00050177 (2) TINO
CI BUDIN( mvISSI
IIONPERMIT CONTRACTOR INFORMATION:
BU1I.DINGY169I�$;0 LARRY WY HOT WATER INC FERMI"f NO.
1 c
OWNER'S NAME APPLICATION SUB Ali
NAMBA SHIZUO AND GRACE 2531 GRACELAND AVE
HONE: SANITARY NO. O
❑z a ARCHITECT/ENGINEER: BUILDING PERMIT INFO
OPLUMB MECH ELE
LDG CT'
<�E (650)298-8494 Bu
�aN
z S y'
LICENSED to cuN'nsed rax R'S DECLARATION Job Description
O z_o I hereby aRrm than turn licensed under Pnsvi,ians of Cbapmr 9 LLnmmcncing
Foew with Imaion]gN))of Division 3 of the Business and Professions Cole,and my license
is to lull Pince and ellen.
S z`i a Licemse Class Lie.e
°'O i O Dam Cordoust
3 a ri, ARCHI'1ECT'S DECLARATION
C u O 4 I undemund my plans shall he used as public mcordx
tit i p O
REPLACE WATER HEATER
'"twed Prufcssionml
wo OWNERt exempt fo onTION
=�, I hereby affirm that I am exempt fromrn thePr Contractor's License Low for the
e 3x 2 following reason,(Section it 7031 s, 1.alter.
and improve.
d nens Cone:Any city or county
FD
whichrequirespsrmn o 1 h p � J ikh repair any:omctuc
a.3$ prot t I. m4 0l ppf 1 f b ra o f Bred o mmem
that hers licensed parstiont toda,tom, provisionx ofh Coat1oes LivenevLawo0mili Sq. Ft. Floor Area Valuation p ff,
tu, nn ,I,exem Scnmr]OfABrf Dbaision orlezi B,,cd and
optim, :' :Code) $50QI
.,,bar M1c 7 31.5 b rang applicant
anJ the brei,for otic allege)exemption.Any violation
of action e b LS me any hundred
doll fnr a pemtit subjects the applicant to a civil penalty
of not roma man siva noodled dollar,tssau. APN Number Occupancy Type ,
❑I.as owner of the p(openY.or my employees with wages m dmir ode corn,mmum. 31.602029. 00
will do the work•and the structure is oat intended or offered to,sale(Sec.9194,
Business and Pmlb,sions Crde:'Ihe CorunNn is U,tm,e Law doe.,am apply m an Required Inspections
r of property Who builds or improves thereon,and who doss such work himself
o 11hrough his own entpinyvos.pow Wed that.each not, vamnm urs not inmari or
offend lin sale.IL however.the building or impnn'cmcnt is sold within one year of
cotnpletidq the ownc,lam ildv,will have the huNcn ofprovingthat he did not build our
improve hit ...c o 502 — FINRL PLUMBING ENERGY
ol.m owner or the property.amecm.ivdy contracting with licensed conimcmn to 506 — GAS TEST
cnnamm the pmjceo(See.70,44,East—,and Pone ssions Cnlaa The Contractor',
License saw does not apply to an owner of property who build,or improves thmenn, 507 — FINAL PLUMBING
and who contracts for such Projects with a contracmrl%)licensed pursuant to the
Contmnor's Licensor L-w.
0 am ce, In under Sec. .B&1'C fnr this ma,an -
Ownet Date
WORK17R'S Co MPI?NSAI'ION DECLARXI'[ON
I hereby affirm under Penalty of perjury one of the following declarations:
] 1 have and will maintain a Cenificute of Consent to sell-insure for Worker's i•/ ��
Compensation, a, provided for by Section 37W) of the WMr Code, for the /
orfnrmunce of the work for wwhorl,this pmnnit iu'w,ncd.
❑1 have and will maintain Wo loos,Compensation Insurance,as requited by Section O
3700 A the Lohor Code.for the performance of the work for which this permit is
issued,My Workers ContPensaoion Insurance carrier and Policy number arc:
P
Canrier: Policy No,
CER I'IiICAI ION OF E%EM(TION FROM WORKERS'
COMPENSATION INSURANCE
('leis section need not he compicied if ilia peanut is for one hundred dollars
(5100)nr Ica.)
I cenlfy shut in the p,,o...nou,c rel'1lie work or which this permit I,is,tu d.1
shall not employ any person in any manner w as to become subject to the Workers
Compen,ation Laws of Gdifarni-.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Cemif icme of H,emption,you ehouid
Femme object to the workers Compensation pro,nme s of the Labor Code,you must
Q OmfonM1wi it,mmPly w ah,mh psrvm I,or this permit shin l le dcenuvl revoked.
z (ai CONSI'RUC ION LENDING AGENCY
a > I hereby nlTim,Ilia(them Is u amstructino lending agency nor the arforrounce
W of the work for which this .,it o,issued(See.307.Co.C.)
L Q Isnder',,Name
Z lender',Address
V Q 1 certify that 1 have mad this application rand state that the above information i,
ia. [a et rrcet.I agree no eomply with all city trod county onimmcec and Into,laws refuting
Q C.1building con, uctlon,and hereby antlenm repmsenhnives of this cityru nmcr upon
W th-e aMrrcrrenuoned pmpeny for inspaion purposes"
F 0. (We)agrecit)sax e.i ndetnni fy and keep hornless the City of Cupertino against
4 halad,fic,judgments ena,and e,pen,c,which tory io any way aettue-1-61111 said
C.) z City in consequence of the grunting of this permit
APPLICANTUNDERSTANDS AND WILL COMPLY WITH ALI.NON-POINT Issued b � l Date
SOURCE REGULATIONS, y'
Signature dApplicar YCornramor Dam Re-roofs
HAZARDOUS MAI i7RIAI,S DISCLOSURE
Will the applicant or future bidding tecupom some or handle Bcomius m-nidalType of Roof
as defined by otic Curynino Municipal Code.Chapter 9,12,and the Health and Safety
Ctdc11tos 215320)? 0 N
All roofs shall be inspected prior to any roofing material being installed.
Wit the nppp.,ou mica btdldingteeupam ase e,mi mnent ar da.ica,which If a roof is installed without first obtaining an inspection, I agree to remove
mil h chohms air conlaminant,as delined by the Bay Arca Air Quality Managmetn
stun all new materials for inspection. Applicant understands and will comply with
ID Ye., Cl No all non-point source regulations.
1 have read the h.ronfi materials requimmcnts under Ch-ptor 695 of the
Califmniu Hauhh&Safely Calc.Seniors 25505,25533 and 25534.1 un ba,umd that
if the building Atm,not,onrnily have a comm,the II is my re,prtn,.Inday m notify the
occupant of the requirements which mu.a be stet prior m issuance of a Cemificam of
f"`'-Pouv, Signature of Applicant Date
...',o,-,tmori.d-gent [)amAll roof coverings to be Class `B" or better
OFFICE
CITY OF CUPERTINO
1 of 2 BUILDING PERMIT RECEIPT OPERATOR: yvonnek
COPY N 1
Sec: Twp; Rn9: Sub: SIR: Loe:31602029.00
DATE ISSUED.......: 05/25/2000
RECEIPT 0.........: 12326
REFERENCE ID 0 ...: 00050177
SITE ADDRESS .....: 10600 LARRY WY
SUBDIVISION .......
CITY . ............: CUPERTINO
IMPACT AREA ......:
OWNER . . . . .. . .....: NAMBA SHIZUO ANT) GRACE
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-2057
RECEIVED FROM ....: MAIL
CONTRACTOR .......: GUSLANI, CHRIS LIC K 21311
COMPANY HOT WATER INC
ADDRESS 2531 GRACELAND AVE
CITY/STATE/ZIP ...: SAN CARLOS, CA 94070
TELEPHONE . . .. . . . . : (650)290-8494
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ------- --- ---------- ----------
SPWHEATER PER HEATER 1.00 9.99 0.00 9.99 0.00
PPERMITFEE FLAT RATE 1.00 35.52 0.00 - 35.52 0.00
PERMIT . 45.51 0.00 45.51 0.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ ............................ -------- ............................
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING