02050153 (2) OF
CI BUILDING DPI ISSIIONNOPERMIT CONTRACTOR INFORMATION:
Bjllf 2y'MN WY JUST WATER HEATERS INC PERMIT NO. 02050153
Cflt 'C*YIEURQUHART 1764 NATIONAL AVE AU9Ct 03"`0JNU2
PHONE: (510) 293-9901 SANITARY NO. CONTROL NO.
u O C ARCHITEC TE:NGINEER: BUILDING PERMIT INFO
s U BLDG ELECT PLUMB MECH
N a cy C_] L7
LICENSED CONTRACTOR'S DECLARATION
;iK..o Iherebyoffrtm,na,IamBecnsedunderproviom,ofChapter 9merencecing REPLACE WATER HJjgK ription
tofu; with Section 7000)of Division 3 or the Business and Professions Cale.and my license;xE- i.imm�rnm ®
e 6 License Class Lic.#
C i O Date Ar 2002
t 3 ARCHITHCTS DECLARATION
ECLDECLARATIDN
_ 1 undersmnd my plam'shall be used as public records
}
i a.n O j
Licensed Professional
OWNER BUILDER DECLARATION VILDII�IG
.r 1 hereby.(liens that 1 am exempt from the Cosions Code:
License fsw for the p
N E 6 following reason.(Sermon 21131.5.Businms and improve,
de Professions Cade:Any tiny or county e v
which requires a Mmri,to ron.ervct,alter,improve,demolish,or repair any swaom $875
a 3 s�O .poo to ts ss ane al req the pplicant rot such permitt GI asK ed n tement
her Imix licensed pn the p si nfNeContractors a Ice (Chapter S Ft.�FloorArea „ Valuation
or(commencingt with Sec, ]000) f Division an 3 the a Business tl Professions Code) y j�J
of Sec he is exempt therefrom and or bass for the subjects
the
d cxetnption.Any vmla,o t ,C ` '35921030-.'Ob' 1 a
-of Sectiome than
iv any applicant foroPermit suhjecs,he upplicammacivil prenulty
nr not mor.m.n B.e nooses sonars fssoB). APN Number Occupancy Type
ol.a.owmernnneprnpeny. r yemploYeerwithwageaaaneirsnlerompn ,inn. 502 — FINAL PLUMBIN ENERGY
will do the work:and the structure is not intended or offered for sale(See.7044, bub _
Rnsvnec.and Professions Code:The Comranm'a License Law does no,apply to an d n5
bspeetio -
owner of property Who builds or improves thereon,and who does such work himself 507 - FINAL P g NU
or Nrough his own employees.provided than such improvements arc nm intended or
-,offered for'sale:If:huwcvcP:,M1c building -. ._. -. _. .. .. . .. _ _._..._._ ._........ .. . . . .. ._ _ _ ._. ._
dr irriprnbemcn,is sold wiNid one year of
'rompleti.e.the owner"builder will have,he burden of proving that he did not build or
improve for purpose of sale).
_ .. _. . . an -ly motors- _ .. . .
❑Las owner orthe progeny,am ex clu Business a comrofeisi with licensedo Cotectm "
consort theLaw
project(Sec IIo a,Business and Professions Cotler)The improves
Contractor,
Lid wh Low d«s no,apply to an owner of progeny who builds of imam...thto the '
- -and een,snwets focauch.projects with a.comrac,o(s)littnzed.pursuam ,o.me _.. _ -. . _.,. ... .._. . .._. .-_._..
1 a. s rip,under
Law. '- - -
❑lamexemptunderSec.' s '1 �" .B&PCfor this mason
Own ' 'Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm andel IKnahy of pe jury one of Ne following declarations:
❑ I have and will'maimain a Ccnifc'm of Consent to self.'are IDT Worker's
Compensation. as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑1 have and will maintain Worker's Caspar s pion practitioner as required by Section
3100 of the Labor Code,for he performance of,he work for which this permit is
nsucJ:My Workers Canpnrsalion Insurane<cavier and Policy number are: "
..
Caol
1 iti
! 'Pal'yNi.. .. ., a . .
II� CGRTIFlCATION OFCOMPEN.COMPENSATION
INSURANCE',WORKERS
.,":; COMPENSATION INSURANCE'
p permit is for one hundred dol t .._...... ._..... .......... __
(Thise�tion neca nn,bream (erns tense lar. ... .. : , , _
(5100)or kss) , .,
sM1' 1 iempl ,hat in Ne n in�fcdrvamce of
mann r Ba,k f -h e this-perm, - ' - - "" --"• 'issued
all not employ any person m any manner so'as to become mh3en online Workers'
Compensation Laws of California.Date
-Applicant -
iNcomesuOct10 he ANT.B Orme nakmg h stc ofd c p, u.houat -"
fins Fj n, the Workers Compenm,o previsions df,h Lebo Cvoked. mux,
Z O to- - comp- with such pmvrCons or this perms shall- deemed revoked.
ti
0 of list kfrwhichCONbTRUs ac0ol LFJJDfNG AGENCY - _ "_ - 1.
F y _. .
1h by aR thatthe issued
do agency th
'. gage Y perfom,ance
W Q 'his p is'sued(S 309]Civ.C.) -
0. -lenders Name
Lender's Address
I certify that l have dal this aPPliedim and scale that,he above information is '
tss'F" c--or I sgree to comply with all airy ani]enunty ordinances and seam laws rerun,
,b building construction.and hereby cdhonee representatives of Nis city to enter upon
'D•''IY7 he above-mentioned,property for inspection purposes.
AN liabilities, agree m save,indemnify and keep handless the City of Cupertino against /a'
V Z lis n cons judgments,cost and expenses which,may in any way accrue anima,,aid
City o,tree of the granting of permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL:NbN:POWT ��
SOURCE REGULATIONS.." .' 1, Issued by: Date
Signamte of Appficam/Cmnfacror". ''. a' `Date Re-roofs /
HAZARDOUS MATERIALS DISCLOSURE.
Will the appucad,or Noreberthing..,art start n,handle hzaa,anx;material ..Type of Roof
as def J by the C pen Municipal Cad Chapter 9 12 and N Health d Safety
c --
od Section 2553_(a) err
❑r<s ❑Nn All roofs shall be inspecte'd.prior tri.any.roofing.materia]being installed.
„ -BBN applicant r t Wildinged Oce p t aaAiequipment devices whichrs If a roof is installed without first obtaining an inspection; I agree to remove
earn,haz ll a r nntamm t as tl ed is N Boy Arc A Quality evinigeman p
District,
„ , all new materials for inspection. Applicant understands and will comply with
_ all non=point source regulations:. -
1 have read,he'.h dour ale I req gments unde.Ch pier 6.95 of the
”
Calif a Health&'Safety Code Sections 25505,25533 and 25530 1 understand Nhe '
i hhe building does not comedy have a cannot that it is my mponsibili,Y,o notify the
Occupancy, n,s which mus,be met prior m issuance of a Cenincam of
oecnpan,ortneregairtme Signature of Applicant Date _
ownernraa,nnnacaagen, , Dare. All roof coverings to be Class "B"or better
.:. .. i . . OFFICE ..