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02020129 (2) CITY OF CUPERTINO ''•=•' '- "' BUILDING.DIVISION PERMITCONTRACTOR INFORMATION: . . BUILDING ADDRESS: •. .. PERMIT NO. 20249 NW. SQ, JUST WATER',HEATERS. INC, , , ;,. ,02020129 ~ DS _. .._ : � t.__.-1764'- -NATIONAL AVE AP 01 S E CATION US DAT WUTININ 2/28/2002 PHONE: - - SANITARY NO. CONTROL NO. (510) 293-9901 o ARCHITECT(ENGINEER: BUILDING PERMIT'INFO re- BLDG ELECT PLUMB MECH L'J L-'J L._1 f « Lm that ID CONTRACTOR'S DECLARATION •�v� 1 thereby alRrm that I am licensed undo rcha ter v uninmenem Job Description prod Prens o p g ?w_m isinfllforeandofDivision3ofthe��sinessvndPmfnsionsCWe.antimyliccnxe REPLACE 40 GALLON GAS WATER HEATER i x s,-, i.in Inn firma and mbei. a Licence Clasz Lic.tr / 0 a`O Wm S DELLA _ 5 3 Ia ARCHITECT um DECLARATION On I uindenuW my plain.hull Ik•usce as public records r 3 O O Wccnsed Profcssianvl a.' a ON NER BUILDER DECLARATION I ' =' 11 byih t 1 ;n r from the Contractor s License Lax for rhe ?a following ui (S S ii 7031.5.Basinosand Professions C Cute An,mry ter county EsxrC ..,which requires a permit to t malter.improve,demolish. repair ny.nuam .Q 2pncr1i ;....nor.rilsw requiresthe ,pi anfar such peimult'o filensmgned nammi - . �3- that he sl emJ Pursuenn the pr" nsofthe Cnnwmory L;cenu law(Chap; 9. :, 1 Valuation ecom ncng with Secton]1100)of Division 3 of the Business mid Pryfess acts Code) �S}3�(]� m that he it exempt therefrom and the has,,for the alleged aempuh Any violation-of Section 703 1 i5 by any applicant for a Permit subjects the..plicate te a civil penalty- of net mom than roe nanarce aad:n,(ssm). 50�PN"iThL PLUMBI G 'ENERG1Qcc pancy Type O 1,a ...at of the property,m my employees with wages m their sole compensation. II d the rk d Ne amemre is nm t d J' R d for sale svr.'?W;' .. d ti e. 1 d ereu ass Cale'The Ciiii r I 1 w doer not apply to an . .... __...5 07 - ' FINAL-'Pt.1tAiS.lil40pections. _• - ..... ...__ ..... .... ._._ r of Property who builds or raided that such.and who east such work n ed or . . .. orthrnagM1 his own employees. building that cepr improvements art not intended or :oRcred for sale.If,knsdvcr,the buiteing or imprav<mem is sold within ane Year of - oniplmion,the owner-builder will have the buMen of proving that he did not build or improve for purpose of mler) •' ❑1axwner ot_he.ropenYir exclusively contracting ontruting w_ith l.licensed_n.ued_contractors mr . . ..... ...... .. ._. _. - ._. _ imorconstruct the does (Sec.]to a Business and Professions Chep The Contractor's '- Liccnsc law docs not apply man owner th property who builds se improves thereon, ..an arracu contiaas for ouch.projects wiiM1 a.commnottx)licensed!Pursuam�o.thc _._.._..... _ _ ___.._.._. _... . _. _ _._ .._._ _. _ .__..._..... .. 01 ma cora Liana low.. --- OleincnemptunderSec. ,B&PCfar this reason Owner Date" - WORKER'S COMPENSATION DECLARATION 1 hereby affirm under Penalty o1'perjury one of the fallowing declarations: - ❑ 1 have and will maintain a Cenificme of Consent to self-insure for Worker's Compensation, as provided 1'nr by Section 37W of the Labor Carle, for the performance of the work for which this Permit is issued. i ❑1 have and will maintain Worl n'.s Cnmpensvtion Insurance,as rtquord ey Section 37M of the Labor Codd,for the performance of the work for which this Permit is - issued:My Worker's Compensation insurance came,and Policy number are: .. "' 1 .t . rat .,.�. . .. .... Cants -r: t(':Policy No - - 'I CEIT1�FICATION OF E%EMPOON FROMWORKERS( L1 '�' rk.�r. h COMPENSATION INSURANCE" nFi.. rfis sea an need no be completed if the permit is for ox hundred dolls ,. f•. . . ' ..I .: . .".. .... r 1 ceM,I that in theperformance nyance work for dons,object t or J I .hhll not cmPloy any personnn anY manner so as to become- b)at to the Workers - "" - _ "' - "'s•` --__ _. _... .. .. ..." Conircmmioh Laws of California.,Date - - .. 'Applicant- NOTICE TO APPLICAN I.IL afrer making his Cenifieme of Exemption,you should become subject m the Workei s Compensation provi.ions of the labor Code,you..at Q forthwith comply with such previsions or this permit shall h deemed revoked. -; CONSTRUCTION LENDING AGENCY, a.> 1 hereby affirm that then is a cons taction lending agency for the perfommnm of the work for wn ch his promi is i.sued(Sc6.309] Civ C) � 0' L'e"Jcr's Name A. .._. ... .. .!n ' ._.... .... . __..__._....._ '-. - __._.. ..._.._ ._ ... ...... .... ... Le .D;Z nticr'a Address 'V-C) Ianiry ihmlhave and this application vnd state shut the above infotmmion is W.E. Goner,1,ague to cep,dy with.11 city and county ordinances and state lawn relining O C.) to building constriction.and hcieby authorise representatives ofthis city to enter upon Lr] the above-mentioned property for inspection puipous. y: UMO agree tattoo,indemnifyind keep hmmless CW the City of Culirman against /f_ilt UI/ rteliabilities,judgments,cosm and expemex whichmay in any way accrue malnst,did U Z City in consequence of the from v granting of this per ' ''"- ^' APPLICANT UNDERSTANDS AND WILL COMPLY WITHA1.LNON-PO Issued by: r Date SOURCE REGULATIONS.- y' SignaturP,4fnpprcaocantraen, . .' :' Date'„', Re-roofs HAZARDOUS MATERIALS DISCLOSURE - .”. Wlldic applicant or future buldm8occupant smeorhandle blinarchmaterial Type of Roof-'. .. _ :,..... -• _. _-. . ._ as dkfindd by the Coisdirm Municipal Coar.Chapter 9.12,and the Health and Safety. Code Section 25532(a), N All roofs shall be mtspected,prior to.any,roofing material being installed. - "t Will the pantusccqup t a.epr,-wmeny If a roof is installed without first obtaining aIt inspection;Lagree to remove emit haaardous air contaminants as defined by the Bay Aka Air Quality Management Di,rnda all new materials for inspection..Applicant understands and will comply with ❑Y 13 No all"non-point source_ regulations:,•. hese'rcud the hrecolds Immen. .,armments ontl Chapter 6.95 of the California HealthA,Safety Cade.Sections 25505.25533 and 25534.1 undemand that. - if the building does not cunemly have a tenant.that it is myrcsponsibility to notify the opum of the rcquimearmi which nmst be me,prior io issu..re oro Certificate of a cc° apo"`y Signature of Applicant Date Owner or amhnd,ea ager:, - rare All roof coverings to be Class "B" or better -.� - - OFFICE.