02040147 (2) CITY OF CUPERTINO --
BUILDING DIVISION PERMIT . CONTRACTORIINFORMATION:
BUILDING ADDRESS: PERMIT NO.
20978 FAIRWOODS CT JUST WATER HEATERS INC 02040147
OWNER'S NAME: APPLICA'SION SU DATE
CHAN RODDY C AND BRENDA M 1764 NATIONAL AVE 04/262002
PHONE:
(510) 293-9901 SANITARY NO. CONTROL NO.
C ARCHITECT/ENGINEER:
E O O I BUILDING PERMIT LNFO
BLDG ELECT PLUMB MECH
u C-1 L. J u
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby )of ihom 1 nm of he d under provisions of ns Con.and mmecense P
y- wishSeaioreandefect. onJaftheBusinessartaPiofcssionsCode.andmylittera REPLACE WATER HEATER
e-E L in mu cores arta effect. (5 0 GALLON GAS)
s a Date Class Lic.cr
uca c U Date S DELLA;
O�' ARCHITECTS DECLARATION
g 1 understand my plans shall be used as public rttrMz
r
rc o O Licensed Profcvnnnal
S a OWNER-BUILDER DECLARATION
os 1 hereby affirm that I am exempt from the Convector's License Law for the
t a
following«assnermitt 7031.5,Business and Profession,Coac:Any cityerrcounty
Exp which requires n permit ani'he,alcor,nt for
demolish, fie pair any swan«
63$ ..pnonoincensed issuance._else ni to thsaha oisions O for wrhpermr 5 License
signedstatement - _-
(comma derma n Sect m t the pp ' of the Conwanes L nd pr low Inns Cod)
(commencing 'nh Section]000)of Di,'s onJof she Business coal Professiom Code) Sq.Ft.,Floor Area -•fI Valuation
or that he is exempt mhcrcfrom and the haus(err the alleged exemption.An '
0 S P Y violation
.of Semon T0h L.3 by any hundred
d ll(ora permit subjects the applicant m e-civil penalty
:"none,n,dretnanR.rnanar<aannnatasrpl. � APN Number „1±:p.N.ir\o Occupancy Type
0 1,as on net oftlis,propen).or my employees w ith%ages as their sole comPs,asation, 502 - FINAL PLUMBING ENERGY
will do iba.mork;-and'be xwcwr<is-net handed.1 offered for salrrsn']oaa: '
fBusineix and Professions Cada:The Contmnor i License law area, 506 - GAS TESs not apply to an ITequired Inspections:XrraDi,E
Owner or pro sem who wilds or improves mora on,and who does such work himself 507 — FINAL PLUMBING
or tbrou h his own cm to res.provided that such im rovcmenis are not intended or_
amplo) P - P _ .._. _ .._ __. ..___._ ._ ..____..... __ _
offer d, Ie If,6ow<ve the building o mmproens n an N ore year of '-- -- -- ---._..
'improve for me owe rw ldcr will have the burden of pros ing than he did not build or
improve for purpose of sole]. '
..-_ . . - __— -._ .. __..._..__ _ .. ...._ .............._ .- .._------------
1.
progeny.am exclusively contracting With bttned Contractors to
muct herarma n
conswdthe project(Sec 7010 vBusiness and Profess ons Code:)The Connector,
License Law m rw
Law :napply an oxmer of progeny who builds tls omprovthereon.thcon.n,
and-who contracts for.such pmjens with a
onLicense
Cuann
orsL cLo
❑lamexa pt der5 ' f,B&PCfor his reason IHC__ li
Owner Dme
WORKER'S COMPENSATION DECLARATION MAY O 2��2
s .. _ MAY I herby aBium mor; penalty of perjury one of me following dmlerations:"- pk y
, ❑ 1 have and will maintain a CcniBeam of Caroni it;self-insues for Worker's BUILDING Compns
eation. as provided for by Section 3700 of the Labor Code, for me
performance of the work for which this permit is issued.
❑1 have find will maintain Worker's Compcnsatibn hxe m xsi.as requircl by Section
3700 of the Lvwr COE<,for the pakmmance of the work'for which this pcmdt is
Issued:My Worker's Compcnizdon Insurance carrier and Policy number are:
Gainer i < 6,u 4:. 1. 1 Pd11CY N
. .. .n. ..1
l CERTIFICATION OFEXEMPI]ON FROM WORKERS
-,,.;COM ENSATIONINSURANCE;:. "
0'� (This tie,
on need not he tom leiM if � -�t''I:.: t --�_ -�-�-
f5100)orlessJ p Permit is for one hundred dollars .:J,11' .:t 1•� „I- ',Lr f-
--�_-_._...._ ,._.,...-.. ..
I cert fy th t n me peAomi c of me work fo h¢h th rssueda
sh611 note ply- y person n any nem , beroma subject to the Worker$
Compensation rows of California'Dine..
.NOTICE TO APPLICANT If afn""'in'InCen Orate ofE empuon You should -'--
Z tiecom bjec„ th'W kef Co pe ,in joravilimns of the Labor Code:you must
Z2 fonhwnh aomp1Y with such pray I lions or this perm,shall bo deem d«yoked.
_- t - - __-.. .._. . .. . _..._._ -..._...__... ...._ .._ .......
I„t y 'r'' ° - CONSTRUCf10u LENDING AGENCY " - ,y -.
I hereby Eirm chat men¢ aons,iun o lemm�g agency(a the peifo'rmwce ,I,s; ,, .,-.
y '. rf the ark for hrth th s perm t s issued(S 309]'Civ.C.) " ` "
`-o -I;cndrsN e —
D:Z lindera ABdkss "'"' ' a: •
jq
1 erffy tM1at 1 h v <ed th ppl cat d scot thanhe oboe formation is
�+ f+ carrtn 1 prt to comply th ell by end co ry o d ntts a sate Ira minmg 7��k/"' _( Tl _
I,-,.
wild goat aon'a ahercby authorize cop«scout v<sb(mis�ryt enter upon / ./ \'`-�
theabove-mcnuonctl property fonnspcaion purposes._-r„
L.cG i We)egret io sive:indemnity atM kttp harmless the City of Cupertino against
r-h liabilities,judgmems,costa end expenus which they in any way accrue again: said
U Z Ciy into sequence of the gra t ng of this'perm t - -
:tPPLICAN`I'U\DERSfANDS ASD\\'ILL CO\1PLY W'ITN ALL NON
-POINT r
SOGRCEREOULATIONS Issued by: Date
s er^?anrc Or Appl¢nnvCbmra t .. D t Re-roofs '
I,; HAZARDOUS MATERIALS DISCLOSURE ` '
W II th "a corm,or Mhim bmhim,occupant oto«o handle huvaoua material , Type Of ROOF
as def ed by the Cupeni o Mnoth d Code chapter
h pte 9 I Z and the Health
end Seery _ --
Code.Sec
333RG)21f1 L\P.
riNo'''• ` L"' All roofs.shall-be nspected.prior to any roofing material bemg.tnstalled...
Wll m ppl car mance ff gucrupa,Os'q , ,,O d i�as which If a roof is installed•wlthbut first obtaimn an'ins ection�,'-I a"greeao'cenlove
d bj the BayA Aro alry Mengmet g p
D1tr11 - - ' all new materials for inspection. Applicant understands and will comply with
m, zarao s s stn lsdefine
f ❑Y ._ .
I,
r` I all non point source regulations.. , .• w _ ._
1 be,
e«n,is
c,b. mamnils rtga n encs once Chaga 695 of me -
Cal
if
Health&Sefny Cade.Sea
tions 25505:...3'and 25330.1 undersmnd met
Ifhie bal.
u lthe
ddn not cunca, ha c at'nan, th P, i my Y. as
iifY,dic-
ocrupam of me requireme m b ch m st h t oto fssuan a of C n fate f - -' -'-
T �capa y !'' ',� -
Si-nature.ofA Meant
- ' Applicant Date
. Owu or h dopera .._.s t .... -_. -.
All roof coverings [o be Class "B or.better '
- ; .`.. `\jn + . . .:.. . . .OFFICE......