02040087 (2) CITY OF CUPERTINO - ••
BUILDING DIVISION PERMIT 'CONTRACTOR•'IIVEORMATION-.
BUILDWGADDRESS: PERMIT NO.
10423 HISHOLM AV JUST WATER HEATERS INC 02040087
OWNER'S NAME: APPLICATION SUB DATE
PIPE JEANNETTE L 1764 NATIONAL AVE 04/17/2002
ONE:
S.NITARY NO. CONTROL N0.
(510) 293-9901
O BUILDING ARCHITECTF GINEEWR:
HOING PERMIT INFO
V BLDG ELECT PLUMB MECH
`�Fa�
O v z LICENSED CONTRACTOR'S DECLARATION Job Description
x1- Ihertby0)of ivislamoftheBrenterpndPiofssiChapter.ndmylicense REPLACE WATER HEATERp
wr with In II frce.ncfDivision)of the Business and Professions Code.and my license
is in full forte and eRect.
License aa5e Lie.« (4 0 GALLON GAS)
3 L v Dao Conuaaor
tv C ARCHITECT'S DECLARATION
5 1 understand my plans shall W used as public records
c o Licensed Professional
a6 E O\VEER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Convector's License Low for the
C?a fallowing reason,(Section 70315.Business and Pmfessiara Code:Any city or county '
E D 'hh h requi es a Peanut to eonswv,alter,improve,demolish,or reW'v wy swvure
3$ P!mrtoss swance,also req the applicam for such pemut to fileastgiiW.etc ns - .. _.
Wlheul¢im pdrsua un"a pro stuns of du Contrxtors Littnx Law lCAapser9 -,._._ ......._._._
leommene g NSect 3000)ofD 'iion3oftheBujineuamProkssonsGm) c'..t�C:'•5 a )5' Sq, Ft.;FloorArea;1 ' < .. Valuation
or 0m he rs exempt thcrtirom and the Wna for the
alliged exemption.Any violauon i-v'.. L, 3of
'of tSecdon TOJ18'by anYappllcom for a'pewirsubjass the epplicont w a civltpcnalry-
reard
than fsve hundred dollds(S500). AFN NumberOccupancy Type
❑l,n5mwnerafN__epropcny,wmycmployccswithwugcsuthci,.I,.mpeustion, _
.ill'do the work and she stricture is nm intended or otfeied'fdwsdlc(Sec:]pal
'Businev and P.11a"inna Cmc:The Contractors License Law does am apply wan 506 - GAS TESTequired Inspections °�`U""::>TF
owner of propcny Who Wilds or improvcs thereon,and who does such,work himself
-or Nrotrgh hi>gwn employees.Provided anal such impm,cments are not intended or FINAL PLUMBING
offered for Ie If hm.,..Wildin or m .- --_.___ _ _.___. - INAL ._ __ _.
'ccmplciion,Ne If,
Wilder t ien ofprovrtsold within and year of - - G .... ._
vwill have du Widen of proving,lath tldmt Wild or
reprove for purpose of isle.).
❑1:u owner of da propmY•am uduively eontmetint vent 1 tt d eonvumrt ro _. _. ---- _ _.__ _- _ ._
a altm-she project fS. 70aa Bunmss and Pmfassions Cod )The Contractor's r.
e License law does not apply to sn Own,of pmpeny who Wilds or improv.thereon. 1:�
C uacw c1 Luise la h peJecss-wish• omracimO IioensW pursuer ow.the _ _ __ ___ _ .. __ ._ __. __ __ _
Ellam.-P,trade Sec I �8 At P C far.this reason - -
OwoePENS
.. WORKER 5 COMPENSATION DECUBATION
tau (here aRrm umv 1 of g —
bY pw ry pc Jury uric ofthc follown tled exons:'
1 ha'v ad'will maintain Cenificete'of Conacm 6 self-houre for Worker's
-S, Compcnvtion- _povi
as- dm-fn, by-Sectio -J]00-oh n Ne-Labor'Cmc,-for'she
performance of Na woh far which this permit is iuued,,,t,
7 ❑I have an" will meimvin Workv i Compeuat on l sunu req-red bY.Section
3700 of th-labor Cade for the performance of Nc wart foi whi.h Woe permit is
ssued My Wortears,Counk seudn l rance come policy nbmbe
ClrHcr
f CERTIFlCATION OPEJCEMPnON FlZOM WORI�FR$n. L 51 i 1 yi>l_ t CZI 1`(rl>.'i'�� 1.._t
....
._CO PISVRANCE,'l ••_
5
••r _. ..,-----
---
11 "n need nil be cdmplcwd if the perms a for ane hunched dollars '`1•' ••,.i r -- �.Y..T I
fS1007or less.)..
torts 1 ckfY that in the per/,tsar ce of the wfoA f which th j _
I
pcmui Y s'ed 1
C.m1hall not ploy y person y tier so u to becii e's bJect m inceWode
Compenhas nIs sEf Cal form Dir'- .. I
�..
1 NODCE TO APPLICANP If after m k F Nls C nlf see of Eu pi o Yo M Id
becomes b)ea to th Wod rs Co pens t o
0 forth the reply ,lis ch pin onto thsp ons of the lAbm Cme you most
Z Q _ - perm t shall be dtt ed re ked
L:S fc5 r 'CONSTRUCnON LENDLNG AGENCY � + ' -"'
"'� 1 hereby aSmi that there a co swot o 1 nil n agency for the pcdomu Ice
a�.i. of Ne a k(o( h ch tM1a permlus i seed ISec J09T C C) 1:
Gds- !=riders Naeie."..'•. �. ,_: _.:,., ...-..w... i,r. -.
V
O:
nionons
A,_, Ic nfY th tlhave dths ppLcat n Mute th tri aW cmformu /� Z
coirttt 1 gree ro comply 'rA 11 mtY ire coo tY mrd n rocs am sine hws rtlamng
V' to Wild gromwv on.amh rtbya thorize rtprescnuuvca otdus airy to enter upon
tM1e ebave mentioned properry for,ipspecdon puryoses,„� I
y.L” fM'e)9piee}o,ave;indemnify and keep'haiMess Ne Ciry of Cupertino.gams,
h liabilities,judgments,cosy orb.pens.which mry in any,wvy.aecme•against said
V Zr,� �Iry n c nuquence of the pram g of 'perm t
_ APPLtCA\TL\UERS7A.\'pSA.\'�t}g74L CQkfPLY RIi}I ALr[\O\�POL'v'T""t 1
soused REGbL:A7iGs Issued by: Date
StgNmre of APPI wUContnnor x . /
1 7, f HALIRDOUs MATER]ALS D7SCLOSIIRE t i Uxi-. '�1t i, Re roofs
a W 11 the yrpl cant m f tort Wlbmg ate pent store a handle herardo's metenal7),'Pe Of BOOf
u defined by the CupcnSrro M sec pal Cme CNet 9 12 sed She Hca1N and Safety - - ------
..-All
_All roofs shall.be Inspected, nor to any roofing.
n Wllthca➢Phcantmfuturc W
09..Pe t useequipmenth d.tta n n P matenal..bemg installed.,,_.., .....
t hazardous air content rets de by the Bey Area/ser Ovaldy Manaj mem If a roof is iristalled without first obtaining an ifispechon I agree'to•remove
IsnlCl
„ oY t „ ON. __all new materials.for,inspection. Applicant,understands and will-comply with
t ` y all non point source regulations
Ihass.revihthe It. material''rtquirtmenu'andar Chapter 6951oinhe 'J71.
California H.Ith k Safety CmrSecuans 25505:755)3 and 25536:1 understand that
it.Pa illi g do.nmgtrrtcm hick most
be Net us my rtspons b l ry to notify the
_.....
aeecput of Ne equ rements iiieh must be net p66 u isivarice of.C rii8cate of s ,;.•v
Octy utc 1 .
p Y lll ,.
Signature.of.Applicant.
- .. .Date
Own ro ph nttd ogcnt F t i .v , D¢ .-_. ..
a
,e•. All roof cove rin s to be Class;5`B or better �
g -:rc