02090107 (2).' CITY OF CUPERTINO
BUILDING DIVISIONPERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS'
10153.CAMINO VISTA DR
JUST WATER HEATERS INC
PERMITNO,
02090107
?MIVURTIS. W AND SARA L
1764 NATIONAL AVE
SUB TE
APPL109%17?2002
1 PHONE:' ;
r[
(510)293-9901
SANITARY NO. CONTROL NO.
zo ARCHRECUENGINEER: _,.
-
BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
LI CI L.I L"_-1
LICENSED CONTRACT'OR'S DECLARATION
Job Description
IIOn
I hereby affirm tbatlam licensed under pro.nrChapter 9a
(commencing
..' with Section 70(p) of Division 3 of Ne Business and Pmfcseions Code, and on, license
p
- REPLACE WATER HEATER
is inDfall re<ano curia.
- roass
(5 0 GALLON GAS)
6 u Cl
License Lic. s
U
a¢,r' Contractor
. .: ARCHITECT'S DECLARATION
g ` 'I ": `I undersmnJ my plans shall be uuJ az puhlic recoNs
'
O'. Licensed Pmfcammu l'
.1., ., tt;�„a, : OWNER -BUILDER DECLARATION
' I hereby firm 1 from Contractor's
that am exempt the License Law for the
<'. • following reaun. (Section 7031.5. Business and Pooksions Code: Any city or county
O .which requires a permit to consumer, alter, improve, demolish, or repair any structurems'pdor
to its issuance, also requires the applicant for such pemtino file usigned statement -
- - ..__._____ 90.0_..
that lid slicensed pursuant toteprovvisonsoftheConoactoesLicenseLaw(Chapter9
1( ncng with S rmJol of Divmor 3 of Ne Business and Professions Code)
t.,�� y _Sq:Ft.Floor-Area 9 , f,... Valuation
4' ;,� {,. . ars i'a hE1:03
o fli he s e empt the fmm'and the basis for the a0c8ed =aempdon Any nomti9n
:"n'l:
34214084.00
+of Section 7031.5 by any applicant for a permit subjects the applicant a civil ,malt y
,of dm more than five hundred dogars (150)).
APN Number , :.a.'•: ` : Occupancy Type
'oT. as owner of the property. or my employees wiho wage, az their sole compensation,
502 — FINAL PLUMBING -ENERGY
do
-will s the work; and the structure is not intendedoroffered' for sale'( Sec,' 7044;
Bdineis'and'Profcssions Cute: The Cummmur's License Low does not apply to an
5 O6 GAS TEST .. .._.
Re aired Inspections'",'
owner of property Who Wilds or improves Nere m. and who does such work himself
`
507 - FINAL PLUMB ING
or through his own employees. prevailed Nat such improvements arc not intended or
s offered for—sale. If however, the 'bmld ng or onPmvcmem is sold oidonmeyttir of
'cont
ction, the owner bu (der will have the burden of
F pros ng thin he JW not buil) or
improve for purpose of zale.6
_ _._.
- - fN p du- ly t t do t ctmrsto
_
,OI BwNo
ec.7
consumer - theproject (Sc 7044 Business d Professions Cod ) Th Contractor's
tv d t pply t o f p pony hob Id improves Nerean
, II ) i r.i
1 I _ r N
a
:.,a d who eta.
Licenme,s far uch P leets. tN.a.connacmgsl beensml Pursuant -to Ne.
...._ _ . _. _ .__. ._.. ___.....____ �®.
Cionnouev
se Law.
_ D in ioo,rum mode 5 . Ct "x B&PCfor this rc
___—.. _ _.. ..._ --------- -
tOQYx g)}
12002
. Owne Data .
k - WORKER S COMPENSATION DECLARATION
1.. _
I h ffirm by aJ pen Ity of itdrory,mr. of the following Jedmtians -
I
BUILDING
❑ 1 h- rend will ore I'Cmif m f C aunt in self-moure for Workers
Compensgtionf as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued..
P I have'atiti'svill'm nu Workcr'r Ciiinkromina4 Inv6arcc as acquired by Section
3700 gf,he Libor'Csde, fur the performance of the work for which this pcnnit is
'd
My Worker, Co pc:otonlrs 'wfli,rimil Poilivy atindoer our -,
PliNo.
iC•.L-K
_... _.�_- ,_; __ __ •.rz...�....�.�...
-1 ...,
'''tl ti sl
.p
..I.I.P,,.ItC,A.TrI_O-NO-F:.-E%.Fr.M.n.-I,ONFROMEW4OaRt,•E'tRnS
CONIPENSATION INSURANC
._. _ .-1
't' orb i -section need not by complued fNe pcnnit is ror one hnndme dollars•
fyv r•a •siPRC•.'" I G '.I:' `�r !i:': I - .—"N, �s,,'_. ...�-,,,_.
1E10p1 or less)
I n (ylt'an d h pe f ce 01 rk 1 which s issueke 1
s 1 lu•. t '
shall not employ ws person n any , ri cl n
so av to become subject to the Worked
t tG .l, vJ„ • ..
itanner
Compensation Laws f C I f ,v. Dem -
t makigth.Cnt to fE Duh IJ
"NOTICETOAPPLICAN1or%Compensation
NCWoder.Catons m npra iv ons a(Ncenbor Csde, you mutt
aCtsbc
fissilbcosubject
Tonhwith comply with such'provisions nr this permit shall be devoted revoked.
CONSTRUCTION LEYDINGAGENCY
r ( t f----'
I hereby off th1 the bo 'Iru a on led n8 a fo the
F c
'ofN kf hehth pe t '..ud(S 3097 Civ C)
Cendr?, Name
(� f 1
1 - -
V
-r,_., .1 certify Nat I pave read Nis and sum Nat Ne above information is
-gree tr comply with cityanauiod
city county pNinanes and state lows relating
Dnepr ng
th con ib ur o
representatives of this city menmr upon
and yf
I the aboI
albove-mentioredoapert
progeny for i
for impaction p
a goon m f, and It I , _
(We) hgrce to save: indemnify and keep hannlLss the City of Cupertino against
. Iiabiiities, judementx, eons and expenses which may in any way acme against said
. Or consequence of the gaaming of Nis permit
APPLICANT U.y'UERSTANDS ANO W ILL COMPLY Ws1TH BALL NON.POISf
- •SOURCE'REGULATIONS: ; ;{';p"y, p llr:i, orl.
Issued by; Dale
Signor rent Applica tlC "tractor". : .: tUam
HAZARDOUS N/ATERIALS DISCLOSURE
Re -roofs
t 1 W-11 the -pylic tort u building occupant tole or homlle h'aua -ret minimal
-Type Of Roof
as dcfred b the C
y pert M n Cipai Cod Chapter 9 and th H hh d Safety
Cd)OY r�N .1
_^'•" * -•••-*
3
t/%3.t 0-
3}t ar
nFS$d1(I j, i'
islT �1Q, s
tC
..
__All roofs shall be mspected.prior_to any.roofing.material being installed
Will the _pplm t home Id-ga pant use<9 p t d .. 1.
th rJ rcpt t. an Jeft dhyN ByArcaA Q'Ity Marta$main
' - "
If a roof is i'nstalledlwith'out first obtainin an inspection'; Ilagree'to°remove
g
D
Dta ,.
"'
' ❑Y ❑No. f
. , all,new materials for, inspection, understands and will comply with.
1 have read N h a d bar
,Applicant
all non -point source regulations;,-,.❑ -; """ " "
qct oemor u d Charter 6.95 oLthe,
Cat Tom o Health & 1 fety Cale. Sections 25505.25533 and 25534 1 understand that
the puildingdoss not cmomrtl) have a tined. that it is my mspodsibiloy to notify the
skcupant of the requirements which mist be met P, eto in. on cola Cenificmebf
�_
1-
Oc p cy '; -
..
Signature of Applicant. _ _...- — .. Date.
ass _.,
All roof coverings to be Class "B" or tie[ter' '
Owner or authonred:tiger, -. -
„'I,.. Dat
... .... _ _ .._.- - ---OFFICE'--