or improves lhemon,and
who contract for such project with a contractor(s)licensed pursuanuo the Convector's
License Law.
D 1 am exempt under Sec. .B&P C for this reason
Owner Dat
WORKER'S COMPENSATION OmLARATION
I hereby affirm under Penalty of perjury one of Ne following declarations:
1 have and will maintain a CersiOcale of Consent to self-insure for Wortri s Compere
7307M
ion,m provided for by Section 3710 of Ne Labor CWe,for the performance of the
rk for which Nis permit is issued.
El 1 have and will maintain Worker's Compensation Insurance,ae required by Section
yh erlabor Calc,farZNework forwhich Nis permit]s issued.
yWorkers o nsai wlnsu cant randPolicynumbem r. Policy No.; �-
CF,R3']V CATS OF EKEMPfION PROM WORKERS'
COMPENSATION INSURANCE
Obis section need our he completed if the permit is fimms,hundred dollars($ILM))
or less)
I certify that in the perlimmance of the work for which this permit is issued,l shot not
employ any pro om in any manner so as become subject to the Workers'Compcnmlion
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:IL after making this Cedi ricalc of Exemption,you should
becomu subject to the Worker's Compensation provisions of the labor Code,you must
oz forthwith comply with such provisions or this perm it shall W deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
[-+ � I hereby afirm Nat more is a construction lending agency forte performance of
E
Ythe work for which this permit is issued(Sec.3097.Civ.C.) /^\
VU C Lendcr'I Name
r7 z Lenders Address
� 1 ttnee Nal 1 have read this city
ncand state Nal and
abeve information mention is
L4 U torten.I agrconstruction,
to comply with all city riz county ordntativ ncessof and city
t laws relating to
QU above-mentioned ion,and hereby authorizerepresentativesof this cirymenter ulam the air
r 0s above-mentioned afire 1.burlysame for ernityina keep ha.
41. (We)agree m cost,indemnifyandhicp harmless she
wyineof CuPenst said City
r z liabilities,judgments,rest and"Uthisperami which may in any way eccmc against said City
l,J z in cWa
ranting of this permit.
w+ 'PLIC
S'fANDS AND WILL COMP WITt�oA .`NONPOINT Issued by:9 Date
SOONS. ,Iln'vA7-/ ?/Cpl
Re-roofs
SiComrator �(— Date
HAZARDOUS MATERIALS DISCLOSURE. Type of Roof
Will due applicant or future building occupant store or handle hazardous material
as defined by Ne Cuptnino Mun opal Code,Chapter 9.12,and the health and Safety
❑
cnue.stednnes 25532H)" All All roofs shall be inspected prior to any roofing material being installed.
Y
Will the applicant or future building occupant use equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit haaamous air contaminan as defined by the Bay Area Air Quality Management all new materials for inspection,
Oisvicf/
0Ycs Nu
I have read Nt hazardous materials requirement under Chapter 6.95 of Ne Califor-
nia Halm&SafetyCask.Sectinns25S6,25533 and25534.f undo shod Nal if me building
docs not c tly have o tenant,met it is my redarromilil m n ti]y the occupant of the
re mhmusrbemetpr;ortoismanr
ceoface aa y Signature of Applicant Date
Owner mmnrhed agent Date All roof coverings to be Class "B" or better