00080065 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR IN
i'- PERMIT No.
FORMATION-
BUILDING ADDRESS:
SANITARY NO. APPLICATION SUBMITTAL DAT
ll,717j49 NORWICH AV JUST WATER HEATERB INC 01080065
OWN[R'S NAME:
NIC CONTROL«
PHONc, RBARA W 1.764 NATIONAL AVE08/09/2000
ARCIIITECUENGINEER t51.01293-9901 IULDING PERMIT INFO (`-„;,
00
U
LICENSED CONTRACTOR'S DECLARATION
z S rov,'' 1 Wrtbd athrm tNt 1 un liccmcd under pmviaimer of Chawer 9(commeKi.g Job Description
ONe� with Section 70W)ofl ivivon 3 ofthe Business and PorlesooCode.send to,holm,is
<y^'� in Pon force Lq
gown seam las Li=.« REPLACE 40 GALLON WATER HEATER
to 3 u y Date Cono-acm
H a O 3 ARCHITECTS DE ATION
1 understand my plans shall W tad as Public reenacts O
i sS WcensM Profemionel
s
OWNER-BUILDER DECLARATION J
C:'+' 1 hereby dRrm door I sm exempt from The Conmacm/a Loaner Law loo the /1
n—�O following noon.(Section 7031.5.Bounteous W Preftoiom Code:Any city m county ✓✓
iz-very which tequtm a permit d.comtmct.alter,improve,demolish,Or repair my saecou, S FI. Floor Area V' anon
a5— 'norm its iatrnc,ales eegniae the applicant fmsuch pemit W Fla.sigKdmtetKnt q
that he se llunsed pursuant to Ne provisions of the Cmaractote Liom.law(Chapter9 '
(commencing with Satan 7")of Divieion 3 of the Bustmcu and Professions Code)or APN Number Occupancy T
tMt he is eeempt therefrom and the bars.for the alleged exemption.Any violation of P Y
Section 7031.5 by any applicant for a pemdt subjetts the applicant to a civil penalty Of
not mon,than five hundred dollars(5500).
I,as owner of Che p.opens.na my cmplgers with tea{m m the't sole compemdnab 31 F,290&FFUi@@ l nspections
will Bothe work,and tW atucmm is Kt inteodd w Offetd fm sale(Sc.7044,BmiKa
and Professiom Cade:The Contractors License law does ora apply to an Owner d
property who WiLdsorimproves door",soul who does such work himaelforthrough
502 — FINAL PLUMBING ENERGY
his awn employers,provided That such i n rovemenu am not intended a offered for
real..If,however.the Wilding.,fmpoo.ocm is sold within We yearifcOmpldOn,the 506 — GAS TEST
.,,Wilder will have the burden of Proving That he did nm build or improve for Too-
5 07 — FINAL PLUMBING
coLastdo,pofthepropend•se.exnessi am=omo-adng with:i'Biad ,.1&dsi-
answer Ne projeit apply
o ser wnc,of ad Professions Cede:)The Conhorme.nd
cease law cKa ern apply to us with
ar Of protons ace Wilde rr Imptavm Contras or s
who contacts for each pmjaa with a eontrecmr(s)licenad punwm to the Contractors
Licena
1 unnere exemp,undo Sc. .B&P C far this reason
Corner Das
WORI(ER:S COMPENSATION DECLARATION
I berahy affirm under penalty of Perjury,oK of the following dclara,ioK:
O I Wve and wi11 maims!.a Cenificate of C..uwu.wif.insum fm Worker•Compeer
cation,as provided for by Sectio.37W of the Labor Code,for the performance of the
w k for which this permit is issued.
1 have and will maimain Woekefa Compensation Inu ove.u taloned by Section
3 afthe labor Code,lor,he PeHOrmance oftbsud
c work for which toil permit is it .
My Wmke(5[afnp an I urt�c int Ind P ROM u n bf,r•efS 1 n./I
Cartier: Policy No ��J[(rj(�J.t(V_LtL1Ya
C'RTI P SATIONIINN FROM S
COMPENSATION INSURANCE ,
(This action need ora h completed if the pem,it in foronehudred dollen(5100)
na I<a.1
I certify my par j.The in my nu wince doer wink for which this tomtit is saved,l daB
nm employ any person in any manrcr so as IO become vugct 10,W aortas'Compcn-
Ation Laws of California.Date
Applicant
NOTICE TO APPLICANT.If.Compensation m making thio Certificate Of Exemptla d yaa uhaulst
forbvi eubjmt y the Workela 0,TisPermit
mal or the Libor Cede.you moor
foMwith comply with such provision m this perms,aia11 W dared revoked.
CONSTRUCTION LENDING AGENCY
O p I hereby tdfrm tat there is a comtuctiow lending agency far the performance of
wZi ^ the work for which This permit is issued(See.3197.Civ.C.)
PLcndcls Name
a ladee,Addre,s
fy ^Q 1 certify duet 1 have read this application and tate the,the above information is
0. const.I agfc to comply with at[city and county ordinances and saw laws noting an
.7 Z Wilding construction.am,hereby,inaborio,npresrntori,ey of this city to enter upon the'
U O above-mentioned Property for inspection Purpoacs.
R F., (We)agree to save.indemnify and kap harmless the City Of Cupertino against
O U liabilities.judgments,c.sa and expenses which may i n any way eccae against said City
W in consequence of the growing Of Nix permit.
_ S APPLICANT UNDERSTA )SANDWII.LC(IMPI.YWIF"A1.1.NON.11[)INI'
f..) Z SOURCEREGUTAT10N. //y77y ///VI]]]I
'Sigrid rcuf Applic Co m r
H ARDOUSMATERIALSDISCLOSURE
Will the affliction or future Wilding occupant n(ne or handle hazardous material Re-roofs
u dvfiwd by,he Cupertino Municipal Code.Chapter 9.12,and!The Health u,d Safety Type of Roof
Cda.S«6..1553x.)+ YP
Oyer ONo
Will the appliczm or future Wildingfuseequipment or devices which All roofs shall be inspected prior to any roofing material being
«cupsot
Ake
hvadoue air contnmivna mdefind by the Bay Arca Av Quality Mmegcrosm installed. If a roof is installed without first obtaining an inspection
Di,tim7 I agree to remove all new materials for inspection. Applicant
❑Yea C]No
Ih.ven.d the heraraoa.m.adall m9airtmer,a Y.der GhaPrmb.95 nfthe Cal, un erstands and will comply with all non point source regulations.
fnanu notho d Safery code.Semmen,15585,15533 sued 15534.1 understand this,if the
Wildin,domnctorme t veaawm.,lutitilmyrtspmuibiliryronaiytheoccupmt
of i Ke of a Cer ifiva, Ove y.
Signature of Applicant Date
Owner ro gemI Dom
All roof coverings to be Class"B"or better
OFFICE