01060139 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10570 DEODARA DR WATER HEATERS ONLY 01060139
OWNER'S NAME: APPLICATION SUB DATE
INCERPI HARVEY I AND ELEANOR 500 AIRPORT BLV 06/25/2001
HONE: SANITARY NO. CONTROL NO.
(415) 349-3747
IOu,O O t ARCHITEC TENODMER: BUILDING PERMIT INFO
F 2 f BLDG ELECT PLUMB MECH
a GJ
LL-1 L_J I-1
rad
z En_ LICENSED CONTRACTOR'S DECLARATION Job Description
O Z—O I hereby affrtm that 1 om aide B under P and
Pmfe of Chapter 9 commercials
FyF� with Section7000)ad ofect. un3of the Business end Pmfcssions Code and any license REPLACE 40 GAL GAS WATER HEATER.
amp;
ism full tome and effect.
ec sea License Class
Lim.e
3 p" Data Canlmcmr
ARCHITECT'S DECLARATION
u O I understand my plans shall be used as public records
�r
w p O Licensed Profe.asioml
n n es OWNERBUILDERDECLARATION
I hereby ellirm mat 1 em exempt fmm the Cmuractio License Law for the
C g a following reason.(Section 7031.5,Business and Professions Code:Any city or county
Eo which requires a permit to construct.alter mprave,demolish,or repair any x,rele e
oc pr 1. . I the_ppl if suchpc to fl g W stammer,
.._ ._
thth t Bronsedpurruction In the parati,itio,of the C—anudorsL Law(Clons'9 5 Ft Floor ArLa p
(c gwith5 ❑ Division,70(if3fthe Business dPJ .Cod) r } '� : - ,l �iy;so , $.�xs'}IUHLlO❑
or that be s cscmpl therefrn n and the basis for he alleged exempt on.Any violation - Y V V
of Section]031.5 by any applicant for a permit subjects the applicant to a civil penalty fin[
of tim am halt five hundred dollars(S500). - 316AMYmVb ':•-.'so >: Occupancy Type
i
El 1.as owneror, progeny,ramyemployees withwages astheirsalec (Sons.7BI4, J
will ne the work:and the ude:ramn is not intended or LicenseofferedLow, oe.ale(v y to our' 5 02 — FINAL PL9WI§T#C GY
owner of ono Professions Code:lee Contmcmro , nd w Lowes such
nota to elf S
owner of progeny Who builds or improves thereon,mpr who encs such work himself t "
arthrough h' ply ..provided that such improvements are not immdJed or 506 - GAS TEST
offered rm sale.If,howeveF the building t s sold'within one .f - .... ._..___ .... _ _ .
ge b Improvement of pro yeldor FINAL PLUMBING
improve for
the owner builder will have she burden of proving mm he did not bade or -
improve for purpose of ale 1.
I as per pr the prapeny,WinWill
<u sine ely contracting with Coal
D contractors r a +
t :instar she project(Sec.7(W,Bus and Professions Code:)The vea Contractor Business
q License Low does not apply man owner of progeny who builds or seimproves thereon, JJ
- Commer e,License
for such projects with a.comractorlsl cense)pursuant to the .. .. .. ___.. ..._..... -. .._._ ......_ .L....._.... .. _.... _ __... _ ._.. ._ .
Ir
and.who
contra
C 1 m exempt
Licence Law.
❑lam csempt under Sec. ,B&PCfar this
Owner 'Dam
_
WORKER'SCOMPENSATION DECLARATION FINALE®
•' 1 hereby affirm under pcnahy of perjury one to following deelamtians:
❑ 1 have and will maintain a Ceriitiealn of Cement to ulf-inmrt for Weaker JUL 10 2001
-- - Compensation, as provided for by Section 3700 of the Iabur Code, for the
_ performance of the work for which this permit is issued.
❑I have and wilimaintain Worker s Compeoixlion Insurance,as required by Section BUILDING
37M of she labor Code,for'the performance of the work for which this permit is
is' d.My Workers CompersaLlom Insurance carrier and Policy number am:
.. ...,. _.._. ...,_._. . ... ........ . ...
Courtrai ::r •. „-...; "rPolicy No.:•.... _
CERTIFICATIONS OF EXEMPTION FROM WORKERS'i..
11 COMPENSATION INSURANCE
., - .... .. _ -
Chisi secaan need na be cont IetN if the Permit is for one hundred dollars to
161001 ter Ins.) -
.. y _.
I ttrp fy thn'n m'pcf any our 'the irkforr whichth amu is used ' i 1: •,,
shall n t interhrp,lo,Law, pe if m any manner m ax to become subject to Ne Workeei
Compcnsolion Laws of Califomii Date
'
.. . . ' ..... .. .. ...._._
.NOTICE TO APP LIC ANI If aftermaking provisions
ovisios of tof he Labor
ode,you
i@ r
becameath c.recu the Worker's Compensation pro r.onsll the Labo Code,you muss
00 forth with c ply with ch previsions or th s pc t hall he d Joke)
'
�'W "i ° 'CONSTRUCTION
' r emisaEGENCY
LNDING A
5... a e
� t
S-;Q ....Lende!N(herebeffrm lh lam; s� lending agency ued(S t09] Civ.C) f ar the rformanc
of Nenfor htis __ .. _.. ....._. . ._ _ .. ._. ..._ .... ...... .. .. ._.......
o z I radoras Add ss
1c, I certify that I have mad Nis application and state that the aboveformation is
rice,I agree to comply orcin all city and county ordinances and stone laws relating
'Q_V 1.building constronian.and hereby authorim representatives of this city to enter upon
the above mentioned property for inspection p rpo. s
Fay
eagreein save,indemnify and keep hamintat,CfCupertino gain'_
s
liabilities judant taI p nee hi y n any ay aaintsaid
2 City n consequence Scooting of m permit.'
Issued REGULATIONS.
Date
SigtmmrcorAppllcantipooductor- . `t "/ •.Date; t Re-roofs
1. HAZARDOUS MATERIALS DISCLOSURE
W II ih s pphc t r future building proper,store no article h�aeaadcoto material. Type of Roof - - . .. .. --... .,_.... ..... .... ...:... .._.. . .. ____
as deEped by the Cupertino Man c tint Code Chapter 9,12,and the Health and Safety
cod Section 255321 I .,, i . `., .•k s
Ell yes ._' ❑N 4. t
o.
All roofs.shall be inspected.prior,to any.roofing.material.being.installed . ._.. _..,
tWill the applicant or butom building occupant use equipment or devices which If a roof is installed'with'outfirst obtaining arc'inspection;'Pagreetotremove
em t h' S rJ us air cn t is as defined by the Bay Area Air Qua1'ny Management
D r t - , all new materials for,inspection._, Applicant,understands and will comply with,
s Disc, . . . .. ..
❑Y .,, I' ,:" all non-point source regulations:
I have read the Safety
Code. mains 2 regb 25333ta tinder 4.Chapter
understand
of the
ifteCalifornialHeads&Safety Coda Sections that
t it is and sponi. understand Inet _
.i(thebuilJldg does nolcurten0yhave atenant,lhht it is my esponiibility to hmi(ythc "-
s„ ,L
p p y,i p tar nee oft CeniFl<ate of
_ - one pal oY.If the re rem t manmtatbe' n to Signature of Applicant Dale _
o aamonacd ago of-. - - .Dao All roof coverings to be Class "B" or better
tn , .._. _. .. ... . .... .. ... _. ..._ ._._ _.. ...
t OFFICE
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