00090189 (2) CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS' - FERMI F NO.
. 1164P
,.. HOTWATER INC.• . 000901.139
OWNf;R'S NAME'. ' APPLICATION SUR DATE.
':'2531 ,GRACELRND AVE 09/2912000•
HONE: - '„�1 - SANITARY NO. .CONTROL NO.
_ 4
't�ir 0 0 ARCHH EC'DENGINELR. _ r. BUILDING PERMIT INFO.
BLOC rELECT, PLUMB MECH
z r .r =1' Cl IJ L-I
LICENSED CONTRACTOR'S DECLARATION
•z 5 y= ' Job Description. ,,,
O Z 'a I retch
Y ritual lam I licensed J p f Chapter 9(convene ,g - p ,
F uhS t 9010) fDv. n,3ofthe Bu dP fsionn Code,,,rd my
ee., C ceand nBo l REF LACE"WATER HEATER
-
Dole
z Lee., Class L p
°K O a U Dote Cameroon,
W 3 W y ARCHITECT'S DECLARATION' -
El + I undervandanyPP ..hhI1M1 .,,,it asp hl' d: rk
w OC lice II' (.sinal I
-OWNER BUILDER DECLARATION
l hereby affirm that(ern excompt tan the Control L m iso Law h r the I
Following reason (Section]1131 5'Btranw,and Pufle Code Any all, - mnly
N it O
worth 4 permit t t Ile P demolish, :r I I c e - ✓ ✓ ' . .
prof t. 1' P l
nodules m tl beet a II g I m
that n .licensed l n( Inn f d t Commerce,L e I Chapter, - Sq. FC Floor Area 3itl�ati n '
gest 9mat rhe 3fdB and Fred Coda) V -
orm(1 pt therefrom oder basisr m age pt Ay Fin $500
of Se l 7031.5 by y ppl ca t f M Iobject,0 ppl a I p Ity, _
ora thanrhundredd diary(550(oI . A'PN Number - OCcup•
ff,
,d (he if the p"any, -on,is or "in or sfee Jele(Sec.70 ,
El V
ill d lM1 k I In I' t s i offered d o of (S )044,
Finland"a e P r l cd, Ther t , 1 does work
o ra an ri Required Inspections -
�,m-of prnl>eny wbon ud�(tinprove n eln and luno 1 ea Snob work lfmself • ,
gall wnc,+, ,providedf r: 1 p ver t: not ur 502 — FINAL PLUMBING ENERGY. .
offs d f sale I If,naw (I ilding p nets sold 11 le nth year of
- omplmlon:menwner4mulderour have ereLondon urpruvmg(lint hedid nor buililm 506 GAS. TEST .
nmPrnve for pu(poag arxaie)- •507 — ,FINAL RLUMB,ING.
El E.,owner 4 the property,and eulusively contracting with licensed contractors to „ -
construct the Ill(Sec.9044,Business and Professions Code:)The Contractor's 1 s
Llcanse Law docs not applgro it owner of"many who builds or in,P.ove,thetwn, -
and who matrons for such model with a eontractot(st licensed parson to the ” -
Com®emds Lleense Law.
- ❑I an,exem,l undeeSec B&'P C lot hls reason -
(loner - Data .. •'
WORKER'S COMPENSATION DECLARATION
I orehyadult. 'ad,,penalty lir po fury tine of the l'ollowingJwlumtiims: - -
° I have.ane will mainmln a Certificate of Consent to self-insure for Worker's `1 `• _
Compensation, as provided for by Seaton 3700 of the Labor Code, for rho
pednmranee of(nn is k to,which this Peru,;,is issue(. r ' "
111 h d vrill adiamill Worker's Cca,gursa(ion I :u s req,retl ng Section • '
3900 of the Labor Cmle,fill pe
r the tlmmance of the work for Much this read,
sued.My Worker's Compcasu(ian Insurance mrier and Policy number are
Carrier. I Polley Na,:
CP.RTI FWATI ON OF EXEMPTION FROM WORKERS' -
COMPENSATION INSURANCE. is
(This can,;)need netb amplacd ifthe Perot's frounc.mandradembas
($100)or less
^ I certify Ida(In the performance find work foramen(Iris p...m,i.;.wadi,I
-shall not empley,any person in uny`manner so as to become subjret m the Workers'
Cmnpcnwtion Low,of Culimmin.Date -
Applicant
NOT[CH*10 APPLICANT.If.alter Toleing(his Certifinne of Edreption,yon.should - - •.i
6cme subject he W aker's Compensation Fan,mi n.of(he Labor Code,yml maI. _
0mtt
forthwith comply with such provisions or(his Irohnit shall he deemed revoked a
aw CONSTRUCTION LENDING AGENCY `
I hcrenyaffnm thaddare i,sconstruction loathing agency nam
Future Niforc
. W afthe work for which this peroluts suard(S 3097,C'v.C) -
0. (� Londa,Name
Z Land,,',Address f y
V
1'eartiff,that i haevad this apllicmbr and ,are that the oliva afrmil'oti is -
tzl Fy carred.I agree to comply with all city and county endurances and state laws relining
V mnoddingconstmafon,and hereby awhdri,,represcomev,ofllda citylo emir neon - r
r� the obove-umallonedproperty finspection Purposes
�.I a (W)u,nc to save,indicatorIyand k pl la:(he City of Cape,'i ktnsl "
Fa Ul liabilities,judgments, I J c,XipcdscS which may at any way settle against said '
V .Zi City in ca"Nuarar,ofdbe gmnngafdfspermit.
u-•'
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Date t
SOURCE REGULATIONS. Issued^
Si,ouldre of AppheamfCommemr Data 'Re-roofs
HAZARDOUS MATERIALS DISCLOSURE s ' -
Wel the apphourat lumarre building c p' r loreW handle ha,ladars moon ial Type of Roof . .• ., -
- u dolmed by the Calremfiao Mun cyad Cn lea Chapter 9.12,and the(forth and Safety- r ..e - r
Code Searle.25532(a)+ -
` °Y °N - Allroofsshall.be inspected prior to any roofitig material being installed'.
Will theilcapplicant future holding g p I .e. p I d iwnat If a roof is installed without first obtaining an inspection, I agree to remove'
vmc and usarc' and ua dufnW by the Bny AocoAir Qudlry Manogemem p }' r .
torr t - all new materials for,inspection. 'Applicant understands and will comply with -
°Ve °N all non-point source regulations. _ -
i have read the monitors er h requarromas underChapter 6,95 of the r
Calif H Its&S Idyl de Sectimm,25505,25533 and25534,1 undide,,nandthat r
ulldmg docs no¢urtemly hmculenonl that t is my respo sibildyh nuffythe
Ifthe( ,.
cerpan(of rbc reilturearents Wrich must he met prior to issaince oft Cortficate ar
Ocm pvney - ri - ,
` Signature of Applicant Date
^5 r
Owns,oraumaraee isnot - Date ,'All roof coverings to be Class,`.`B" or better