03010172 CPfY OF CUPERTINO
BUILDING[)]VISIONPERMIT CONTRACTOR INFORMATION
BUILDING ADDRESS: HOT WATER INC PFRMi rNO.
10375 WUNDERLICH DR 03010172
OWNFR'S NAME: 2531 GRACELAND AVE APPLICATION SUB DATE:
DONALD VANBUREN 01/28/2003
[ONE (650) 298-8494 SANI'T'ARY NO. CONTROL NO.
ARCIInTCTIENOINCER: BUILDING PERMIT INPO
BLDG ELECT PLUMB MECII
00
LICENSEDCONTRACTOR'SDECLARATION
1 herchy affirm Thal 1 am licensed under nd Pronns of Codic, 9(commencing Job Description
iN Satins 70kq of Division Jnf the Business dRofessinv Cele,and mylicemeis
mmnDdean ePa. �. } REPLACE WATER HEATER Fi1�lALE®
Z07�'Z Lifullf 1 Lic.M_
O14 Date C'S D.nr 2UO3
o—Q ARCIIITIiLTS D: R N FEB 1 1
W U 1 u cµlan y plans shall he used u tic records
LLOLiccnmd Professional
OW NF.R-BUILDER DECLARATION BUILDING
u�a a I herchy affirm that I um exempt from the Contractor's License Law for the
a-00 following reason.(Section 7031.5.Business mat Pmfecimu Code:Any city or county
cee which acquires a permit to construct,alter,improve,demolish,or repair any xtrudure
FZ< poor to its issuance,also nyuireuhe applicant for such permit to rile a signed statement ,,t.�w
That he is licensed pursuant to the provisions of the Contractor's License law iChapter 9 Sq.Ft. Floor Area $vt,p"tlon
NO (commencing with Section 7000)of Division 3 of the Business and Professions Code)or t
that he is exempt Newfound and IN basis for the alleged compute.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than rive hundred dollars(15110). 8 Occupancy Type
❑1,as owner of the property,or my employees with wages ins their sole compensation,
will do the wish,and she atructurt isnot intended us offered fur We(Sce.7044.Business 502 —
and Pmfcesions Code:The Contracror's License law docs not apply m an owner of 506 - GAS TEEM nspec Ions
pertinacity who builds urimproves Ihemon•and wh tdoes such work himself orthrough his
own employ=.provided thauuch improvements me not intended or offered portable.If, 507 — FINAL PLUMBING
however.the building or improvement is sold within one year of cumpletiun,the mairm,
builder will have the Wrden of proving that he did not build or impas for purpox of
axle.).
❑1.as owner of the property.am exclusively contracting with 1lcemeA contractors to
construct the project(Sec.7039,Business and Professions Code:)The Contractors Li.
cense law dms nm apply m an owner of property who Wilds or improves theme,end
who contracts for such projects with a contractions)licensed pursuant on the Contractors
License Law.
❑lam esempt under Sec. ,B&PC for thisruwn
13700of
wner Dan'
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury Na of the following d Iantiom:
I have and will maintain a Certificate of Consent wit Ensue for WmIn r'a Comped
ion,as provided for by Section 3701 of fie labor Code,for the performance of the
rk for which this permit is issued.
1 have and will maintain Workers Compensation Insurance,as required by Section
the laM1 ,Code,for the performance of the work for which this permit iv jsmed.
ker' Cmpe satiotlnruroncc/tea/ d Puln `/rrier. Z A' Poliw u , ,!J
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
is section need nm hecompleted ifthe permit is for one hundred dollars($100)
Iess)
1 certify that in the performance of me work for which this permit is issued.I shall not
employ any person in any manner sr as become subject to the Workere Compensation
Laws of CHllhmmla.Data
Applicant
NOTICE TO APPLICANT:Ir,aIle,making this Cenilicate nl Exemption,you should
become subject to the Workers Compression provisions of Ort Iatsr Code,you must
OO forthwith comply with such provisions or this Permit shell W deemed evoked.
z M CONSTRUCTION LENDING AGENCY
I hereby affirm that more is a construction lending agency forte perliumance of
($ ti the amok for which this permit is issued(Sea 3D97.Civ.C.)
W� Q Under's Name
z lender's Address
U 0 1 certify that I have read this application and shire that the above information is
U,H comet.I agree to comply with all city and county ordinances and some laws minting to
0U building construction,and hardly Ruined=represenotives of this city to enter upon the
n] aWvr(We)a Teen saveperty for inspection laposes.
u0.J (We)agree ro save,indemnify and keep harmless the City o(Cupcninn against /9 ///QQQ
py liabilities, costs and expenses which may in my way acerae against said City /
U z in con a of the granting of this permit. /
F-t APPL
AN UNDERSTANDS AND WILL COMPLY WIT I AI. ON-POINT Issued by: Da
SOU ULATEONS.
Re-roofs
oat ApplicandConracmr ate
IIAZARDOUS MATERIALS DISCLOS RE Type of Roof
Will the applicant or future building occupant some or handle hazardous material
m defined by thc Cupertino Municipal Code,Chapter 9.13,and the Health and Safety
I'd
nyeszss3z(a)7 All roofs shall be inspected prior to an roofing material being Installed.
❑Yes Nn P P Y g g
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
it harzAous air contaminants as derined by the Bay Arca Air Qual try Management all new materials for inspection.
DkIlicty
❑Yes �Nn
I have mad the h ounlous materials mquirements under Chapter 6.95oftheCalifor-
nia HcalN&Safety C,k,Seco.m2 505,25533 and 25534.1 understand Nal if the Wilding
does not eummly have a mood,mut ire is my rci,maihility N rano the rx uPon t I Ne
rcyuimme w h mus he mem o,1. one Ccrtiricate of eg Signature of Applicant Dale
ncr nrauthoriaed agent `T Dat All roof coverings to be Class "B" or better