02050120 (2) CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BM�DMSCOIGNE DR JUST WATER HEATERS INC PERMIT NO. 02050120
tX14`WXHIMOVSKY 1764 NATIONAL AVE AeftCt�fnbl'ff2
PHONE: SANITARY NO. CONTROL NO.
(510) 293-9901
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
ad BLDG ELECT PLUMB MF,CH
C_l
LICENSED CONTRACTOR'S DECLARATION -�_�II��3'3�t�$]jj]]ro��� p
i z!2 Iherebyaffirm that lam licensed underprovisions of Chaprcr9(commencing REPLACE WATER t-t$A•):'$"Rfl hOn
C W
lab Section]000)of DivisionJof the Business end Profcsxions CWe.and myliccnu
s run force and effect. (5 0 GALLON GAS)
=z z a License Clau Li,.tl
o a a Dam Cm minor
u O t' ARCHITECT'S DECLARATION
so
I understand my plans shall be used az public records
r o O Licensed Professional
assn� OWNER-BUILDER DECLARATION
-m I hereby affirm that 1 am exempt from the Contractor's License Law for the
Z G following reason.(Section 7031.5.Business and Professions Cade:Any city or county
t°Si63m pct _ req, applicant permttofileas edsamment
which q permit to construct.alter improve.demol¢h r repair any structure
t t nee,also the I tfor such g __....__. -._..._.__..
th5thenm,will,Se n tM)ofDlsion.10 the
Businesan wIs mis Coe) Sq,.Ft. Floor Area- v, Valuation
or atheI exempt
tthe 70(go fhe Division the Byameoe dii f ns Crude) f.R INt ( 9 1 �.`L 4f a,')�'f
or Section
the Is exempt thercfmm and the basis for it sthe andged e,lica m Any violation '3'7 S 3 T O Z 5'.tO O
-of not mom than
iv any hundred
ws rsfaia permit subjecu the vpplirvnno a civil penalty
-
mrnmt metre men fi.e wWrea donors(ssoo). APN Number Occupancy Type
El 1,as owner onheproperty.ormyemployees with wages aatheir sole compe saran' 502 - FINAL PLUMBIN ENERGY
will'do the work,and the structure is not Intended or offered for sale(Sec:]044, t r
tBusiness and Professions Code:The Contractor's License Law does not apply to an 5 0 7 - FINAL pfd Inspeetions'`•
owner,of pm,.,Who builds or improves thereon,and who does such work himself Ne,
or through his own employees.provided that such improvements are not intended or
-offered por-We7 If,w however the building have
t or burden
ofpmv n cold he d none year of
'i mmpld on the owner builder will have the huNen of Prov ng this he did not build or 's
improve for purpose of sale.).
.: 01,vs owner of the propcny,am exclusivell conducting with licensed contractors m ---- -- ------'— - - - --I NA LEDt.. t p ,,.I �-
,:
command the levical(Sec 7044.Business and Profess ons Cade)The Contracto s 1 a
License Law does not apply to an owner or pmpny who builds or improves thereon, "
:.: madwho commix.for.iuch.projects witha.commnons)Icensedpurauatu 10.the. .,.-..._.__ ...........__ ....... ... .. .__._..Jt1 L...1',-7..200 -..._. _ ... !._._...., .. ..._.
Cantractars Licemon Less
❑lent exempt under Sec" '6;B@P C for this reason
;),,,.,.i .. r a.DECLARATION.. ,.,..
- _ Owner "' "'Date
WORKER'S COMPENSATI""OBUILDING
N
I hereby affirm under penalty of Pat one of the following declarations:
y ❑ 1 hiveand will nammain a'Ce'AMcose of Consent to elf-mature for Worker's
- Compensation, as provided for by Section 3700ofthe Labor Code, for the
performance'rf iln,work for which this Norint is sewed.,.
_ ❑1 hove erid will maintain Worker's Comperosat!oti InaamoaF,es required by Section
= 37Mof the Labor Code;(ai the performanceof ffic work for which this permit is
ikiocd:My Worker's Com and Policy number arc: "
Compensation Insurance
.. - Carer d 'a ! j:. h^ -PolicyNo a 'x ( ,r .. - _.. - ,u. I t`0 __.....
} t CERTIFICATION OF EXEMPTION FROM WQRKERS }. I s r v th : t {y s'' ! t.'
'COMPENSATION INSURANCE`
'e t`1'(th ut n need not be eompinea Rthe permit is future hundred dollars y.' �'t •"f F i,`- � f fC
($100)or less)
izl.1 - I th t in th Performance of the work T -which thisPerrot is issued,I „ 'L L r. "i a.i lt. }, `
,hall'n t employ any person in any marine,so as m become subject to the Workers ' I!
It
Compensation Laws of California.Dam - "" • '
...APpit t .. ..t, ., ...
NUTICEemoul TO APPLICANT:If after Compensation
sovndcmeml Exempt de,y should
Mdowdsubject lathe Workers Colons or von provisions of the liber CWe,you mum
cc (ooh uh comply with such provisions or this permit shall he deemM mocked
(•+ '^t r "t
CONSTRUCTION
a. .-:CONS ..c O.iNwLENDING-AG-_EN-CY
I he by this them is a o lendingagency fortheperfom nee
. okfk hich this Permits issued(Sec. C.)
j: 'Q LemdersNeme. . ,,, e., _•r•
1.
- s
Z de sAtldrt
1 c n fy this I
have ad Ni.applic t n nd st m th t thestate
forme on g yam_
W'.Fy correct bag t complywillhe oil city it and c unty ofd n s and t tc laws esu ng
�'f, to mbuilding rust mo doh binspecozrps testae of this<nymenmrupon
_cw the bo c tit meed pot f fy and purposes.
GL (We) ge m s moan dy and keep hick 1 ss the O ay acc pen' Inst est
Vj
liabilities,judgments, is i d pontes which may 'any , a against said
t..1;� City I uaequ ccoftheg t AND
p t - -"
APUVCANT,U LAT1ONANDS AND WILL COI.1PLY y5'ITH ALL NON POINT
- ,' so13RCE-RecuunnONs:t•!.�-'•' -r'� :� '"•-�' .• Issued by: Date
Sig entre mf AVNicanvc nu a- •.: ;. Re-roofs
HAZARDOUS MATERIALS DISCLOSURE '
`„ Wll meapplicant future b ldo,'act,pant store o,handle hamN ratonal .,.Type Of.ROOF ..
as derided by,the CupertinoMunicipal CWe Chapin 912 d the Health and Safety "-
CodeS a 255J21a) - ,a'•�iS •tri`a'l it ] , } j 1i ___, -\rc J
❑Yes {, t ys1%b No - s ..
i _a . g. being-installed.. _
Al] roofs shall_be inspected poor to any-roofin mater al
WJl the,applica t T(w hu lding upanrumcqu'p c to devices which -" _
If a roof is inst-alled'Without first obtaining an inspection-),I agree tolremove
cort dous air cdmemmams 6s'defncd by the Bey Arca Air Qualhy Management
g g
Dittn<toY 0Na- -„ all newmaterialsfor inspection.. Applicant runderstands and will comply with
pP —
f r . •, '.. f; .,. .' all non=poin[�source regulations- -
ead'ihe haze don,notteri I. tegturcmenti-nmc,Chaper 6.95;of the '
California Health @'Safety Code,Sections 25505,25537 and 25534.1 understand that
If the Wilding does not currently have atenant,that it is my responsibility to notify the -"" -"-' " '-'-"..... . ' -- -'------ -` ^-" -- --'--- -
accupom of the requirements which must be it prions iasuance of a Cenificlue of
Signature of Applicant Date
-Ow m . _ All roof coverings to be Class
B or better
a ag m Dae
.. , t _."_t i_ -. OFFICE-.,