01050083 (2) ct nuoF CVIS
ur ION
lPERMIT CONTRACTOR INFORMATION:
BO LDING ADDRESS: - PERMIT NO.
7547 DE LA FARCE DR HOT WATER INC 01.050083
OWNER'S NAME. - APPLICATION SUIT DATE
WATERS JOHN H 2531 GRACELAND AVE 05/09/2001
PHONE: SANITARY NO. CONTROL NO,
(650,)298—. 8494
QceZ ARCI if'ri:cflliNGlNIiER: BUILDING PERMIT INFO
tv - It ELECT PLUMB MECH
Nrt6 f=1 Cl 1=] I-1
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LICENSED CONI RACrOR'S DECLARATION
s I beret. farm mat 1 am fviniwd ucti - Job Description
C =, Y a pml P.ions o.Meter ..itmt.I.e. P
FmCm wish Sel force and efDivieiun3ol'the Husinsys and ProfessionsCWe,aoJ my nanse
m g; is in full farce sari effect.
of regia ueenseClasa Lc.n REPLACE WATER HEATER.
R,c u Dace Coo...... -
ua 3 0,
, ARCHITECT 5 DECLARATION
f= 4 1 understand my plans shall be used as public records
�Y
i
10 Licensed Profersional
OWNER-BUILDER in he ORATION
al 1 naso v(Gnn on 11. swamp.from the c,sion,ceiCo License:Any c law co the
Z a following reams tenni,t ],m,h t.alness and Prodscrim Code:Any city acounty
+d H which mf,i...a pent...or cnmwn,alter,improve.h venin t m repair any strumure
He,he isliensnee.alsomto thene,th,provisionoard fur mchpenor,Limas o file it 1.e(Chnmem
ma.heislieenxdpm.ai( 7000p fDi,,n.onne the Business
and Prfesson,Co 9 S FL Floor Area Valuation
(comnibeis with dhen, 7000)of Di basis for
healeg idcssanJ on.An ACWe) q'
o,the he 7 31.5 b tang ap m vnJ the arms fns ubj subjects
the.ixcmpni o Any l Nieton
of Se,tionemn vanyapplicantfor apermitwbje<L+the applicant macivil penahy
it ni(,m,m m:In see b,ma,.I anII:,F(swan). • APN Number - Occupancy Type
❑I.as owner of the properly or my employees with wage%as their zoic compctnaion, 1
will do the work.and the scruchre is nal intended n,oW1cd fir sole(Sec.964.
Business and Professions Code:The Co nowun's Licence law docs not apply m:m Required Inspections
ox I'of property Who builds or improves thereon,and who does such work himself
r through hi,awn mnployee,.provided cent enel,ilnpr(,veinenta are Iceo intended or 502 — FINAL PLUMBING ENERGY
offered for sale.IL however,The Wilding or impmscment is wild within one ywr of
iit.tpl...c'meowner.bund„will have thebnenofpm,ir, he,be did amnaildor 50E. — GAS TEST.
mpro.e fm pem��eor,ah), 507 — FINAL- PLUMBING
❑I,as owner of(he property,n o eselusmely contracting with licensed contractors to
construct the p lett(See.70,14.Business and Professions Code,)The Conms.er's
License laity diets not apply to an owner of property who builds or improves thereon,
and who contracts for such Inoses with a simmccer(s) licensed pursuant to the -
Contractor,License law.
Otic esenpt under Sec. .B h P C fr,his reason '
Owner Date a`�.
W(1RKEWS COMPENSATION DECLARATION .. I NA LE®
1 hereby affirm under penalty of perjury one of the following declara.ions: -� JAN
p q q .0 1 have aand!will maintain a Certificate if Convent m self home for W'orker's JAN O U L�O[
Gmipensa.iun, as provided fb
in by Section 3700 of the Labor Code, for the
paf,nnm,P,of dv work his which this p,nnil is issued.
❑1 have wild will Insurance,as required by Section BUILDING
)]ill of the Labor CWe,for the performance if the work for which this permit Is
,sued.My Worker's Compensation Insurance canner and Policy numbs,am:
Carrier: Policy No.:
CHRI'IIIC'ATION OF EXEM]"HON FROM WORKERS'
COMPENSATION INSURANCE ,
('this section need on be completed if the permit is for one hundred dollars
($10(1)Par lest..)
I cenify,hul in the p,rf nonce of fie work for which.his permit is inaed.1
shall.,it employ any person in any manner si as ,,hccnme nnhjcm ,,the W..kery
Compensation laws of California.Date
Appleanl
NOT ICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject to aw Worker's C'ompensmion provisions of the Labra Core.You must
O
z Q forthwith comply with o0i pmvi,inns it his pemtil shall he dcenmd revoked. .
F" CONSere o n LUN LENDING AGI!NCY
a. > the to, hichhisth.ifis amsuumlin lend:ngagcncy loathe perfonnnnec
0I the work firs which this permit is issued(Svc.3090.Ci,C.7
4 Lenders N
z ems
..
� Z 1.enae;a nese..
LUT. 0 1 can ify that I have reed this al:skin and state iliac the above information is
t.. correct 1 agree m comply with.1I city and cumany mdinences and sm(e laws«fining
Q V mhu fog construction,and hereby authorise represenmtives of'his city,,enter upon
(� the above-mentioned property for ingwet ion purposes.
L. 0.s (We)agree to save.indemnify and keep harmlcw(he City of Cupertino again, .,
fn Imliili.ie,judgments,town,and expemm which may in any way accrue against said
U z City in cnmsequence of the greening if this pent.:.. -
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT
SOURCE REGULATIONS. Issued by: Date '
Slgna(me,ifApprcanUCommeorISDate Re-roofs -
HAZARDOUS MATERIALS DCLOSURE?
Win the applicant or future Wilding recumo(sone or handic hazardous mmetial Type of Roof
as dclined by(he-Cupertino Municipal CWe.Chapter 9.13,and the Health and Safety '
CWe.Need..25132(n)Y
G Yes 0N. - All roofs shall be inspected prior to any roofing material being installed.
Will the applicant orfuture huildingo,eup:imn,,r,.pov.occdevlueswhlch If a roof is installed without first obtaining an inspection, 1 agree to remove
mi.hain
ardoun air coaminums x,defined by the Bay Area Air Quality Management
Dis (de11 all'new materials for inspection. Applicant understands and will comply with
f 0Ycs [)No all non-point source regulations.
1 have lead the hlnndo is,natenaix reynire,hems and,,Chapter 6.95 of.he
\ C]Iifomia Heahh.$Salny CWC Sect ions25505,255.13 anJ 25534.1 nndcrstand lh:n
if the build:ng do, nal cmemly have a omnit.do,it is my resrym,inili(ym notify the
occupant of the requirements which most hu ata prior to issuance if a Certificate of
Occupancy. Signature of Applicant Dale
\O.onroraothmiaeaagent Dam All roof coverings to be Class "B"or better
7 OFFICE
/ 1