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03010196 (2) CITY OF CUPERTINO • BUILDING DIVISION PERMIT @ONiTRACTORVINFORMATION 4 BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT NO. 21753 CAS OWNER'S NAME: 1764 NATIONAL AVE APPLICATION SUR DATE NARAVAN NAKARAM 01/30/2003 ONE (510) 293-9901 SANITARY NO. CONTROL NO. ARCHITECF/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ��00 LICENSED CONTRACT'OR'S DECLARATION Job Description w d F 1 hereby affirm that 1 am licensed under pmvisiom of Chapter 9(cnmmoncing p with Section 7000)of Division B of Ne Business and Professions Gyle,and my license is in full fnrecand effect. REPLACE WATER HEATER WALE req? LicenseClass Lic.0 ?y-o Dale Contractor (50 GALLON GAS) S—m'J` ARCHITECT'S DECLARATION MAR 2 1 2003 iowU tsnbe Iundcnd my plans shallusedaspublic records 33wt, Licensed Professional BUILDIN :uyoj OWNER-BUILDER DECLARATION G i @ 02 T moue affirm that I am exempt from IW Cuntncm/s License Law for the 7-00 follwhich routines permitScomm 703 LA Business told Peale iolih,or Any city or county �$�i which requires a permit ns construct.alum improve.demolish,or repair any stnmum Fza prior to its issuance,also requires the applicant for such permit to rile a signed statement mm< that he is licensedpursuanttotheprovisionsoftheContrucuu'sLicenseLaw(Chuples9 Sq. Ft. Floor Area Valuation ss-o (commencing with Section 70W)of Division 3 of the Business and Profcasinns Costs)or $898 $ that he u therefrom and therefroand the basis for the alleged exemption.Any violation of Secdon Ton 1.3 by any applicant for a permit subjects the applicant to a civil penaly of APN Number Occupancy Type not more Nan five hundred della.(8500). 035618071 . 00 h as owner of the PropenY•or my employers with wage u their sole compewtion, will do the work,and the swmure ismm intended or offered for We(Sec.706,1,Business geg�yy,Y,�,pr��fI��p and Professions Code:The Conuxtor's License Law does not apply to an owner of 502 - FINAL 5tTi SINl T'?aRGY progeny who builds or improves thereon,end who does such work himself or through his own employees.provided Wl such improvements an not intended oro@red for nate.If, 506 — GAS TEST however,the building or improvement is sold within one year of completion,the owner. Wines will have the burden of proving that he did not Wild or improve for purpose of 507 - FINAL PLUMBING sak). ❑1,ea owner of the properly,am exclusively connoting with licensed commumn to construct the project(Sec.70414,Business and Predations Code:)The Contractor's Li. . ccnw Law does not apply to an owner of properly who Wilds or improves thereon,and who contracts for such pmjccu with a contractors)licensed Pursuant to the Conoaclor's License Law. ❑ I are exempt under Sec. B&P C for this mann Owner Dal WORKER'S COMPENSATION DECLARATION I hereby aRrsn under penalty of perjury one of the following declarations: I have and will maintain aChroficate of Consent to self-insum for Worker's Compem 703100.1' tion,as provided for by Section 3700 of Be Labor Code,for the porformano,of the rk for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,is required by Section the Labor Chain,for the performance of the work for which this permit is Issued. y Workers Compensation Insurance carrier and Put icy number are: rtier. Policy No.: _ CERTIFICATE OF FAEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not lw completed if tbe permil is for unclouded dollars($10) lir loss.) 1 comity that in the pertimmann Of the work for which this permit is issued.l shall not employ any person in any manner at,as to hecomo subject o the Workers'Compensation Laws of Califurnia.Dam Applicant NOTICE TO APPLICANT:If,after making this Cci illeme of Exemption,you should become subject to the Worker's Compensation provisions of the LaWr Code,you most 0 Z forthwith comply with such provisions or this permit shall he deemed revoked. z O CONSTRUCTION LENDING AGENCY [ti I hereby affirm that tore is a constmcdon lending agency lin the performance of / a > the work for which this permit is issued(Sec.]INA,Civ.C.) _ aQ Lender's Name Z Lcndcr's Addtcss V 0 I minify dust I have read this application and want that the shove infotmmidn is kfr F correct.I agree to comply with all city and county ordinances and slate lows relating to 0 U building construction,and hereby authenee opresentutives of this city to enter uDm the W above-mentioned property for inspection purawer. (We)agree to an,indemnify and keep hmmleas the City of Cupenino against IF—t %1 liabilities,judgments,costs and expenses which may in any way accuse against mid City U in consequence of the granting of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POIT Issued by: Date SOURCE REGULATIONS. Re-roofs Signature.1'Applicautincentractia Dote HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or furore Wilding occupant score or handle Ileardous material C de,Sed ar Ne"id,no Municipal CME.Chapter 9.12,and the I lealth and Safety Code, Sachem zss5z(arn ❑Yes F1 No All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occuPam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it haamdous air contaminants as defined by the Bay Area Air Quahly Management all new materials for inspection. 70s wnG7 ❑Yes 0 N Ihaveread Nede.SNousmemnalsrequiremc55under Chaptert 95uilbe Calling anith&Safety haw a tenant,that it i My retSM]sSM.T unh.laM le m ifthe Wilding s not currently haw a tcnem,Nat it is my rt5pomiMliry m wdfy Ibe IccuPant of the uirementswhichmumlemapdormiont...toCCAruromOflRcupaucy. Signature Of Applicant Date neror amhorimJ agent Dale All roof coverings to be Class "B"or better