01060052 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1173 CRESTLINE DR HOT WATER INC 01060052
OWNER'S NAME: APPLICATION SUB DATE
NAST WILLIAM E TRUSTEE & ET AL 2531 GRACELAND AVE 06/08/2001
PHONE: SANITARY NO. CONTROL NO,
I\ 650) 298-8494
O OZ ARCHITECT/ENGINEER: BUILDING PERMIT INFO
m BLDG ELECT PLUMB MECH
fs a i LJ f-1 f-1 L-..I
,�- ,`r„3''• 4.ICENSED CONTRACTOR'S DECLARATION
o
q 1 hereby affirm that 1 am licensed under,ovskibns of Chapter9(commencing
! Job Description
2.=W with Senion]000)of Division 3 of the Business and Processions Code,and my license!
7 in full force and effect.
�o � ucense.Clnsa uc.a Z REPLACE WATER HEATER.
a'�3 a u Data Contractor
ARCHITECT'S DECLARATION
�=O I understand any plans shall be used as publle records
p O Licensed Professional
{
Htis, OWNER-BUILDER DECLARATION
in I hereby affirm that I am exempt form the Contractor's License Law for Ihel
C?r, following xcation.(Section]0J 1.5,Business end Professions Code:Any city or county:p
which requires a permit to conzwn,alter,improve,demolish,or repair any structure
d>m prior to itsissuance. L q utheaDPl cam for such nernin to 51c a signed sts'emem.
nt,t nq ea Et nttt ma gro sof meCd taro". I yUhr" Sc -I G Cloot Area, p
(co gwith sen ]e(gdrD' i.diJonneBaslne naa�,r°asnnaed) !.1;: YJ.Is.��� k t, a'1;.:�'i'f' $5'O�.uLLlon
or that he is exam i the¢rtom and Ne bans for the elle jaebxem tion.An
D g p" yviPlaion
of not Section7031.5road five
any undocddollarrui orapcmdt subjects the Applicant acivil pcnvhy Occupancy Type
iofnotmnrem.,nE°ehnndreaeonars(a5oo1. 36NIYD!�U '''� i .' P Y '
❑I,as owner of Ne property,or my employeds with wages as their sole compensation,
Business a work;and The simple.The
C not intended
cra Li en a Law foes no (Setapply tons, 502 - FINAL PL"1sM[iff`*Ags rxvn�iY
owner of and Professions Cole:The Contmcmro License Law s such
not apply m an - -
m through
of property Who builds or improves at such improvements and who such wink n i ed or
- .or dgdugh nis.wit employees. Wildin Nat such andemisofare not imcnN:J or -'- -,_--_ 5.0.6- -._-GAS.._TES.T_-._.. ..-----_.�___
iifierea m�sale.v;boweyec me wdemg or imvmyement is sola whni�ono rear or
completion,me owner-builder will have the burden of proving that he did not build or 507 - FINAL PLUMBING
improve for Purpose of sale.),
Ed I as in f the progeny xcliness con.sing with]idea seee tractors to ,
constrain the project(S ]044 Business ad er f. ns Cod )The Commoner's
Li La ane f pply t r f property to builds improves s tht the
..and h cit t ns for h p 1 aa.wim a c t t H) <en ed.p am to the.
Contractors LicensLaw. - -
❑lani pt nd}5 ., ° B&PCT this remora ✓.I' )�
Owner
Data r ^ /
- -
WORKER'S COMPENSATION DECLARATION
Thereby uffirm underpenalty ofp rju6 one ofth following dcl tart
• ❑ I bave mad wtll maintain a Cedureaie of Conant m ulf-insure for Worker's' D/
Compensation, as provided for by Section 37W of the Labor Code, for the;
- performance of the work Tor which this permit is issued;
13 have and will maintain Workers Compensation Insurance,as required by Station
boo of the labor code,for the performanee of the work far which this permit is
` iss d MyW"kers C pe at Incur c c rt nd Palt y e tuber are: "
v.....
Camel S" rt (.i' :d.tL _ -.,«. - _.... _.._................ ...._.._..__...-
PEMPTH t 'gl I? }.,..y.•i'.P.. IT��'l ki..S 1.el �I.i,*
CERTIFICATION OF E%EMP TION FROM.WORKERS'S-' + )
„: ,a .:. .,,.,-COMP,ENSAnON,INSURANCE
ohis seeiion need not be complei d if the permit is for duce hundred deltarx i { s 1.
(Simea ass.) , - - '
I intent That in the p f ctance'nf thework for lack thist s'ss ed I -
p
'shall not employ any person 7n any mnnner sd vs td become sublcn to Ne Workers'
Compensation Taws of California.Dam"
I NOTICETOAPPLICANT:Il;obertankingthis simimsof ofexemption,youshould s.. ..
QZ tihhwilnuidna,rethe Workers Compenzaiiis provisionsof the Ichor Code,you most
O forth Ih c reply with such p s or This permit shall be mandiand resavad.
Fr ZI S; ti s ,''CONSTRUCTION LENDING AGENCY
I hereby SRrm th u there is a consuv t on lending age cy Smite pezfotmatee 1 o_. ti s
aQ ' ork fo
which This permit issued JCC1
Lenders Nainc.
Lea a Addre
I c n ry that I have read di agpli t o and state that the above information is
far-t:
cormal.1 agree to amallywith Itchy ane county ordinances and state laws relating
to baudding conshoiction,add hereby numdrm cpresenmhycs ofth: 'tyttenter upon
'r.0. the abc t n d.P ve tid f„ pea P W. ;.
F.. 6i (W) gree to sa dem ipe and ke p harmlessmay
in the City
sterna
peri o ag Inst V
V.
liabilities,sjudgments,o a ran expenses armhich may any y against said.
yueme RST grant 0g d1 th permit t
_ 1.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALLNON-POM''
SOURCE REGULATIONS. Issued by: Date
,•�a.: .,
71
Signature
-OfAPplicant/Cmumo I . '> , - ": Dare Re-roofs
-,, HAZARDOUS MATERIALS DISCLOSURE '
w lim applicant or fumm
u" t bat Idm-g ocP no-se+S:r.handle 6�r6mna rommud
_- TrYiTPe i qf Roof f
defb d byh
SeuChapter , SafetyCoe s32
�Y` °N
---._• ----. -.. __ ._.._. .._ .._ ._.
All roofs shall-be.mspected prior to any roofing.material.being installed.._
emu Will the applicant or future building occuparame equipment or devices which If a roof is installed without first obtaining an ins ection;Fa ree[ol remove
u hazard agement g P g
Dstrtct . . , t tle0ncdb the Ba Area It Management all new materials for ins ection. A licant understands_and will comply with
s Y Y Quality
� � all non-point source regulations:,
I have read the ham d us materials requirements under Chapter 6.95 of the
Califo..in Health&Safety Code.Section,25505:25533 and 25534,1 understand thou
..if life b IJ' does not orrentiv have a tenant.That it isthe
gy m po sb'l ly to notify f ,t
Occi a c yuirtm t hmh masa M met uo rsx antt of a Certificate of
am of the m' x p for '
Signature,of Applicant _C)•t[e
3wher PI xohnuxedagain Dam',.., All roof coverings to be Class `B•' o[better
..-..OFFICE.'.