02090104 (2)'C ffYlOF CUPERTINO,
BUILDING
r'alienOwne
CONTRACTOR INFORMATION:.
DIVtstory PERMIT
B}2116���DDR�s6NRADIA CT
JUST WATER HEATERS INC
PERMIT0209017�0,4
`' VA'AtnCK RANDY AND SUSAN
1764 NATIONAL AVE
APPLIc'61�NgTB 'A
1002
' PHONE:' :
(510)293-9901
SANITARY NO. CONTROL NO.
iARCHITECf7ENGINEER: -
- _
BUILDING PERMIT INFO
_
BLDG ELECT PLUMB MECH
mC-J
CJ C.1 L'._I
Z"LICENSED CONTRACPOWSDECLARATION
I hemby affirm that l am licensed under provisions of Chapel 9(commencing
JJ b pe cription
k : with Section 7000) of Division Sof the Business and Professions Code, and my license
' is in full force and effect. al
REPLACE WATER HEOATEls2
(5 0 GALLON GAS)
U' Licedse Class M
DaU " Ci protein,
N ARCHITECT'S DECLARATION
g�..,.,� I6churoand my plans shell M used as public remade
OLicensed Professional
uu. -OWNER-BUILDER DECLARATION
"I hemby affiiinthat 1 am exempt from the Contractor's License Law for she
a "following Feasor. (Section 7031.5. Business and Professions Cafe: Any city or county
esf which're,macs a permit soemscamu alter, improve, demolish, or repot, any machinem
its issposex
- ..____._.-$700-
x%00_that
, prim, to mrequheuheapplicant for such pe.it o Be. signed statement
'hit be located puriant to the pmvizmasof the Cmnuacm's License Law (Chapter 9
"(cam nc gwith, Sey I7000M of Division 3 of the Business mel Pmfeceionz Code)
Sq.- Ft. FloorfArea, Y yy
a
Y,:iIjo { y,.t SF t•,v+If.I tp a'p`IL{'
Valuation
or that he la exempt thertfiom and the bass or the a12ged exempnan. Any violation
3'5623056.00
- of Section 9031.5 by any apphicuin for a permit subjecte the applicant to a civil penalty
'.arelmare than five nntidred dollars (3500).
APN Number -
-z.... .; Occupancy Type
C1 1; as owner of me property or my employees with wages as their sale compensation,
502 - FINAL PLUMBIN
ENERGY
-will dome work; and 'the 'structure is* net intended or ofktedfar 'sale (Secf IDU;
Business and Notation., Cole: The Contractors License law does not apply to an
---------
506 - GAS TESTRequired Insp'ections',-,.
owner of property Who Wilds or improves thereon, and who does such work himself
507 - F I NAL PLUMBING !
Lir through his own employees, provided that such taprovernscats am not intended o
Ced foraile. If, however, W the Jd ngcir improvenorif is sold' lhiolane year ofo
,alife
completion, the owner -W Idcr will have the burden of proving that he did not Wild or--
imporm for purpose of sale.).`
"o 1; owner of liep-ponymexclus to'with I scJ contractors to
ly t
L_ .,_.
\
_ crummuct the project (Sce7014. Business and Perfessim s Cod )The Contractor's
' License Law does not apply to an owner of propcny who Wilds improves thereon
..fond who comme".6a, such .p 1 u wM a conwuur(sl I sed pursuant to the
-_..__
1._9002 .__., !.
_ ..(i
Cis t : L n.eL
.... __... _.
_. _ _. _.
OCT L
_ OI am exempt under Sec c' ;B'&PCfor this rtasan
.P. 1),- P, .P
WORKER S COMPENSATION DECLARATION
BUILDING
1 lonethy am. M 'Tit, of C Ivry onef he following detl torn:
❑ 1 havemid"will'ty t - Cklicaic of Conuent m self -insure for Worker's
)Compensation,, as provided for by Section -37W of the-L,Wr Code, far the
- perfomlance'of Ne work for which Niz permir iz issued. tr'
I h ✓ a dwli'Limim W k ';Co pe I 'Itnumnce, as required by Section
. .
3700bPlhe Lobar Codc, for the peffoimance of the work for which this Permit is
- ITiucd.. My Worker i Compehs5tum Insurance carrier and Policy number arc
policy No }' ..
� f y' 1 _ _ ,.,.�...............
T -\'r I'""'
�.�f, �r., Y..s\•5tr�ti qs] a•1P,}'il
YIi`7CBRTIFICATION OF EXEMPTION FROM WORKERS
-COMPENSATION
t.
_ INSURANCE ''
''s'`IThssmlinn'need nmWcompleted fthe p<nmt is forae
ohmdrNdollors
!I:• --_`qL tri,); �, 'J pl)_.._.._„•.M....
,1SIfp)mr less)
lar :
.. $. .. _
I c n fk that In pert s c of the k f which Permitis !s vee 1
_ .. a- x _-..::. v .- _�..�.e..rs. a •e... n...... -a n...� s..+aer _
' er a
employ ,son n any mane a as to become subject m the Worker
ub
w.1 f
Ca
C nerimon mon laws of C f :Dole
t .,'Apply I � r .,.
o
; NOTICE T3 APPLICANT If, alter makithis Certificateyou should
s s;• sO ,.i, ;
u
Ps Compensation Prov sofedemed Code you must
i bccomillica
campywith
lonhwilh comply with such pmvisions .,,his permiuM1all W deemed revoked.
such
CONSTRUCTION LENDINGAGENCY
of (he Ink ocrebY ah which M. that men, ' st aro lend” gagencyo the pert
permit cd (S a 3097 C' C)
_n___ s(.. CrL, l-
t-.
a ,Lend Nme'-.'-•- �. .
__._ .. ....
Le d tt Ade `.�
1 '..,
j,s..,
y, I ccNfy that 1 Woe read this application and sum ft, the above infammioo is
ctirtece l.,me to emadl.with all, city and county ordinances and state laws misting
to building consmbolan:and lurmhy commie reprevartatives of thiel city to enter upon
the abm
_ovcentioncd pmpeny for inspection pdryoscs.,w.,-
Iw'0 agnec to save. iMenamfy and keep harmless the City of Cupertino'against
liabilities, judgments, costs and expenses which may.ln any way accme againsaid
'n "•'
m
City n sequence of the B'n(y fsh permit.
TPPL1C ANT GINDERSTAND$ AND WILL COMPLY WITH ALL NOK -POINT"
SoURCEREGULkTIONS
Issued by; Date
Signature fAPP;candC tract ..�' '.r:r"' ., :,nate' .
�. C,,1 iy- HAZARDOUS MATERIALS DISCLOSURE q
Re -roofs
will the applicant future building acculwalstore or hatdl harallo usmom ad
-u
.Typerof Roof �"'
defiled by the C.Pcehno Municipal Code Chapter 9.12,and the Health it Safety
Code S eon 25532(,) t - -
_
"` -= -_—"'"""'"'�^^ "'^ a •
'.. 'i 'd k'c"f ; f(i(�)e j:R9 i, '. % f-.111 hl: ❑s
�'
❑Ye 1 '❑No>I x4T�...df.Sff{ -
S. .tri➢ J • s'
All roofs shall be inspected
WII Ne -Pp ,-at ch, Name Wilding m p t eequipment deviceswhich
emthanudos contaminants defined hyN Bay ArtaA
I ,•r
prior.io.any roofing.matenal being installed.,_____.__
If a roof is insialledl without first obtaining an inspection; I'agree`to remove
Quality Management ,
•i,_ oY -r .,. No -, - "
= all new, materials for inspection -,•Applicant understands, and will comply with
. p•.,o
1 haiardous 'mmerf
_
all'non-point source regulations . 1„T ('
h ate read the 1 o gmrtments u der Chapter 6.95 of the
California Health & Safety Cafe. Sections 25505, 25533 and 25534. 1, understand that
'if
IFlhebuilof
th does of currently have a tenant. that it is my responsibility 1. aril, die
”- _ .. _.. _._ ... ....... ... .___.. ..._..._.. _._... _ _ ..... __ _ _ .. _
nidi there
the
,pa requirements which men be met prior to iisbanca'of 5 CeniBcae of
` t
Do.wrey
Signature of -Applicant
-, .
I
All roof coverings to be Class B oi$e[ter
thmiud Nam
;.:.• I,- ;� ._-- .' .. i i.... . --._.OFFICE ' - --_.. ._ .. .._ . . ._