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02030142 (2) Cl BUILDINUDIVISION PERTNNO GOPERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 10160 FIRWOOD DR JUST WATER HEATERS INC 02030142 , OWNER'S NAME: APPLICATION SUB DATE SHARIFF KARIM 1764 NATIONAL AVE 03/25/2002 r 'HONE SANITARY NO. CONTROL NO. (510) 293-9901 GOO ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ¢i r S y 2 LICENSED CONTRACTOR'S DECLARATION I hertby afrum at l am licensed under provisions of Chapter 9(commencing Job Description rtf.; withSection7000)ofDivision3of the Business and Professions Code.and mylice.1 REPLACE WATER HEATERS . ems.: is in urn tome and effect. (40 GALLON) I m w Date Class Lic.tr 3 3 t6s,y Dam ARCHITECT'SS DECLARATION O 3 1 understand my plans as public shall W used as public records i p p Licensed Professional OWNERBUILDER arDECLARATION I hereby,(Bete that I I.S.exempt stem N<Conaaam s License Any c Law,for the m G following reason.(Section 7031. Business and improve, de io demolish, Carr:Any my m county E F O which requires a permit to consumer,ober,imptova demolish,or repair any structure ' u3 „prioreu licensed Imil th Provisions Contractors Law r9 troth flcenedp Section 7000) Neproiiision3hfQueBustorsCc Le cinsCar9 •YC.�' S FGFIoozArea (cote - g with S ct -71810) t Division or the a Busine x q i r txiom Cade) e`_t,+i\) .9'"L t.-Fl or Aro `i�2 Valuation or that he s exempt themfmN and the bests for the alleged cxmipuod Any violation of Senio^7031.5 by any applicant for a pcmur subjam the applicant to a civil penalty or net mom than Bae hundred dollar.($500). A um Fer .. ., 'a' Occupancy Type 01.as owner mthe pmpeny,nr my<mployas with cages az their sole roo,somotior, _ T7 INA I ENERGY will 0.the smk,-and'the vorcmfe'I,'not intended roe offered for sale(Sec.7814,' BLUMBINk 'Business cod Professions Care:The Commcmr's License law does not apply,o as 506 - GAS TESRequired Inspections ^ " owner of propcny Who builds or improves thereon,and who does such work himself or through his own employee,.provided that such no"rvemems are Clot intended or 507 - FINAL PLUMBING : -'offered for iale.IL howeve7,the building ." -- murde.cemro,ir,sola within one Year of- - rompleeion,the owner-Wilder will have the burden of purring that he did not Wild or C improve for wipnse°r sure). F,fi ❑1,u owner of the progeny,am exclusively commnfng with IicensW convectorsm se,_� .• x L;,,,,,, ,,;,,, - -- onxwn she Projcci(sec.7044.Business and Professions Code:)The Contractors ® , License Law docs not apply to an owner of progeny who builds or improves thereon, •' ••+ and who mmncts for such P°3 tx rns).liesursed pursuant to the. _- .__ ._ .. ._.-_ .____ ..- , . . -_ _ with a contractions)no Conwcmrs L ccnx Law - ❑I am exempt under sec 0&P C for Nis reason pp R., owner'- nate' = - "' " " WORKER'S COMPENSATION DECLARATION 1 1 1 nq` .� Iherebyamun Rrderspc^altyofperjuryonens of - BUILDING O 1 have and will rinainmin a Ce.ificam'of Consent in relf-insure for Worker's (9Compenmtion, az provided for by Section 37W of the Labor Code, for Ne performance of the work for which this permit is issuedi ❑1 have and will inaimain Worker's Compensmio°Insurance,es required'by Section 3700 mike Labor Code;for the mfiro orocc of she work for which this permii'is ' r 13sacd my Worker's Compensation Insurance carrier and Policy number are: Cimer'. i II IFC T O O M Pdlic N 1 r� t ' yy T CERTIFICATION OF EXEMPTION FROM WORKERS a aT\ .�4 p� i1d , 11 • -'_,COMPENSATION INSURANCE's•-"'° ' __.�.._. _. .,..�. ..___ ... __........._. rrle s m on need not be completed if the permit is for one hundred dollars ($1007 orlessJ - _ 1 fy yM1 t er parvo f N k-to, which'his "f'issued I shall m not pl Y Yson nn Y e e u m become subject a t the Workers' m Copensation Isws of'Calilom e.Dem „ NOTICE TO APPLICANT If.Crmaking n k 8thC nfcmd eE pt o bouts - become subject t N W rch r Co pen. on p ons f the Labe Cay you tech Q p fdnnwlh comply w th'such provisions or no,permit shell be deemed revoked. z � _ .- _._ - __. ._ .-.-._ . _. _. _.. .- .. _- -. .__. _ __-_. _ �.; -.1 „CONSTRUCTION LENDING AGENCY + -'-..-_ ..._. _ _ .._._.. .. 1_ _... .. . .. "" 1 hereby affirm that there is a constmi,tion lending agency for the pert e an offfiesvorkfr which dts percroti ¢ d(Sec 3097,Civ C) siU Lonz de s'Name'.. "6 .._, _• . - _� . .� •.I certify that l have read this application and state Nat the above information is F com<t.iI agree to comply with all city ono county ordinances and state laws relating :Q U tobuildngconstruction:and Hereby eu,horlm representatives of this city to enter upon . (T] she above-mentioned property for inspection p°rpous., q p( (Wc)agm,,. save;indemnify and keep haimless the City of Cupertinougeimt 'IX W liabilities,judgments.costs and expenses which may in any way accm<againu said V Z Ciry ICconsequence of the grant ng of his perms '^„ - '- APPLAM UNDERSTANDSANDWILL COMPLY,WITH ALI.NON-POINT''" 1 - '1 SOURCE REGULATIONS' '"' Issued by: Date Signature ufApPliermsCo t t '.;r' - - Re-roofs HAZARDOUS MATERIALS DISCLOSURE r Will Ne applicant or future W kl g occupmn state handle hai"us menterid T e.Of Roof_. m deftied by th Copenin M pal Code Ch pt 912 d the H IN d Safe ry yp "' - - -+ ^'• +- .. Code:S et 255320 - ,. t. ❑r " ❑Nu , ' 'ft} ig ices won If rnok oof ishns[alled with•I try' s _ -'r - ed no to n roofing Will the appl cam o f t building o p t eq tpn ant a - - m installed. .... ._ _ ,h amo s < Tam n.azo f edbyNeB yAreaAvQua1 tyM genet out firs obtaining an inspection;-I agrree to remove District?. all new materials for inspection.t Applicant understands and will comply with -ores 101N.- r t, - -. - allnon=point source reglations • _ - 1 h e read the ha>a d mamrd"re"N rements under Ch Pte'695 'r Ne Califomie Heahh&Safety code, ode Sections 25505$25533 and 25534.1 understand than t ' Ochu boaamg dues not cu "y hay....mo -,hurl y respo urbiny t notify the - acupant of ate rtquiieme¢ hbh most W men p br to issuance of Cen'ficem of i Signature of Applicant . _ Date —om or imummixese agent Date . All roof coverings to be Class "B 'or better-7 L . _. .. OFFICE -