01110035 (2) CITY
J YOF cUnPERTINO CONTRACTOR INFOR11fIATION:
PERMIT
BUILDING ADDRESS: PERMIT NO.
; 10161 CARMEN RD JUST WATER HEATERS INC 01110035
"FIR'
APPLICATION SUB DATE
"FIR'Y LARRY 1764 NATIONAL AVE 11/06/2001
PHONE: SANITARY NO. CONTROL NO.
r i (510) 293-9901
D FARCHITEC fEN'GINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MF.CH
w i LICENSED CONTRACTOR'S DECLARATION
5„ Job Description
i Z-0 1 hereby a)mf aha 1 am licensed under provisiws of Cwper 9(commencing , REPLACE WATER HEATER.
:2ro with SecaorcA.ri)ofect. on3of she Businessnna Professions coat.and my license
;mgr ia.n ten roar and etfe<r' (75 GAL GAS)
:u�6 License Class Lit.M -
1 3't h ,Date• Conuacmr
•a o ARCHITECT'S DECLARATION I
I undemmnd my plans shall be used as public records
16 p 0 Licensed Pmficoa...I i
Si
OWNER-BUILDER DECLARATION
I hereby a0irm that 1 am exempt from the Conuucmr's License Law for the
t? 'following....Section 7031.5.Business and Professions Code:Any city or cuunry t
Y F o which requires a permit to convect,alter,impmve,demolish,or repair any swcmm ,
i3� ypd_ a 1 nee;til try the pphcam far such pemuuofkas 6iwd areae t• — .. _ - _ _ .._. .. _
rhar hd sl nsed"pbrshnfto thepovscris of me Comradofa License Law(Chaps 9 S vFE Floor'Area-. a aT Valuation
(commencing with Section 7").FDivision3afthaBycmc.AndPorfgssim¢Code) l.;li.`-"J'I5�1 q'tl.:.. f_�d •.�k 'f_::
of that he is exempt tfcrefmm and the basis for the alldge'd ciemprtoh.Any violation
of Section 7031.5 by arty applicant fora permit subjus the applicant toa rnil pcnahy
I kernotroomthanfivehundreddollarsSM(u. APN Number '1 - Occupancy Type
t
❑Lumv.c,.ftA,mAst.urmy employees with wages astheirxlccompersation, 502 �
will do the work.And the smartme-is not intended or offered for sale(Sec.7046, i
(Business And Professions Codc:The Contractor's License Low does nut apply m An 506 - GAS TE S Required Inspections"•' "
owner of property Who wilds or improves thtreon.and who does such work hlmsalf. 507 - FINAL NAL PLUMBING 1
or through his awn employm.provided that such improvements are not intended or, _-__,- -__ -,.-_ -- .-. _ _-,-
.. - ._. _ ... _. .' r__ ..
•oRdied far sale.If,however,the Wildingorimpmvc,mv.soW within one year of --' --
ompinion,sheowncirsalaer will have the burden of proving that he did no[build or
impmve far puryox of sale J.
[ 1 ❑1 o t f the property oro endusi elY contracting with licensed en[acmra to t „• i s --- -
•co r t ah pmjem(Sec 7066.Business and P of ss o s CWc:)no Contractors'
License
ice . La does not apply to An owner of Property who Wilds prova theieon,
_And h Anse fo such.profacrs wiN c v toils)licensed pursuant as the . .. .. .-
Co , r r G ensu lv -• ...... .
❑1 e pt under S< ,B&P C forrhis reason
Owrid O -
Data
_ I
WORKER S COMPENSATION DECLARATION J
I hereby affirm aadcrpcnaly of pc7l:rye of the following declamrions: /��
❑ 1 have and'will maintain a Cenificme of Consent,to xlf-insum for Worker's Q
Campensatiun, es,pms,'cd for by Seen.. 37W of he Labor Code, for the,
"performance of the work for which this pmmit is issued.
❑I have And will maintain Worker's Compensation Insuiwce,As required by Section
3700 of the laver Code,far the performance of the work for which this permit is _
'2 issued!My Workcr'i ComperisarioA Inxmnce carom and Polity number am: '
CM r+ S ...I CATIO OF,EXPolicy No: - c'r
• 'CERTIFlGTION'OF,E%EMPf10N FROM WORK
EfIs I, i- '•+d+ 4:S i. l t._ .. -. ':•.'4, '
COMPENSATION.INSURANCE,,
' '''(TTiascnidn need nm be completed if the Permit is fm one hundred dollars a'" 3'-1 '• 1;, - •It.', •; r
:
(slW)mless.) '
-. . . ,.. _
t r I ttn fY that in the perfotman<x of the rk f which th peiirn,n i,socal I s..� "� -`•- '
Compeotem
p y ony perxn m any ma u is become xubfaa ao the Workers'
.i 5aion laws of California.Date
pplUnpa
, rm
, f
^NOTICE TO APPLICANTorer's ftal ompt iation pr provisions
or Esemption,you must -
become subjecttiily rhe Workers Compen r hiA pwv itions ofshed laver Cade,you masa
i
z' µnhwiah comply with xwM1 provisions or Inix permit shall be damctl revoked. '
� ro
F'r of Le'd Name
CONSTRUs corLENUQeAGENCY. .:;;•.. s - `'.:1
affirm rbat Here is a a donnswctov lending agency fame performance
to ork f nbh d pe n issued(Sec.3097,Civ.C) -
tr] 9Z n .. a.. .. _. .. .. . .....- i ._ -
- -
-aa'-�.' La d. Aad eSs...
rr I certifyee that I have d this ity Andu o d mate that thew e information s V
cone t 1 g e ro.comply he all city ends, are Snive d state I ws relating /' / v n
I;) ;ro 'building nwctio dh<mby guano zk p imt5tivcs fNisc tyt soar upon 1_nt f'lti`�l(/
�,,, W the w mento ed p._puny f specs o puryoses„
(Wc)Sgreem save;indemnify ana keep harmlcsi ih<Ciry of Cupertino against.
4 V] liabilities,jodgmenu,casts andespensev which mayin any way accme against said
'V[� City in consaquenea of the yanaing of this permiC
-: APPLICANT UNDERSTANDS AND WILL'COMPLY WMi ALC NON-POINT
_-: SOURCE REGOLAnONS. ' Issued by: Date
Signature of AppycwUConmctor .. r .- , ..,.Data � Re-roofs
r.HAZARDOUSMATERIALSDISCLOSURE ,'.i'°3- '.
T.-,' ' W II the applicant m fimre w'Iding ottupavutore eta ale haesra6as meienal' -Type Of Roof• •- -
ss d ficd by,theCuperono Municipal Cod Chapter 9.12% d the Health and Safety
Cod Section 25532(al ,ay .. s - -"I [\s, e'i`,r�c, . tl..:.k•
. All roofs.shall be.inspected prior to.any.roofing material.being.fnstalled. ....... _
,Will he us applies mm.msremoldingoccupant ast,bytheBayAm.Ai metgaMtes whin. If a roof is installed'without first obtaining an ms ection,'J agree to remove
emit hazallous air nmmmmanu as defined by the Bey Area Au Quality Management• g P
D1Sna1" ON. _ 1 all new materials for inspection. Applicant-understands and will comply with
all non-point source regulations.
in
Ave mad;the haivardous material <y mems under Ch.ptscrlfi.iiii'oflha, I"l•
Cal forma Health'&S6fery Codii.Sections 25505,25533 and 25534A understand that
Line wilding does not currently have a tenant.that it is my re,poasibiliay to notifythe'
.Acupan,of she requirements which mum m mea prior m issuantt of a Cenifceae of
•- Occupancy:
Signature of.Applicant . Date
•' D .._
owaet gt.utnanuAagent . .. . . All roof coverings to be Class "B"of better
ti'1 —OFFICE
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