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 -