00080066 (2) CITY OF CUPERTINO ' ++' PERMITNO.
BUILDING DIVISION PERMIT CONTRACTONF
RIORMATION:
BUILDING ADDRESS:
SANITARY NO. AI'PLICATIONSUBMnTAL DAI
JUST WATER HEATS S INC 0 .08@066
OWNER'S NAME:
NIC CONTROLM
PEON-: 1764 NATIONAL AVE 08/09/2000
ARCHITECIFIENGINEER (510) 293-9901 IULDING PERMIT INFO
wU
y- y LICENSED CONTRACTOR'S DECLARATION
oi=0 1 hereby affirm Ws 1 ns Ikeivd under provisions of Chapter 9(conwiercing Job Description
F==w wi6Section70110)ofNvision3ofrbe Busimssad Professions 'cemea
< 7 in full face an 1[�Sfn 1� m
X0 o = �8—c�u.m REPLACE 40 GALLON WATER HEATER
F u O¢ ARCHTfEC on DECLARATION
QJ� 1 understand my pWs"I be used as public records
i a oz Licensed!Professional
u'f R y OWNER-BUILDER DECLARATION
t 6 1 hereby^Rem that 1 ma exempt from Ne Cmuraemeb License Law for the -
O following mason.(Section 7031.5.Business and Profexamas Code:Any city or county
i. $ which melanin a permit to countries,Whet.improve.demolish,or iepaie my awnme S FL Floor Area Valuation
3_ prig so ata iseuarce,Jso require the applicam fw such permitmBleaaigned sirq'
Nat he is licensed pursuant to the Provisions of the Crnaawots License law(Clapua9
(commencing with Section 7")of Division 3 of the Business end Profcssiao Code)or APN Number OccupancyT 732
Ws he is exempt therefrom and No Wait for the Wkgd exemption.Any violem.of SIP
Section 7031.5 by any applicant par.permit ml facts the applicant toe civil penalty Of
of mos than rive Windmill dollar 1$500).
❑ I,uowrwo(thepropeny.wmYemplaysswithwagauthairwlccompesaatian. 316380th%_ eGlInspections
will doth.work.ad Nc avucwrc is ret imcded w oRcrd la We(Ss.1061,Bualrcas
and Piefmsims Cade:The Cmeractwi License law dart tar apply m an owner W
proper,who buildsw improves doormat,and who does each work himself Or through S@2 — FINAL PLUMBING ENERGY
his a employees,providd that such improvements ere not intended de offered fee
We If,however base building w improvement I.sold within One yearaf completion,the 506 — GAS TEST
owner-builder will have the burden of proving Nat IN,did nor Wild Or improve fee pur-
poseafsdis,due 507 — FINAL PLUMBIN
❑I,as owner,of the property,ant exclusively contracting with licensed wnvacton to
conevuct the project(Sec.7(N6,Busmen and property
who Professional Cede:)The es tasstor'a W-
whocerevaclow decoam r such
to an owner m iscoiny tubo Wilds n improves Norton,and Y
Lomas,contracts for such projwa with acontnnar(a)lisnrd punuaw to the Contrssmh 45 O
L ttnu law.
❑here exempt uder5ec. .B&PCfee this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
• 1 hereby M.under penalty of perjury one of the following decimations:
Ihave aro will of
fbynetion 37 eofConsortr ode.for is Woekera GO Of
cation,is provided fPe mi Section 3700 of tha Labor Coke,for Ne perfomarce of thio
w rk for which this
permit is mord.
see and will Permit
Worteh Compensation Imuraiwc,u rtquirt0 by Session
tp Of the Iabwcde,fw the performance of the work fee which this permit Is Maud.
Myn.rai�ptpy� iron certinPoldY Noynj �!a
G.der�
CERTIFlCATEOPSAIRONI 1NFROM WORKERS'
COMPENSATION NSURANCE '
This union radna W complesd ifthie permitis fwone hundred dollars(3100)
on
less.)
I.miny that in thepream, f th
oewwkforwhichthis Weis issued,Ishill
rm
ata employ any pes in myy m nor m m become m
as ecombjam the t the Waekub'Compere
rasion laws of Conforms.Date en
Applicant
NOTICE IV APPLICANT:IL afar malting this Ci6mes o of Ex W1 Co,you;bould
became subject y the Weaker,Pro Coons or
is previsions of the ImWe Coke,you muss
forthwith comply with such provisions or this permit shall W dimmed!rtvokd.
CONSTRUCTION LENDING AGENCY
Q 1 tnsby,pmt tlw these iso construction lending aentcY Native pedwrwttt of
z ^ the wool,for which this permit is Issued(See.3097.Civ.C.)
F., Lcdcla Name .
a, lender';Address
I certify that 1 have read thus application and state that the above information is
z
7
5 z Correct.l ages to comply with" erd county ordwncn andwe laws slating to
Wildin;conetruction.and hereby eurneem.iepteamoi vsof this city on enter upon Ne
U C) above-mmsianed peopeny for inspection Wrposes.
ts. (,,, (We)iters 10 save.indemnify and ksp bamileas the City of Cupertino against
Q U liebmlihien,jdgnems,ante and expenses which may in my way accrue against said City
>n W in consquercc of Ne granting of this pc—it
[� d APPLICANT UNDERS" NUYAND WILL COMPLI'WIl'H ALL NON-POINT
V 7 SOURCP.RI'UL1TR /,O
Sig Appli JC coot Date
.ARDOUS MATERIALS DISCLOSURE
WillNe epplicmtorfutum WildinSoce part Hort orhmdle hmadous material RC-roofs
az defined by she Cupedno Municipal Code.Chapter 9.12,end the Ha ds erd s cry Type of Roof
Coke
Cods.Sedan 25532(11)1 YP
CYea ON.
Will the applicant or future budding ocmpam um equipment or devices which All roofs shall be inspected prior to any roofing material being
emit henrdous an contaminants as defi.W by the Bay Arc.Ah Quality Management installed. If a roof is installed without first obtaining an inspection
Dierks? I aree to remove all new materials for inspection. Applicant
❑Yes ❑No
Ihave mad thd
eh.>aaconsensus under un erstands and will comply with all non point source regulations.
Health&Safety code,Settlors 25",23533 and 35536.1 understand Nat if the
building does nm cuieently hav semm,d n n is my responsibility m swify Ne occupant
o L Ic ren nor.......am.cmificnaof Osedpan,
Signature of Applicant Date
tTw ad a oa
All roof coverings to be Class`B"or better
OFFICE .