01090011 (2) OF
CI BUILDING DIaVISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMITNO.
10233 MINER PL. JUST WATER HEATERS INC 01090011
OW'NER'S NAME: APPLICATION SUB DATE
SCHWETTMANN ANN 1764 NATIONAL AVE 09/05/2001
PHONE: (510) 293-9901 SANITARY NO. CONTROL NO.
O z Z ARCHITECUENOINEER: BUILDING PERMIT INFO
1.00
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LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that 1 oto licenced under pmvsioof Chapter 9(commencing
I_� wanse"mn7ota)nrDis;.;un3onneBu.;ne..anarmfefesamn.ende.anamyfa<n.e REPLACE WATER HEATER.
u
:YEJ
m fell force and erre". (4 0 GALLON GAS)
z z a License Claw Lic.p
:O eu U Dole Contractor
ILL Oil ARCHn'ECT'S I FCLARATION
wse
I understand an,plans shall be used as public recortls
�
i E a,ea Licensed Professionalae o ta OWNER-BUILDER DECLARATION
1 hereby off rm that I fen exempt from the Contractors License Law for the
t Z< following reason.(Section 7031.5,Business and Prnfescom Code:Any city or ommy
which q p n0 entstm" ahe'improve,demursh p yin tore
w3a. pwrl 't I. q .th rpt tf s hpe It fl 'E dstt nr _.. - _ .._ ...__. - ....._ ___
Thain l dp : atom p' p ... .. _.-. ..__ .._..
m e t a t .c L r., I r e S FC Floor-Are Valuation
or that Bes ,eu,c n}on9n0and Divson 30ftneewmen nems.Any it aq ' '(-! \; t F. 9'r 6' iT .._1••M1, .
or Inst e is 31e5 bi Iany appm'ane the bass for the subjects
the p pliant to Any violation
of Saloon 7(than v tally hundred
dollars
for a Permit subjects the applicant m a civil pcnalry -
lornol more man five nanarw emmra(s5001. Occupancy Type
❑I,as owner of the pmpsny,or my employees%ith wages as their sole compensation, RGY
will"d0 the work,and thestructureis not intended or offered for sale(Sec.7044;-
tBusluese acid Profescions Code.The Contraetora License Law does not apply to an 506 - GAS TE S7Mequired Inspections
owner of Poi Who buildsm;mpm, amereoe,eidwho doasuch workhimself 507 - FINAL PLUMBING
or Ihraugh.his own employees....cded that sacs impro er ems are not intended or.
"-ore,rea r : 1.If,n n nm g o - p -t : la- m'n v tar o -' . ." ..... . - .. ..-_._.. . . . ... . .. ... ..
e f
�ordple,rumfldc ownerm Ider ,If hmc the h rden of prow ng that he did not build or
improve for purpose c f sale c
.-..... of _ ..._ _. ..-. ... _ .... .. __. ' . -
I.as Ownerrtuthetee property. m cdiness a contracting Professions
with sed contractors m _. . . .. .... .. .... .. -
_
construct the project(Sec. ,.4.an Business m and an,who F nds or The Commenters
License Law docs sol apply man owner h propcny who bullas se Improves thereon,
_and-who contracts Ra.w<h projects with a contructogs)-licensed purwant no the _.. .. ._ _. .. .. .. . .._ __.-.._......._-.... .. . .. ... _ __ ._ ..
ElContractorsIeser License Law,..
❑1 um exempt under Sec:' '� :B&P C for this reason
-`
Owner.•:. site PINALED
i WORKER'S COMPENSATION DECLARATION
-F hereby affair under penalty cfperiarnme orthe following declimaons: NUV 0 2 2001
-? ❑ 1 have and will maintain a Certificate'of Conxni In Self-msum for Worker's tY V
Yz Compcnsatlon,-as provided for by Section 37W of the Labor Code, for the
peffannanFe of the work for which this permit is issued.
❑Ihave•and mill neficlm Worker'sCompensmiun Insurance,as equired by Section BUILDING
3700 of Labor Code;for the performance of the work for which this permit is
sued.My W kis Ccur,monvine If...cove 6rriar and P fey turner are',v __ .. _ ___
Cent : 11 - (Policy bf, .. . .+ . ; i r✓ m^t tf t r� a
.1 CERTIFICATION OF EXEMPTION FROM WORKERS',, - '{'
COMPENSATION INSURANCE .. ,_..:._., ..„_ .-...._..... ,. ......... ... .. ..._..... - _ ..... . _.. ..__......
°IThis siollim need not he completed If Inc permit Ir ounce hundred dollars
__..- .._.. ...._.. .. . __._... ... .., i .. ._ _. ..... . ._... _ . .
1 n'fY.”' m prf fine kf- ti hilt pc, t"..see" i
.hall not enploy any,p 'n any na o a to or
' 'a'athe Workers
Com f lawx of'a
11 D1
D
NOTin
ICE TO APPLICANT 11 ft kin6 th C h f cmc nfE pi you should
hecn bl nolbeW k canape
sit p sof be
h Labor
h Cwle.you run -
O O fo Ih th PIY won. hp ora p t hall Md d ked. - ....
F- CONSTRUCTION LENDING AGENCY
a 7 I h by R'm IM1 t Ihare
.ary f Brom,open y f th performance
axQ o(th okf h hilt pe t . ':- 97 Cie C) . . .. .._ .._ _. .. ..
Lender's Name'
.. s.. _- ._ . . .. .. ..._ ._. .. ..
uc (
D.'L Lanae c A dr,..' ••: t ' . .'.
U"� 1e111 ,a fy Ihnt 1 h d his nitration d t to that theab f nation is
W0- come r l g t compll with 11.city and .only ordinances and same law,reading
V mob Idng t ion do by mor p 're fm. ty"anteroom
therAwementionedap ty f .p^d p -
ffQ
(W) 6 t e indemnify dk pl .dieCp f Cupertino again
r rA liabilities, costs and re,ense,whichmay: anyWay gin said
U-Z City in-consequence of the gmmldg of mist.panto. r
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-PONT" Issued by: Date
SOURCE REGULATIONS: " . Y'
Stgamure of AppIamUCvmtrb"ar f" .` Date'- Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Willone Sledfurour.,future boiling excestriat vicare orho dl 6 m'us materna Type of Roof
as r.A f d by theC pen n M n'c pal Code Ch pt 9.12 and theHealth and Safety
codes Section y., All roofs-shallbe inspe r
- �Y "o `. _ cted prior.to any-roofing.material being.installed. . .,. .._ -
, t. .. _._ -...
W'd ma ,Iacamor future buildnit, varprin use egfir , devices which If a roof is installed without first obtaining an inspection,,I'agreeird remove
"n;l havardnu.Ca r acrommunion,a refund by he Bay Arca Air Quality Management
Districts.' -.--all new,materials,for inspection._Applicant understands and will comply,wlth
[I Yes 0 No it f I all non-point source regulations:,
I h od'the'b I material y ,etas sura Cn pier 6.95 of the . .
r dm
California Health&of cur ently e a to 255th,25533 and 25534.1 understand the
ifthebuilding edoes
ocnotaramt dyhaveatenant,tem;i is I. reuarive ofd artifimthe
Cc ar rtil of the requirements which muni he me(prior w Icxuanttbf n Ccnifc6te of
Ok.P Y: !. ..,.
•�� Signature of Applicant _ Date
�ownnr rearnor yea age f late All roof coverings to be Class "B"or.better
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r OFFICE