01030134 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20302 NORTHCOVE SO JUST WATER HEATERS INC 01030134
OWNER'S NAME: AI'PLICAI'ION SUB DATA
IAII _IAMS ROBERT B 1.764 NATIONAL AVE 03/23/2001
PHONE: SANITARY NO. CONTROL NO,
(510) 293-9901
ARCHn'EC 7ENGINEER: BUILDING PERMIT INFO
❑ BLDG ELECT PLUMB MECII
2
��✓ Ibcrtby all COVI RACI RNDCLARA'I'[ON Job Description
s "
z. fns Caer v n m ylice oe
:t_-w with 7")of Division Sof the Bu,iaes and Professions Cada.and my license
Din full dao anal d'itet.
ow etas.. Lica REPLACE 40 GALLON GAS WATER HEATER.
Dwc Contractormind
3 a C ARCHITI?CE'S DECLARATION
I understand my plane shall he urcJ x,Mhlic ncnrJe -
tp1+6 i p O Licensed Pmleveionvl
i OWNER HU HA ER DECLARATION
w 1 hcrehy allilm that I am c"ar,t fan,the Contractor.License law for the
t Z following crown.(Scion 7031.5.Business and Professions Code:Any city or county C/
f x o which rtwg.ire,a Penni.u,cononmL alt,Impn,vn,demolish,....cite,troy..fracture r
�3$ port . also ry dl pplic: tl t
such 'G II signedstatement
math licensed psma t to the provision,of theCortaclue.i License La (Chapter 9 Sq. Ft. Floor Area il[jon
(c,ncor an,as illSection 70mu I Divi,ou.3 fhe lbu,rms,and Poll c,oi I,Cale) CJ
or that he is exempt therefrom:mJ the basis for the alleged caempao 1.Any violation iAqq
of Section 70315 by any applicant for a permit subjects the applicant a)a civil penalty
m no,mom man five f ood.m dollars(s50 ). APN Number Occupancy Type
❑I,as owner of the propcty,or my employees with wages as their sole compensation. 31641072 Out
will An the work,and.he maclaw is nal intended or offered for sale(Sec.7194.
Baehr,,and Profession,Cade.The Contractor s Litt„ee Law mc.nal"'fly to 1 Required Inspections
owner of property Who builds or improves thrown,and who da,such work himself
or ill his own a„ployce,.pnwided man such imp...emem,am not ate do([m 204 — UNDERFLOOR FRAME
ofle.1 for safe,If finee,er. he building ,,aralpowrould I,'oId eskifle re year of 301 — ROUGH PLUMBINGonmlclion.the owner-builJor will have the burden of provingthat he did no.Wild or
�nnrnve for wmi,c iraale.) 303 — ROUGH MECHANICAL
❑1,as owner of the property.am exclusively contracting with IicanwJ contractors u,
m,lmet the nmde
ject(Ser.IM4.Business and Podr—on,C, :)The Contractor, 304 — ROUGH ELECTRICAL
Llrenec Low does not apply of m,owncl of pigany who Mild,or improve,there....,
and won comma,fir suet,projem,with a camracto.(o license([pursuant to me 505 —• FINAL ELECT R I CAL -
oc,mmemrs Liansc Law.
ltmn exanpI mMer.See. .B k P C b,l this m:oin _ 507 — FINAL PLUMBING -
Owner Dam 508 — FINAL MECHANICAL
WORKERS COMPENSATION DECLARNHON 514- — FINAL PUBLIC WORKS
I hereby alLnn under penalty of perjury one of the following declarations:
❑ 1 have and will maintain u Cby Secti of Comem in sc Labor re fix Workers
Crtormanceo as provided fir by Section 3is X1 of the Labor Code, for the
perfinm;mm of the wn.A for which this permit is issued.
❑1 haw and will maintain Worker's Compen.wtion Insurance,as"dead by Section
37(g)of the Inla r Code,for.he perh,mumee of the work for which this permit is
Bred,My Workers CmnPcn,aion losumnse currier anti Policy number are:
Carrier: Policy Na.:
CBRn19CAl'ION 01:EXIiMI"I'ION FROM W'ORKNdS'
COMPENSATION INSURANCE
fHis scion need not he cangtacd if the pcnnit Is for one hm,dred dollars .
(S10in or less.)
1 certify that In doe perloriaam(if,he work for which.his periost is issued,I
,hall not employ any person in any manner so as to become.subject to the Workers
Compensation L ms,of Cvlifomia.Date
A,,he ret
NO)IC1710 APPLICANT:If,afar making this CctiEcce of Esau I n,you should
become suhjceuo the Worker's Compensation putsisiuns of the Labor Code,you must
O O forthwith cmnply ,,If such provisions or this Permit shall be banned revoked.
z ^ CONSTRUCTION LENDING AGI7NCY
CL 7I hechy affirm that them is a cunsruaion lending agaay for the Performance
nl'thc w,
d.for which this Iemm is iasllal(Sec.30117,Civ.C.)
D. Q Lender,Name
oZ. Z Lenders Adde,,
U O 1 certify that I have read the,application all ,.,a that the aMwe infmmarin is
fso [-t c,teat.I agree m comply with all city and county ordinances and slate law,mining
O U bonding ur,laclion.I iherchy motor repi,xcmmivc,of mi,ch,I,,enter anon
tie five abuse-mcmioned property for inspection purlxne,.
u6, (We)agree to save.indemnity and keep harmless the City of Cuperin,against
Vl Il,bilitie,.IIdgnmot.s,costs anti expen.wx which may in any way"cam again,.said
city in cndwyaemc of the Sounding of his samil.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RI!GULATIONS. y'
Signature of A,plicart Comencor Ila'° Re-roofs
HAYARDOUS MAI FRIALS dSCLOSURI3
Wm the apphcwn i,forum holding oceu Tal law of handle hevmlons nh::mrial Type of Roof
as cls ined by the Carefiun Municipal Cod.,Chapter 4.12,and the Health and Safety
Coda Season 25532(a)'
❑Ye, 0 N All roofs shall be inspected prior to any roofing material being installed,
Wi11 the applicant(It mturchuiMingoceupanause e,Iai,ronorde,et,,x'inch If a roof is installed without first obtaining an inspection, I agree to remove
cmif rmtdoes air oman..nwm,as dewed by the Ihry Arco Air crudity M anagnncnl
District? all new materials for inspection. Applicant understands and will comply with
❑Ye, 0 N all non-point source regulations.
I have wad the havardous material,reyuirnnenu under Chapter 6.95 of the
California Health h Safety Code.Sections 25505,25533 land 25531 I understand thin
if nw buildingdor,tun ammntly heel,a venal, haliti,my wspon,ihi lily to nafify the
ecepam of nsa the requirements which abe mel prime m issuance of a Certificate of
Occupancy. _ Signature of Applicant Date
0..net iramhomed.,,a' Dme All roof coverings to be Class "B” or better
OFFICE