00090192 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS, ITRMI'I NO
OWNER'S(A..ME:' APPLICATIONJ@19r'
:1 1
10866 LINDA VISTA DR HOT WATER INC E
PHONE: SANITARY NO. CONI ROI.NO
BARUCH DEUTSCH 2531. GRACELAND AVE ' 09/29/2000
MOO ARCHITECT/ENGINEER: BUILDING PERMIT INFO
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(650) 298-8494 BLDGH.ECT PLUMIT MECH
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me LICENSIiD licensed
ivens rd underp DECLARATION Job Description
_o Thereby X)).f iOi am.fthcvdundertund Prnnsof Cbapmr9(commencing
pml_.j with full Rnrmad effect. nn3af the Busines%and Profession,Code,and mylicense
m i is in full lilacs and effcn.
x c K 6 Lica,sc Cin%% LIc.p
o.O u Umc S OECILor
AIICHITECT' DECLARATION
I understand my plans shall he used as public records WATER HEATER
a.'•°i O 50 Licensed I'mfcseional
OWNER-RUILDGH DIiCLARATIO,N
wI hereby allirm than 1 tun exanpt total the Comr.nu,'s License Law far the
C 6 Iiklnwing rcarnn.sccainn 7131.5.13 us,and Pmre,sioos Coal,:Any city aeon ally
which require%a permit to ennmuel,cher,nsuin;pr c.dcnol 0l For a'pulr any structure
�Q prion its isance,alaelip.deslneapplieantfnrsuch permit In We asignN,Imensnt
that he is licensed pursuant a me Infections of Contractors License Law(Chapter9 Sq. Ft. Floor Area Valuation
(commencing with Section om an of Division 3 of the Brame cad nfAny Iz Code)
or that he is 31.5 lot therefrom and the nasus for Ile alleged exemption,a it sinlmiun
,IF Scctlonef1Inanfiyany
undn"Iwant,upmn,it.nbjecu the appllcent macivil pen:dty -
orot+I;m,m tun live hamm�d dollar risWt. APN [Number - Occupancy'I'vp�
❑I,a,owner of the property,or my employees with wages us their sole compensalion. 5500
will Jo the work,and the amaure is not intended or offered for sale(Sec.]Ilii.
Busmns and Professions Ctde:The Contractual',Licenu law does and apply ,,an Re c Hired Inspections
mFar of papally Who hauda or improve.mromal and who d—,each work himself 3561 4047. @l!I
through his own employees.provided tom ouch impmvemnns are nm intended or
offered lin%tae.If,nnwcvea Ih,I,ndied htg..t ... o-scat is[d within enc year..I'.
campmfoot the ownear ria�w�Il nave due muden or pausing mut l+e did not Hood or
imp502 — FINAL PLUMBING ENERGY
rovee puH+use n
❑I.as owner of the property.am exclusively contracting with licensed conchonto 506 — GAS TEST
construct the project(Sea 70,14.Business and Professions Cade:)The Comrocmds
uecn,e Law does not apply loam owner Ofm
pperly who bannn
ds or pdn
muc, , eon. 507 — FINAL PLUMBING
and who ,ovum% lin suet pa9e1a wdh a 1,1111aclals'1 lim;+,ml pursuant a Ne
Contractor's License Low.
❑1 um exempt under See. .B&P C for this reason
O.ncr Dam
WORKER'S COMPENSATION DECLARATION
I hcmby moan I Im ncnahy of let...ry one of the loll—log declarations: .
❑ 1 base and will maintain a Certifeme of G,m,mdt la'all-insure for Winker, FI NALED
Compensation, a% provided far by Section 37W of the IaMn Cale. for the
performance nRhe work for which this Permit is issued. N 1' 0 [d r)C 001
❑I have Hud will maintain Worker'.Con,pm,smlon Insurance,on required by Seetinn JUN N
3700 of the Labor Code.For the pertbnnause OI'the xerk for which this permit ie
i%wed,My Worker's Compensation Insumner carrier and Policy number arc: p
Carver: - Policy NaBUILDING
UILDING
CEHTivicADON OF E IEMPTION FROM WORKERS'
COMPENSATION INSURANCE
CI'its section nand nod be completed if Inc pemul o orane hundred dollars
l81WI m le".)
I certify that in the Performance of the work for which this permit is issued.I
shall nal empty any person in any manner so as in become abject to the Workers'
Gun mu'alion Lows of Cahill m,im.Dom
Applicant
N01'ICit'I'O APPLICANT:IL mtcr nmking mus eradicate OF Exemption,you should
heconle subject a the Worker a
s Campcntina provisions of the Labor Code.you must
Q 0 foahwith comply with such provisions or this Wood shall M deemed myeked.
Zt CONST RUCTION LENDING AGENCY
> I husby umu thdame e ix a oon.amcli....lending agency lin Im peninmuncc _
Of the w,,,k for which lis pernN is ismer(Sec.3097,CivC.)
G Q Lender's Naas
5 z Lenders Addres,
U Q I codify That I have read this apnam
plication and,tate don the above infoion is
W E., casco.I agree m emnply with all city and county crditance,and some laws relating
Q U
to balding conmuclam,and hcrehy amloorimrepres,ntmivesuttnl%city tomtit,IIPUO
'y r� the aliases uncounted propuny fnr "',coII purpa%cs. s
[r 6s (We)agreememe.indemnify and keep hamdes,the City orenpenim+against'
W liabilities,judgments,costs and c,petses which may in any way accrue against said
U L City in consequence of the gmnling of this pernut.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued Date
SOURCE REGULATIONS.
Siloam of APPli,anTL nectar One Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant more Or hart havNws material Type of Roof
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Heahh and Safety
Code,Section 25532(a)l
0 Yes EINo All roofs shall be inspected prior to any roofing material being installed.
Will me lo,licmn at liame buildmgoor,tol 1110 conn, of o,dmiecs whleh Ifif roof is installed without first obtaining an inspection, 1 agree to remove
matt ho¢ardoua sur ammntland,as deiced by he Bay Arca Air Quality bimagcmem
Districts all new materials for inspection. Applicant understands and will comply with
0 Ne, ONO all non-point source regulations.
I nave read bat ha,:ndnus olmenul,ne irmnenh under Chaprer 6,95 of the
Cahfonta Rulth do Safety Conic,Sant....,25505.25533 and 2.5531 1 under orad that
if th,building does Food cnmvnly lone,a tenure,thin h is n,y re,poaiulity m....lily the
u.ant of the requa'
irennu which matt hat tun prior I,ion:ace Of I,Cendicnm of
Fact,COpaq. Signature of Applicant Date
Own,,o,midn"I ed agcm Dalin All roof coverings to be Class"B•' or better
OFFICE