02120022 (2) CITY OF CUPER'1'INO -" r�:.
BUILDING DIVISION PERMIT CONTRACTORINFORMATIOO N
B CDO(y4121s sNORTHCREST SQ JUSTWATERHEATERS INC PERMIT1,102120022
DWBhNDI: SANDHYA 1764 NATIONAL AVE APPLICATIYIf2SYU TY2002
Ak
ZONE: 51 O 2 93—9 9 01 SANITARY NO.// // CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
op LICENSED CONTRACTOR'S DECLARATION p
K ro F 1 hereby alrirm that 1 am licensed under provisions mf Chapter 9(commencing REPLACE WATER ART90 ' FB
a;z with Section 7000)of Division of NC Business and Professions Code.and my license is �����
t« mu Tome and effect, (4 0 GALLON GAS)
zO�' Un DEC 3 0 2002
Z Lnense Claa Lic.N
OZ— Rule Contractor
t—=�o]` ARCHITECT'S DECLARATION
ys5 as a I understand my plans shall M used as public records
taV1 Licensed Professional
BUILDING
f"�=0m OWNHR.BU1LDER DECLARATION
as <F I hereby affirm that 1 am com,n from the Contractors License Law for IM
w 00 following rwsnn.(Section 7101.5.Business and Professions Code:Any city lir county
x m� which retPdres a Imnnit to construct.alter,Improve,demolish of repair oy.structure $667
'n y prior in its issuance.also requires the applicant fnrsuch permit to lite asignedstaement
t?< that he isliicensedpumuantmthe provisions ofthe ContraemrsLicense law(cnapmr9 Sy. Ft. Floor Area Valuation
Wyk --0 (commencing whhSection 7ak)ofDivision 3ofthe Business and Profess...its Code)it 31638069 . 00
�� that M is excmpt themfrom end Ne basis for the alleged enemplum.Any violation of
Section 703 t.5 by any applicant for a Permit ubjects the applicant m a civil penalty of APN Number Occupancy Type
notmorc.ban low hundred d.11for $500). 502 — FINAL PLUMBI G ENERGY
O 1.as ownerofthe pro,porty,or my employees with wages as their ante compenation.
will do ft work.and the structure is not intended or offered for sale(Sec.7W.Business µ1r [rye
and Professions Code:The Contactors Law=Law docs non apply to an Owner of 507 — FINAL UCf1l7CS eclions
property who builds or improves thereon,and who does such work himself or through his
,.a employees,provided that such improvements arc nm intended oro@red for sale.IL
however.the building or improveriem is sold within one year of complclion,the owoer-
builder will have the burden of Proving that M did not Wild in impmvi for purpose of
sale.).
O 1,as owner of Ne pfopeny,am exclusively contacting with licensed contractors to
construct the project(Sec.70414,Business and Professions Code:)The Contractors Li-
cense law does not apply to an owner of property who Wilds or improves thereon,and
who contracts for such projects with a comractnr(s)licensed pursuant to the Contracts"t
License law.
O 1 am excmpt under Sec. .B&P C for this reawn
Owne Date
WORKER'S COMPENSATION DECLARATION
I hereby alfimr under penalty of perjury one mf tM following dectarations:
❑ Workar'sCompen-
ation,az provided for by Section 3710 of the Labor Code,for the perfmmance of the
work for which this .It is issued.
O I have and will maintain Worker's Compensation Insurance,as"mm l by Section
3700 of Ne Laorr Code,for the performance of Ne work for which this Permit is issued.
My Workers Compensation Insurance carrier and Policy number are:
Canter: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need nal W completed if the Permit Is for one hundred dollars IS la)
or less.)
1 certify that in the Pefforrnance of the work for which this Permit is issued.)shall not
employ any person in any manner so as to become suhjecuo the WorkersCompensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:It,after making this Ccnilicute of Exemption,you should
Mneme subject to the Worker's Compedalion prow ns of the labor Code you most
OO forthwith comply with such provisions or this permilihallM deemed revoked.
z M CONSTRUCTION LENDING AGENCY
[.. I hicirchy which rte that there isaad(See,3 lending agency for the performance of n —
G' ? the work for which this Permit is issue}(See,}091.Civ.CJ ^,,ff __//
Wa Q lender's Name ////qAV//�A�Al"
Z Lenders Address
{'
U O 1 certify that 1 have read this application and sate that the aWvc information is
L+r F VOmee'1.l agree to armply with all city and county ordinances and state taws relating to
O U building construction,and hefcby suit i¢rtpfmcmmivcs OF Of,city to to her upnn the
r above mentioned property for insPeainn purposes.
(We)agree to save,indemnify and keep harmless the City of Cupcnino against
tiN liabilities.judgments.costs and expenses which may in any way avenue against aid City
U in consequence ml the granting of this Permit.
r. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicaDate
HAZARDOUS
US MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building e.Chapter
sore or huddle HeadOUS lth and Salty
al
as ddined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Sally
Ode.Section 25532(0)' All roofs shall be inspected prior to any roofing material being installed.
0Yes ONo
Will the applicant lir future building Occupant use equipment Or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit Imiardous air contaminants az defned by the Bay Arca Air Quality Management all new materials for inspection.
Dinricl7
❑Yes F1 No
1 have read the hawallous materials myuiremenu unler Chapter 6.95 of the Califor-
nia Ihealth&Safe,Code.Sections 25515,25533 and 25511.1 understand thmifthe building
does nm currently have a tenant,that it is my resrymsibility tai nonly the dccapant of the
requirements which most W mart prior m issuance of a Crok of Occupancy. Signature of Applicant Date
lownef(itauthorizedallnL Date All roof coverings to be Class "B" or better