00080011 (2) CITY OF CUPERTINO
]WELDING DIVISION PERMIT CONTRACTOR INFORMATION:
BIIILDINGADDRESS; " MI'I'NO
836 KIM ST JUST WATER HEATERS I tG @@08@01. 1.
OWNER'S NAME: APPLICATIOC/1� /2000
IB
JOSEPH 1764 NATIONAL AVE
PHONE: SANITARYNO. CONUROL NO.
(510)293-9901
u O p ARflll'IEC'IIBNOINFLR: - BUILDING PERMITINFO
BI-DG ELECT' PLUR MECH
g
gut
y Job Description
LICE?NSED CON'IRACI'OR's DFC.w ni CION
p Z Ez 1 tion 7th uliinn ivi an,of the d under p al Prom of Chapter. al m,lend..g
a,"jwim1.11im,oandefeci.nirm3nnneen.ire..:+nJPmfe..dnnxen:le.andtanccenw WATER HEATER
m— is in lull fort[and cRttt. '
is d u Liaw Cites C....
t O Dam S DEC ler
Q Z O H An%shalIlZli DI!Cublic rr10N - -
C=va; 1 understand my plan.shall M uncJ as Public moNx
W 5 Limwwj Pmfesnional
6ya,�
OW NI+,R-IfUall'a?Ts UBCLARAIION
= I newsy aso nmrn Inas l mo exempt rmn,tar cenraem Code.
.Any
city
tar the
C>< which ing reason.IScction 7fll 5,Hudncsa and Pmfcsxiionn CINIc:Any city or county
a,S_
which Iryuisuapermit requires
thepplic improve,h emiiitt ore a signed
LLC prionns Isco al lloocomquims theapplicanttforhe wchpem,iuoiveaxignedsta¢mem
a. malhei'niag With msaam Tome p)I Dwini Tao che[I r. and li Lawor,C de)r 9 Sq. FL Floor Area Valu u t B
hmTmtmI.is a With scarce mar of e Wa,,3rTic a Rn'hma..nit pros suh+..a violation citta
or then he is aembT mere from amt or nada tar me aoeged exemption.Acv l ena
of not mo e Chas iv any applicant for a pcm,it'rnjeertim applicant m a dr;1 penally
of net more man foe nrmdmd debars 1550n. APN Number Occupancy Type
OLneowtmrofthe latterly,mm locenwithwamnnxmeirsorecon„anoiaor. - 35919040. 00
lieTemp r t,
will Atu the work,and Thr trui C m Inmmdcd or an I,ov lar one l5cc. I,,an
owner o'pro4.
perty Who Wilds
Code:the rw:f mrldr',,and ss o d s such
not ork himself m an 502 — FINAL 9uPLUlI'16�LN�[s ENERGY
owner nl property Who builds or ire at such and improvements
does such work intended
or
of through his own onnlcyres.pmvidcd than such vervat mcols art nil intended W
offered rte sale R,ho r,me shave o np,reeemaot n sem lar din e e year of 506 — GAS TEST
were
n�mlow,tra the oelboddut wiu have d,e n�tmen of pm ins anal lin did One hTald m
nmve r�rwmesr ornate.). 507 — FINAL PLUMBING
01.a.owner of the property.am exclusively contacting withImenwd contramn to
construct he n,,,jecl(Hce 71)44.Business ,ad ProfesGom Cede:)The Contmclor's
L d wh Law duct'not apply to ro owner mf a coat y lone btu ltd'oe immomi TM1,, T.
The
nnJ why a'macla n,r arch pr jcets will,a ummten,I licensed pursuunT r,the
Ch1 me exempt
pt under
Se
❑1 tart emmpl under Sea .B K P C for this react /
Owner Dom
WORKER'S COMPENSATION DECLARATION
1 hereby of im under penalty of perjury one of the Billowing declaration:
❑ 1 have and will main:::.. a Certificate it Consent m self-:num lin Workcrs
Cnngmnsation, as pmvidcd fa by Section 3700 of The Laher Code, for The
perfimnance of The work fnr which Inas pemnit is IneaN.
Xdhave and will maintain W'nrkef*s Compcnsulam Inwmnce.as required by Section _
)or the Labor Code,for the performance of the work for which This nation is
isnaed�MM W�s�kctx Gmtpcnnn��linu In rano carter unit Par,nnihcr, are
Celriclt`_s't,�FICAT1oONLP FXEMPol ITIn.0ON 4IWORKFR,•S�' '--Io
COMPENSATION INSURANCE!
(efts secflon aced ma be canplcmd it The permit is I'or tune hundred dollars
($100)or less.)
I certify that in the psrorniance of the work for which this rytion is issued,1
'hall not emEloy any pers,m y manner ha)(Z
Y subject In The Worker,
ComPcnvmu+tm
yyllf i�IJum lMVV ,
Applicata
Not'ICFTD API T:Il:she,us'ing thin Ccniticmc of l3aemplien•You sM1ould
Mem se wbjoe.rte the W'nrAePe Compct':nion provisions of the Labor Codc.you me'f
Q O forthwith comply with such pmvi cions or this permit shall be deemed revoked.
FCON S1RUCTDONE LENDING AGENCY
x > I hereby amn t that there is a comsnmceon lending agency for the performance
of the work far which this permit is issue)ISce.3(90.Ci,C.)
1 Q Lender's Name
Z tendo',Add...
U 0 1 certify than I have mad This application and state Thalia above information is
s F., coma.1 agme no comply with all city and county ordinances and state lass.relating
U to building calstronion.and hereby awhorim representatives of this city m enter upon
he above.,allnnN property for mNwction purpowa,
y (WC)agree h)--.indenudfy and wen harmless the City of Cnpenita an”
Vl Iislahlic,.)adgnicris.co,l'anal expencex which ala,in any way arCNe agaln'T and
U Z City in conscgoemeeu I egra dng onni'permin.
gOURICANTUNDFRSTSND. ANI WILLCOMPLY WITH(AfL(y�NjON/-P�O/INT Issued by: Date
siyna I i - z`+�`'1�.I!— Re-roofs .
1 NDOUS MATE AIS DISCLOSURE
esu me a ant or foam building occupmn'low or handle moardats material Type of Roof
an defaal by me Cul+chro mmricip d Code.Chapter 9.12.and the health and sm3ty
Code.Stenion 25532(x)'
0Y,, "" All roofs shall be inspected prior to any roofing material being installed.
Will me applicant er slam nod spam aye egaipmem er dcdnas which If a roof is installed without first obtaining an inspection, 1 agree to remove
..tit hmarloas air contaminant'as dcnnr3 by one Bay Area Air Quality Management
Dgdcrl , all new materials for inspection. Applicant understands and will comply with
El yes all non-point source regulations.
I have read the hermdouv materials requirements under Chapter 6.95 of the
Caligmia HcaIIh&Safny Cal c,:ninny35505.25533 and 355311 undcnland that .
ifthe building Jas nun carremly h: al ail,That it is my responsibility a,notify the
aapn I of tar mglr em'whir net oda To inslta of a cerifrate m' .
NIA (%
Signature of Applicant Date
4.ox..iota dwn2cJa2
Date All roof coverings to be Class ••R•• or better