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00090103 (2)CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: - BDILDINGADDRESS: A085 HYANNIRPORT DR - JUST WAIER HEATER PERMIT NO. INC 11111,7111`1901 L717,' OWNER'S NAME APPLICATIONSUR DATE a - - - V [ONE: - - - SAN[ ARY NO. CONTROL NO. ry Z ANCHITECDIiNGINEF.N: � - BUILDING PERMIT INFO BLDG ELECT PLUMB MECH al z LICENSED CONTRACT'OR'S DECLARATION 1 heresy affirm Thal [ am licensed under provisions of Chapter (commencing .lob Descrl tion p ii with Section ]N)0) lot Uiv ylna j of the Businowma''r fissions Code, loamy license ' in Section N)0) ef& !b i:ieense cm »� L Date -� WATER HEATER —aCI�� Cnmmrmr ANCHIT[Cnse DECLARA 1 uneerxbmd my plans shall lensed as pnhlic rcrords cord, xLicensed i'mfecaunal OWNER—BUILDER DECLARATION 1 Washy that I oto exenmpt from the Cnntraanr's License Law for myt0lov a� j maso . Sect and oa,, dl,ar lin Coe,! Any oily orcoit untyJ� which requires a permit which ire rcmna (Salon ]031.5, construct, aper, improve, demolish, lar repair may sbement re uiresfile, Polar to s l ismavice, also requires the applicantonfor such rotor' m file s signed statement -(coterncingAdPursuant mmeptoDivisin3ofthf the em„orxuecn�Law (commencing Sn,iotional ' Sq. Ft. Floor Area 704110) of Division roflhe Business sionsCde) Cade) xorne fin Any Any violation ,,robot he isexempt1.5 iany and the mora for thj alleged exempnt .tion of Salon ]IU S by any a,fi Ii,r a permit mhjcco the apPllamo to n civil penalty to l ' dirld dm, nr nal intimidator foie nanared souls (asoo). � APN Number Occupancy ype ' ❑has ownerof,hcnd the inytt.00dexageclood rsoleic(Se T do the snrrk, and the structureIx nal 7. 11 lar ,Berea fns, tole ISec. -L71 0 ode: The Contractor',1. an. amnoroxanerrlyWhobend,:TheCrmrmreo,andwLawapexnmorkhmam Required Inspections ' cats rws such wad himself caner ofh his coy Who builds or improves t at such improve, or borough his . If, eabdayhoweveccs. povidin than such vement mems am no, intended necar or ,lured for sale. If, however, the building or improvement a sold wiohin nuc year of Sat — FINAL PLUMBING ENERGY elamplcdaor ft,owner.hwmer will otos till hams,.a' prlaamg non hears ton n'Jm m pros intrrov, for Pnrrnm of sule). ' -, 506 � — GAS TEST ' ❑I.mn~nerefthe propeny.amexclusively mmmeingwith rtecnsedeormaonm 507 — FINAL PLUMBING construct the project (See. ](III, Business and Professions Godes The Contractor's License Luw anus not apply m on fore of It piny who builds or imp nrvu .ninon, - and who contracts for such projects wall a contractors) licensed pursuant to the Cnmmcum"Licenm Lw. ❑ I tun exempt under Sec. , 11 & P C for this reason Owner Date WORKER'S COMP17NSATION DECLARAnON ' I hereby affmt under Penalty of perjury one of the following declarations: Min I have and will a a Cenilicm, ,f Clausen' ,o 1,11-huum far Warkar'v Comrrnmrcc n, or la( be faM1nr Code, for the for for by Sections ark rkrrnrmanee nr me work far which his permit .a ismea. issued, have and will maintain Worker's Co n arrnminn insurance, its required by Section 3700 of the Labor Code, Iia the perfonnuter, of the work for which hors Penni, is Ivamd, M(y't1�'y1rkerr's'Compensation carrier and Policy are fInnsurance ygnumber (( Carrier: `keVW!i TIi U1 T,E,,J) I k3i Z(V• CERTIFICATION OF EXEMPT[ON IBOM WORKERS' COMPENSATION INSURANCE Mil section need nm W completed if the permil is fur one hundred dollars (5100) or less.) - I eerily that in the peroarmia 'a'I ,he wok I'or which this permit is Issued 1 shall not employ any cersun In s�n yeglryr, �uhj¢t to the Workers' Call not empl Laxso ttl tU Applicant- NOPICETOAI'PLICANT:I,ermak'mgt cnt Cenifcote of Hxption, you 'El.—Idhccsnnesuhjttnothe Wnrkcrs Coincenm,inn rvixiuns nfthe l,nhor Gxlc, ydu most forthwith comply wiN such provisions (it his permit shall IIm deemed revoker, ' CONSTRUCTION LENDING AGENCY ' 1 hereby affnn thou (here Is m,unatuctinn lending ogency fnrthe part mnm,l ' oldie work for which this Pcrnit Is issued (Sul. 3097, Civ, C.) I<nder:s Name Lender's AJdra 1 ceniry that i have mind ,hls upplicadon and state that the Wow, inrarnradun is recti 1 agree lin comply with all city ..it county ordinances and s,am laws mind, whuiWing constructioaend herehyamLorira representatives of his city to emerup,a - - 'he shove-mentioned p.K.y for mo,volion purposes. ( WO agree ,o save, indemnify sad keep harmless the City of Cmamino against Iinhilitie.. jndgnmms, mets ;me expenses which ally in any way accrue ag;miro said City in consequence UNDERSTANDS grantingDWI permit.APPLI NT DS AND WILL COMPLY WITH ALL NON POINT SOURCE SOURCE REGULATIONS. REGULATIONS. C—. ISsned by: Date Sigamurc of Applicant/ onlmctor[)ale Re-roofs HAZARDOUS MATERIALS DISCLOSURE? Will ihe.,plicant nr fuwre building occupant loom or handle hazaMus momdal Type of Roof' as refined by the Cupeninn Muninpul Code, Chapter 9. 12, and the Health and Safety Code, Section 2.5532(x)] WYe" All roofs shall be inspected prior to any roofing material being installed. Will me air co act nrrots a lutlemg aeueaHayAint use egmpr utility or ana which mit hazamom air contaminants a. dcfnnl by the Hay Area Air Quality Management If a roof is installed without first obtainingan inspection, I agree to remove p g i"t"at" ❑yes a all new materials for inspection, Applicant _ understands and will comply with p y all.non-point source regulations. - 1 have read the hazardous andelod, requirement, under Chapter 6.95 of ohe do&Safety ioreant,th253]7aner,lear 1unrentand ohm ' if if buildingmly have mo'ion"o, yhaventcnant, that ri Ls n oili notify the - enicailof bore cupam of the requirmnent, w ell muxt be ate, rrinr to, is ounce of a Ccnlliaen of issuance Cc Occu c) ' q `rIw 1 Signature of Applicant Date All roof coverings to be Class "B" or better Dwnn nr asmnrl as n = OFFICE