05050039 (2) CITY UIDF c DIViSiONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10747 LINDA VISTA DR JUST WATER HEATERS INC 02050039
OWNER'S NAME: APPLIC TIONSUB DATE
NACHSHEN BERNARD AND SUSAN H 1764 NATIONAL AVE 057072002
'PHONE: SANITARY NO, CONTROL NO.
(510) 293-9901
CO ARCHITECTIENGINEER: BUILDING PERMIT INFO
ne BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
5 y= Job Description
I(iod7 affirmthaiimu3.ccnscnuinc,provisionsofChapmr,.nd acing REPLACE WATER HEATER
_w Jd with Sediorceadd npDivision3ofthe Business and Professi�nsCee,and mylicenae
mm recon corse ane aftae'' (4 0 GALLON GAS)
C E License Class Lic,a
'O U Dam S DECLARATION 3 3 G ARCHITECrS DECLARATION
1 understand my plans shall he use as public records
�.y
i
.;z:0 0 Licensed Professional
OWNER-BUILDER DECLARATION
Z!+ 'I hereby afftto mat I am exempt from the Ctntmnor's License Law for the
L:?< following reason.(Section 7031.5,Business and Professions Code:Any city or county
Y F O
which requires a permit to c t et alcor.implore,demolish or repair any structure
°u13Cm Prim tot tine al req m pplicam for such permiuofileangnetl smtemem ._ _
math is
Ir ted perp Am.,he inions of the Contractors License Law(Chapter 9 t Sq..F(.)Floor Ar eat �'t'LS Valuation
(comma t ingu'th Seeh ]000) fDivision Sof the Hunness@nd Professions Code) 3,, )xl }�, yi U tt la: - rL.`l:4k u.•.'•.
or that he rs eaempuhertfrom end the bass far me alleged excmlwpo.Any violation
of Section]031:5 by any applicant for a permit subjects the applicant a civil penalty
if not mmrc than five hundred donaa(a50(t), APN NumberOccupancy Type
❑Las owner of the property,or my employees with wages in their vole compensation, 502 FINAL PLUMBIN ENERGY
will do the work,and the structure is not intended or offered for sale(Sec.7614, 5O6 — GAS TES
,will
and Pmfci,im,s Code:The Contractors License Law dove nm apply to an Tequired inspections"
owner of property Who builds or improves thereon,and who does such work himself 507 - FINAL PLUMBING
or through his own employers,provided that such improvements am not intended or
offered for sale.If,however,file building-or improvement is cold within one year of
'completion,the pose r sate.).will have me burden of proving thio he did oat build or �'
* improve for purpose of safe.). '
Lmowner Project
plopenyam exd tress an Professions
'mad Crectorsto 01IN LED _bl
construct the project(See. to a Business and Professions CoeoO The Contractor's
License Law goes notapplysuch
to owner th pronto/who builds se imt...a thereon. '
f Contract cannons formch projects.with.e summations)licensed!pursuant ro me. .. _ .. _
Contrac01..m,rptunde Sec MAY 1 6' 2002;,
1 nm exempt undo Sec. ,B&P C for reason
Owner Dam
;'t„ WORKER'S COMPENSATION DECLARATION BUILDING
4Inc¢hy of rm under penalty ofperjury one ofthe following declarations:
❑ 1 have Cad will maintain n Cadificam of Carter,to self-i...m for Warker's
Compensmion, asprovidedfor by-Section 37W of the Labor Code, for the
_ performance ofihe work for which this permit is issued.
❑1 have andwill maintain M'arker's Compensaion Insurantt,es required by Section
_ 3]00 mrihe Labor Code,fort ,hperformance of me wmk'fm which oris permit is
;. _ issued:illy WorkersCompensation Insurance carrier and Policy number are: '
Can t m t 1' _I;•.l Pol cy No .a ._. -. _'--- .-
":CERTIFICATION OF EXEMPTION FROM WORKE�tS1 �iI111 . ` E. . ,a.
COMPENSATION INSURANCE' '
'(This scchon nttd not be completed if the permit is for one hundred dollars
(S100)or1ux.)
"I courtly
that n in the pains a Wild k for whmh lot'ct tai t issued.1 _
iha11'not employ any person m any mariner so ss m become subject to the Workers'
ComApplicant on Isws of California:Dam'
NOTICE
t ..
NOmoosedIAP.the WoTIL after Compensationng provisions e of
Esemptiode,yen
you ould
mast '
Z bechwith comply
y the such pr Colons or limit
pmvin shall the c Labor Code,you lost
z O
forthwith cam 1 with such n
z p y wi provisions or lois permit shell be tlttme reveled.
r . .. -_... , —
LENDING
- ...... ..... . .. _.. ._ __.. .
" :CONSTRUCTION LENDING AGENCY '
w rkfor%hitm that mer:is C coned(See lending agency for the performance m t
of the work for which this pcmmit is issued(Sec.109].Civ.CJ
� Q —Ilnde'a Name -:__-.._._ .. _
z Lender's Address
V'0I certify mat I have mad this application and shim that the above information is
foneet.1 agree m comply with all city and county ordination and stem Iasis relating
0.,O to handing remtned
on.and hereby aumorice representatives of this city to enter upon
W the above reentiaocd propeny for inspection parpses. '/3/�//,m
.Ft. -(We)since to save,indemnify and keep barrNcas the City of Cupertino against �^
W liabilities,judgment,costs and cspemes which may in any way ettrite against said
UCity inconsequence of the granting of this permit.
SAPPEICANT
OURCE N GUDERSTSNDS AND WILICOMPLY WITHALG NON-POINT" Issued by: Date
Signaure of ApplicaduContmctor •• , 'Data Re-roofs
" •t HAZARDOUS MATERIALS DISCLOSURE
'.Will the s tic Or fmhre building occupation - 6
.. PP g pant store2.Kandlah ealth and Sual .Type Of Roof. -
p ,a d mile Health and Safcry -'
az de0ne by the Cupemno Mu c pal Cod Chat 9 I2
Carl Section 35532fa) •'i',• 1
El ( •'
,. . n , 1 'A II i cm lx f nit , err'
Y t ""'l .
-__• ` . , .: All roofs shah be Inspected prior to any;roofing material being Installed,
win me pp1�c^m err fumm bund ng occup.m.sa equipment,ndenceiwhich If a roof is installed without firs[obtaining an inspection, I agree'to'remove
m v Management
em6h d tamtmntaazaermeb ma ea ArnAh Int all new materials for inspection. Applicant understands and will comply with
r r Quality
Dist at
L - '.. .-- all non-point source regulations. i ,
A�L1 have read the niu.I s aerials quirements under Chapter'695 of the t
oma Health&Safety Code,Sections 35505,35533 and 25534.1 understand mat
buildin does nofcurenil have nrrnont.that it ism g _y y responsibility to nmifymepant ofloberequirements which must be min prior to issuance ofa Candidate of
pncy. . Signature of Applicant Date
eroranin npe,own Date. All roof coverings to be Class"B"or better
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::: . _.OFFICE