02120096 (2) CITY OF CUPERTINO m :.
BUILDING DIVISION PERMIT CONTRACTORfINFORMATION
BUILDINGADDRISS: JUST WATER HEATERS INC PERMIT NO,
10745 MINETTE DR.
OWNER'S NAME: 1764 NATIONAL AVE APPLICATION SUR DATE
KALAMI 12/26/2002
ONE: 510) 2 9 3-9 9 01 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECfi
0 0 0 0
Op firmLICENSED CONTRd under$DIiCLARATION
U 1 hereby affirm that 1 am of
under provisions of Chapter 9(commencing Job Description
with Section](Iofp of Division J of me Business and Pnsfessiom Gak,and my license is
G y infrill fomeandeffect. REPLACE WATER HEATER.
b z License Class Lic.M
cz :o Dam cmarrmlr (40 GALLON GAS)
2iARCH ITECTS DECLARATION
O so U I understand my plans shall he used as public records
ou Licensed Professional
OWNER-BUILDER DECLARATION
fi<� 1 hereby affirm that 1 am exempt from the Contractor's License Law for The
i a.0 0 following reason.(Section 7031.5,Business and Professions Codi Any city or county
which myunes a permit to consoun,after.improve.Jemollsh.or repair any structure
rZy prior In its issuance,also requirestheapplicant forsuch fmaniuu file.signedvummem
q < OurheislicensedpursuanttotheprovisionsoftheCantracmfsLicenseLaw(Chapter9 Sq. Ft. Floor Area Valuation
a�$ (commencing with Section 710th of Division 3 of the B mines¢and Professions Code)or 628
.. that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant m a civil Penalty of APN Number Occupancy Type
not more ham Oa hundred dollars(S50% 37532048 . 00
❑1,as owner of the progeny,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.704,Business $p�{�' [�y,�p �t,�p�,..,
and Professions Code:The Contractor's License Law does not apply to an owner of 502 - FINAL L-'LlJlvl�%V e $ilgt'RGY
property who builds or Infuriates,thereon.and whodoes such work himulfor Through Ids
ownemployees,provided thatsuchimprovemenuare not intended or offered forsele.If. 506 — GAS TEST
however,me huilding or improvement is sold within one year of completion,the ownef-
builderwillhavethehurdenofprvingOaThedidnoTMildorimprove,forputpoacof 507 - FINAL PLUMBING
sale.).
❑ I,as owner of the pfopeny,am exclusively contracting with licensed communion to FINALE-0
consumer the project(Sec.7044,Buri nen and Professions CWc:)The Conformi Li .
cense Law docs not apply to an owner of pmpeny who builds or improves themon,and
who contracts for such propcu with a conommous)licensed pursuant to the Convector's JAN' O ,LO a L&x003
License Law.
❑ 1 am exempt under Sec. .B&P C for this....
Owner Data BUILDING
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of The following declautions:
1 have and will maintain a Cenificae,ofComem To self-insure for Worker'sCompen-
"ammn,as provided for by Section 3710 of me Lerfo
lear Code,for me fchnium.of the
work for which his permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
J]In of he Labor Code,for he performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Carrier. Policy No
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not M completed if IM permit is forone hundred dollars(SIM)
or less.)
I cenify That in the wrimancr ce of The work for which This permit is issued.I shall not
employ any person in any manner so as m become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
Menne.subject to the Worker's Compensation provisions of The Labor Cade,you must
O z forthwith comply with such provisions or,this permit shall M deemed invoked.
z O CONSTRUCTION LENDING AGENCY
[-+ � Ihereby ruirm thin there is a commotion lending agency for performance of ��// /
Ix �, me work for which this permit is issued(See 3M7,Civ,CJ
W Q Lender's Name
z tender's Address
U 0 1 ratify that 1 have read this application and state that the above information is
i~ correct.I agree to comply with all city and county ordinances and state laws relating m
�Ubuilding construction,and hereby nothorm representatives of his city to enter gam the
kQ above mentioned property for inspersion purposes.
(We)agree m save.indemnify and keep harmless me City of Cupinino against
,r, Iiabilitics,judgmenu,costs and expenses which may in any way&cane against said City
consequencein of the granting of
U a
APPLICANT UNDERSTANDS tAND WILL COMPLY WITH AL1.NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
HAZARDOUS
Signature of ApplicaData
I3AZARDOU S MATg occupant
DISCLOSURE Type Of ROOF
Will he applicant nr future building se,Chapter
store or handle hovalto and
as defined by the Cupeninn Municipal Cole,Chapter 932,and the HcaIN and Safely
Cork,Section 235J2(aj'!
❑Yes 0N
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
omit hazardous air contaminants as defined by the Buy Area Air Quality Management all new materials for inspection.
District?
❑Yes 0N
1 have read the h:rsardous materials no,or moots under Chapter 6.95 of he Culdo,
on Ileullh&Safety Gale,Sections 25515,25533 and 255]4.1 understand that if the building
docs not currently have a tenant that it is my responsibility to notify me Merport of me
requirements which mum the met prior w issuance of a Cenifcate of Ccrupeacy Signature of Applicant Date
Owner in anthatimd agcut Date All roof coverings to be Class"B" or better