02110040 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT iCONTRACTOR INFORMATION
Bul rsFITZGERALD DR JUST WATER HEATERS INC PERMIT NO 2 110 04 0
DR'IIIiAUANBILL S AND MARILYN H 1764 NATIONAL AVE APPLICATIL)IiSpUc6rY 2 0 0 2
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HONE: (510) 293-9901 SANITARY NO. CONTROL NO,
ARCHITECffENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
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foo LICENSED CONTRACTOR'S DECLARATION
ce d CI hereby affirm that 1 am licensed under provisions of Chapter 9(commencing REPLACE WATER WTff0tion
iW with Seelhln7N)),if Divismn Sof the Bvsimassand Profemiudf Cale.and any liccnmis
„ mfall rend
force and (50 GALLON GAS)
a If
OZy Z License Class LiFW Da¢ Cnnmam
ARCHITECTS DECLARATION
I ualerstand my plans shall be mad as Public records
�yV
FLLoa Licensed Professional
OWNER-BUILDER DECLARATION
ne Q I hereby affirm that I am exempt from the Contractor's License Law I'ur the
w6
00 following reason.(Section 7031.5.Business and Professions Cute:Any city or county
e w mConsumer,2 iL which requires a Permit ,conmer,alcor,improve,demolish,or repair any suac me $598
prior u,its issuance,also traffics the applicant for such Permd to file a signed statement
that he is licensed pursuant to the provisions of the Contractors License law(Chapter 9 Sq. Ft. Floor Area Valuation
a�m
(commencing with Section 7gM)of Division 3 of the B usiness and Professions Code)or
e, $ drift he is exempt Werefrom and rite hash for the alleged exemption.Any violation of 32647001 . 00
Scadon 7031,5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy
not mom than five hundred dollars(1650)), 502 - FINAL PLUMBI G ENERGY pane y Type
❑ 1,res owner Of the property,or my employees with wages as their sole compensation,
will do the work,and the strvemre is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Conuuters License law docs nm apply to an owner of 507 - FINAL Jfflgections
prapeny who builds or improves thereon.and who doessuch work himself or through his
own employees,provided that such imprommenm are not intended or offered forsale.If,
however,the building or Improvement is sold within one year ofcomplelion,the owner
Wil Jet will have the burden of proving that he did not build or improve for purpose of
sale J.
❑1,as Comer of the property,am exclusively contracting with licensed contractors to
construct the forcer(Sec.7(W4,Business and Professions CodcJ The Contractors Li-
cense law does not apply in an owner of property who Wilds or improves Norton,and
who contract for such projects with a contractors)licensed pursuant o the Conuacmr's
License law.
❑I am exempt under Sec. ,B is P C for this reason
Owncr Date
WORKER'S COMPENSATION DECLARATION fi 0 V 1 Z002
1 hereby aRmt under Penalty of perjury one of the following declarations:
I have and will maintain a Cenilicale OfContent o self-insure for Worker's Compete
satin.,as provided for by Section TA)of the Libor CMB,far the Perfounance of the � '1,®'�G
work for which this Permit is issuUed.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
371M1 of the labor Cute,for the puformance of the work for which this permit is issued.
My Worker's Compenmtion Insurance carrier and Policy number am:
Carrier: Policy No.: _
CERTIFICATE OF E%EMPrION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed Irthe permit o for one hundred dollars(SBM)
or lcsx)
1 certify that in the Performance of the work for which this Permit is issued,I shall not
employ any person in any manner ser Its to become subject bt the Workers Com pansoion
Laws of Cohfi,rus.Doc
Applicant
NOTICE TO APPLICANT:If,after making this Ccniffcate of Exemption,you should
become subject to the Workers Compensation Provisions of the Lamm Cede,you must
QQ forthwith comply with such provisions or this Permit shall be deemed revoked.
Z h CONSTRUCTION LENDING AGENCY
r I hereby affirm that there is a cmmwerinn lending agency for the performance of
C the work for which this Permit is issued(See NAR.Civ.CJ
�W Q Lender's Name
U Z LCMcr'1 Address
U Q 1 certify Nal 1 have mad this application and start Ihal the aWvc information is
U, F Curren.l agree to comply with all city and county ordinances and sure laws relating to
Q U building conswction,and hereby authoriac represemstives of his city to enter upon the
aWecme s.mentioned pct.Cost for a penes phichma.
F 12 i (We)agree to save.indcmni fy and keep harmless the City of Current no against
in consequence
nce of ire coeu andexpensesthis es which may in any way scenic against said City
U Z A APPLICANT
of UNDERSTANDS
granting S Ms permit Issued by. Date
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT
SOURCE:REGULATIONS.
Re-roofs
Signature o(APplicaf ZARDOUS MATERIALS DISCLOSURE. Dare Type of Roof
Will the applicant err future building Occupant store or handle hamodoms material
as dcdned by the Cupertino Municipal Code,Chapter 9.12,and the Iicalth and Safety
xgMILCode.Sf Iran 25532(a)1
❑Yea 0N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment Orih ices which If a roof is installed without first obtaining an inspection, I agree to remove
mil hafardome air comantinanu as dclined by the Bay Area Air Quality Management all new materials for inspection.
District?
0Yes 0N
I have mail the haxodous materials requirements under Chapter 6,95 of the Califor-
nia Health&Safety Code,Sections 25515,25533 and 25534.1 walarvand that if the building
dw.c not currently have a tenam,thin it is my reapmsihil ity m notify the aecuPant mf the
requirements which must he mel Prior ser issuance of a Certificate of DeCuponcy.
Signature of Applicant Date
Owner or awhurised agent Data All roof coverings to be Class "B" or better