02050122 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT ,CONTRACTOR''INFORMATLONc
B�IIbDIta860 6LLYMAN LA JUST WATER HEATERS INC PERMIT No. 02050122
G�TI10A"ILUNG AND JY—HUEY H 1764 NATIONAL AVE AU7C/LT bI
AM
01 PHONE: - (510) 293-9901 SANITARY NO. CONTROL NO.
Mm OZ ARCHITECT/ENGINEER: BUILDING PERMIT INFO
p BLDG ELECT PLUMB MECH
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1-m" LICENSED CONTRACTOR'S DECLARATION Ty,,,y1,,�,�T.1W�$� p
"o w'3 Ihereby a rm than l am licensed underprovisi.m.f Chapter 9(commercing REPLACE WATER HGHIOKri tion
�,Z—n—n�u°e with Section 7")of Division3of olid Business and ProfessionsCWe,and my license (']`j GALLON GAB)
Y j is in full force and effect.
.z 6 License Class Lic.IT
O oFi Date Contractor
ARCHITECT'S DECLARATION
y j 1 understand my plans shall Named as public retards "
i }f
7 O O Licensed Professional
e.
"XOWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contmcmr's License Law for the
C?4 following reason,stain]031.5,Business and Professions Casae:Any city or county
zS G which requires a permit to consumer,alter,improve,demolish or repair any structure 14 0 0
ray3� , pct t t neer el q_ m pplicam forsuch periidu fleesigneJ sat ant - __ ......,.,__. . ..
(hath i nsed withS dont tb-proriots of the theCommences Business License Law(CM1 ode) ,.. .`,, S Ft Floor Arear ,. Valuation
(commencingwmsen on 17000)of Urvision3ofthe Business Professions Code) :' j , i g' 1 . I 2f'; �` , , I ,
or that rte is exempfineiefrom'nad the basis for the alleged ademption,Any America 3'S 9 Z S O'4 4 `O O
-of Section]031:5 by any applicant for arermit subjects the applicant to a civil penalty
APN Number Occupancy Type
asf not more man Rve nanarea eonaia(ssuo). x.
❑1,avowner onncproperty.ormyemployees with wages as their sole compensation, 502 - FINAL PLUMBIN ENERGY
will do dif work;redthestructure is not intended or offered for'sale(Sec:7044;- _
Bvnineis and Refessiuns Code:The Commcmr's License Law does not apply to ana ulred In Spectlon5
ow
r of properly Who builds or improves thereo,nand who does such work himself 507 - FINAL PLUMBING
or gh h own employees building
ur den tl ( h min ova t t rote darn or
offered f all e Ifhowve
er the build ng m
mproveemi is sold thin-one Year of -" ""--"--' " -
+l ----
completion,for the owner ,a Iden will have me burden of proving mat M1e did not build or
improve for purpose of sale.).
.. _. . _____ llwilk ��y��� _._.._.. ..
°I nen fthe p pny, m exclusively contractingwith licensed cntractos to - �NVAL r® - -- r •:i - '
co st l theproject(Sec ]044 Business d Professions C de)The Contre u s 4�L�,i '
License Law does not apply to an owner of property who builds or improves thereon, ` ' '"
Contractors License l such projects.wit a.commetor(s)licensed pamua d m the
JUN 1
and who contracts _ Q q
❑Iem xcmpt antler awl i'` ''__ C,' ',B&PCfonhis reason 8 2Q�1 i La
WORKERS COMPENSATION DECLARATION BUILDING
I hemb,tuffirm d, p by of pcj,ry eofthefoll ngdalanocars:
° 1 have and will°mninumn s Cenire,ur of Consent to self-insure for Worker's
Compression. as provided-(., by Section 3700 of the Labor Code, for the
performance of the work for which ons pemitris issuedIt
.,,
❑1 have and will mal tan Worker's Contpens t on'lnsnrdo e'ss required by,Section
3900 of the Labor Code,for the performance of the work for which this permit is
issued My Worker's C 'p nsat on Informer,carrier and Policynumbier area
Cert tRv'd,''j I Plcy Nn ..r rh +: r it tiM l
ROMiWO
.
COMPENSATION INSURANCE KS'i ... __.
_ F i
IT s section n ed not he completed if the r is for one hundred do
$ � p rxrtni nary :',p ` .`. ', IT
n ._._ .a:yo .a. .: ,..,_. _ _:
I tend'0 anions rhms ruin `in, dl La'd: 11., .:.t ✓ t -• ':;
y pain ny aofm w kir h pe
'-
hall not employ any,para. y man become snbjar t the'Wo kers
s
Comp Applicant, , L, of Cal .rma.Dare'
NOTICE TO'APPLICANT:If,after making Ili s Can ficand f Exemption,you hould ..,
necame subject to the Workers Coniqua sation provisions of the Labor Code,you most
0
aBaG>ai.IVQZ;rwf forthwith
onh thocomply with
tshutchpePr
md ssu
or
dthis ne it shall be d
eemed revoked,
CONSTRUCT16NLENDINGAGENCY
hereby a rnauh rcmawnwon lend' g frM1
(Sac 909]C vC) . - .1.. 1.
Le dersN m ' .. .__ . . _. VT_....._.. 1 __
Lenders Address
-
.. _ . .._ .. _._..... .___..
-
V 0 1 c n fy rhar 1 h e read Ili pylic r d stmt that the ab a Information is / �t-(•(j(/�l
[� kbrten.a agree m,comply with all.city and county mdinas ninantor
d se Iowa relating
�iG to building construction;and hereby authorize representatives of this city to enter upon
�y
the above-mentioned property for inspection purposes,
r .Ga (We)agree to save,indemnify and keep harmless the City of Caperton against
Z) liabilities,judgments is and expenses which may in any way III against said
V:
Cil,i.c.nsequenceofthigraii(ingefthiNpemit
APPLICANT UNDERSTANDSAND WILL COMPLY WITH ALL NON-POINT
SOUR CE REGULATIONS Issued by: ADate
signature,of AppirrefsCombact "....., t -;Date
Re roofs
1 ,HAZARDOUS MATERIALS DISCLOSURE
„r Will in;tippluoultur fluteradbuildfing ocupant contributinga hueardo:mammal ,, Type Of ROOF _
as defined by the C pen o Municipal]Coe Chapter 9 12 and the Health and Safety _
ibe Inspected poo[ ' -_..
Code S in 255321a) Y r :'t F i y t t t 7 ay
°Yr °Nor A11 roofs shallto any roofing material being installed.
W 11 theppphcam r fuwre building occupant use equipment or devices which If a roof is lns6lled'without first obtainingan ins ectlo i I'agree to remove
AM .. y. . 'erd p
°Y defined 1- the Bay Aru'1An Quality Managem
rstnctit handindo communions as
all new materials for inspection Applicant understands and will comply with
o . _ - ...
us aur
D' �
California Henhh& nT.requirements
" all non-point SOD7Ce LegnlaClORS ,r.i:,.t y •" s
1 ha a mirdimI hazardous-tiornals eq ements'under Chapter 6.95+of the -
Safety Code,Sections 25505 25533 and 25534 1 understand that
if the building does not currently have a tenantthat it is my responsibilty to notify the _ ,-------
occupant
_...occu t of therequirements which iib t poor to rax 'a Cetbfcare of
Gbc P Y qoi a '
Signature of Applicant Date
Ow tM1asrtaedag rat r;., Date All roof coverings to be Class B' or better
.. . OFFICE--