01010084 (2) CITY OF CUPERTINOBUILDING DIVISION PERMIT CONTRACTOR,INFORMATION: .
BUILDINGADDRESS: PERMITNO. '
20889 DUNBAR DR., JUST WATER HEATER INC ' 01010084
OWNER'S NAME: - APPLICATION SUR DATE
IRMA PHELPS 1764 NATIONAL AV01/19/2001
'PHONE: SANITARYNOd- CONTROL NO.
(510) 293-9901
W,Z, AR CHIFECTiENGINEIR: - BUILDING PERMIT INFO
{- BLIHS ELECT -'PLUMB MECH
2Sy2 LICENSED CONTRACTOR'SDECLARAI'ION Job'Description
O y_ 1 hereby of iro,tem 1 am licensed under provisions of Chapter 9(commencing -
F=�; with Scetien JUOUp+f Division Sof the Bosincss sail Prolhs.ions Code.and mylimme
is in full force and of vel.
���< Lieenseclo" M REPLACE 50 GALLON GAS WATER HEATER
3 N Date Console
ARCHITECTS DECLARATION _
5 1 understand ay plans shall be.,,it as public lotions _
se
w 6 p O Licensed Professional
u h o OWNER-BUILDER Hour
heC DECLARATION
u�3 I hereby amrm t n i am exempt from Ihe Cram,C, hiccnse Utw for the
C Z a following.i m, immiion JU31l Business and Pirive.de sans il,a,Any oily i county _ -
f X p which its issuance,
a permit to conswc6 alter,improve,Dawlish, fi repair any mtmemm
tda3� pchh t ' e 9 the f hp a g dClb nl9
mmo I n,with urcu4m tothe pct i.im.oftheIt t ,,Licensero (Cl plc ) Sq• FL FloorArea pdtion
Ica g ,sat em an of Division 3 nb Bum m J P I code) `4945
or that 7031.5b theelronand the Permit for ubjecttheal nylon.Any v Uhlon - -
of Seeoon 903 n by nay reined
am far a permit subjects the uppllwm to a clot.penally _
of 1,atm,+re man live hmwrea aouars(550n)., APN Number ,' Occupancy'Type '
Ed 1.as owner of the property,or my employees wl lL wagesas titer r sole coarensmion, ?^, ?i1 r.j L71 0
'
will do the stock and the suumure-is not intended or offered for sale(Sec.7144, ,
Btaslnss and Professions Code:rhe Crmradms License Law dogs an apply to an .Required Inspections
r al property Who builds or Impravcs them ra andnvhe does men work hi ell
'
' owner •'.
through his nwn employees.provided that saell'improvements are not incurred m 502 — FINAL PLUMBING ENERGY
ollmed for mato.If however„rM1a building of ilnflnvemem is sola within ane year of .
camper...,,thenwrer-budder will have the burden of lrinviag dial hudld air(bniIde 506 — GRS.'TEST -
Improve far p,Pose ol'sale.). -
507' — FINAL PLUMBING
❑I,am nwner of the pmperiy.urn endumivel......acting min Licensed enmraco rs.o - a
+muuct the project(Sec.7044,Bnmiacam and Prefcamin is Code:)'nhe Crn
tmdnr's.
Liveme Low docs not apply loan owner of property who hands or improves them,.
and who contacts for such projcet with a commctor(s),licersed pursmmt m the
z' Contractor's License Law.
D I am exempt under Sec. ,B&PC lar this mms
Owner Date
WORKER'S COMPENSATION DECLARATION '
Irecord,
ndwil , d M e fpaj Y of hollowingJ f i x:
❑ I have and will maintain C yMm f C .tint tom If'n' e r Worker',
-Gump. sat on, as Provided for by Seldom flW rt the f box Code, for the
y.:Anrmanee of the work for which this p rnat k issued. _
❑I h..and will maintain Workers Compemmom insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permil is
issued.My Worker's Compensation Inwmn n,came,and Policy number am:
Cartier. Policy No.:
CERTIFICATION OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE -
(This seedmi need not be completed if the permit is for one hundred dollars
(SHIP)or less.)
1 certify that in the perforomnce of the work for which this permit is hustled.I
shall not employ any person in any manner so as a+become subject to the Workers
Compematim Laws of Califrmim Date'
Applicant
NOTICE TO APPLICANT.If.after making this Certificate of Exemption.you should
z -
become wbjecuo the W.,kee,Compensation provisions m the Labor Calc,you alma
O 0 forthwith comply with act,provisions.,,his permit shall be deemed revoked. -
z
f” y CONSTRUCTIONemisacLENOING AGENCY
I hereby or which thin them iss construction lending agency for perfannanee
W .Rite work for which this perms'.issued(S3097Ci.C)
96 Under',Name
Z Lcmle,r,Address
e� 0 1certify that Ihave mad this ppi manall andstate that the inic nfn 'tion iso
correct
1 greet c ply tit II sty nil u tyordinancesand state I tel ting
V to bolding construction,and hereby puthonre ¢
reprenetives ofthis<ty to enter own
the above-mentioned instant,for inspection th rfew,
pW„ (We)egmcm,rv,.indemnify and keep handles,the City cf Cupertino against -
IA liabilities,judgments,costs and expenses which may,in any way accrue against said
V Z city in consequence of the gmniing of this permit. +
r
SOU
HCANTUNEREGULATPO
RSTANDSAND WILL COMPLY WITH ALL NON - INT Issued by: Date
Slgnamreof ApprmileAh eracom - Datc. Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or furore hushing upart nche or handlchamNnas lrn¢Tial Type of Roof- :
as defined by the Cupertino Municipal Code.Chapter 9r]2,and the Health and Sinew
Code,Section 25532(x1"'El yes El No All roofs shall be inspected prior to any roofing material being Installed.
Will the applie'amn;mmre building oceupam me cgmpmenm device,which If a roof is installed without first obtaining an inspection, f agree to remove
emit hazardous air mnu,minumu,as defined by the Bay Area Air Carlo,Marwgernent
wmrme ' all new materials for inspection. Applicant understands and will comply with ••
❑Yam
13 No - 'all non-point source regulations.
I have mad the hazardous materials requirements under Chapter 695 of Ihe'
California Health&Safety Code,Sections 25505,25533 and 25534.1 understand thin
ra '
if the building diner currently lwvc a tenant that it is my responsibi l lty to nor lly the a.
cenpant of the requirements whldh must be met prior to ismlcrier,of a CentOcde of
Occupancy. ,
Signature of.App]irm[ Date
Owner vianmmrxwlagent - Dme All roof coverings to be Class."B+'or better'
OFFICE . .