01010100 (2) CI'FY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING A DDRESS'. - PERMITNO.
10410 NORWICH AV JUST WATER HEATERS INC 01010100
OWNER'S NAME: Aj'1'LICA'rION SLID DATA
BIELEFELD JOHN J AND P ISCILLA 1764 NATIONAL AVE 01/23/2001
PHONE: SANITARY NO. CONTROL NO,
(510) 293-9901
0 ARCHITECT[ENUWEIR: BUILDING PERSH I'INFO
BLIK ELECT, PLUMB MECH
Sv LICENSED that IDCONTRACTOR'S DEionsof haps[ON Job DCSQIpIIOn
g _o henbr 1 lug, I am heea,nd under Provision.of Chapter n(commenting
her,
set with full Luya(red en Divtsinn3nlrhe lLulncx,and Prnl'essumr Co.lc,and my limns
�y ix inwuhtreeandamet. RELACE 40 GALLON GAS WATER HEATER
s ¢ License CI;ca Li,e
O a O Ilse Contractor
a LLO n ARCIIITI!CI"s I)EC1.ARA'riov '
F•-y; I u idetaand mY pl:ms shall ren.nl a,Public recr.rd.
wee
p 00 Licensed P ore„ional
Ha z OWNER-BU11DliR DECLARATION
='w I hereby affirm that I nm cncngn oars the Commcmr'.a License Law lin the
C%G Ittllowins n t.(Sat'i....7(q IS.Itu1t red 1'1111111 tx SLde:Any ell,a uvy
axut tit '1121,1 ice r..c
4c
which iquiresae.also Inpinn%thepplicimfor such
permit t nrrepairany surucmm
a 3= 'bar It y (c pp1 a II hie permitLsigned.Chapter cul
(came I'ag JP a u Ib p . fah t t ine L la ode) Sy. FL Floor Area Valuation
Isom g lhScri 710X1) all n 1 If, B . IProfession,cor... $7^cB
r that he, 5 by err den and rhe t a ming three cgul a tot m.A v o W ion
of Section a ber. v any applicant ddl fur a perrnit suhjecu rhe nPPlicam m a civil Penalty
of......n(can E.�e n1[tarea eonan(s500). APN Number Occupancy Type
❑L,a,owner of he pr11Petty.m my entplover,wide wages as dreir,ale enntremadon, .31629100. 00
will do the walk.and the,tractate is not intended n.agitator ILr tale(see 71W4,
Ramex.and Profession,Cade:The Cantron',License Law tees nor appy m an Required Inspections
orr of pmi Who builds ii,improve,treating.and who does such wad.himself 502 — FINAL PLUMBING ENERGY .
through his own employees.provided that such improvements ate not intended or
offend for sale.If,however.the buildittg or intprovemem is,old within one year of. 506 — GAS TEST
inunpletimt lire nwric,laulder will Inns the burden of Pn liug loon lie did ran ladid or .
almos frtr PaHaole"I'de.). 507 — FINAL PLUMBING
❑1,as owner(if the properly,am exclusively connnming with licensed contractors m
Lndmcr the proj,ct(See 7ylL lit, and It tat, s Code,The Conran ur'x
icewe law doe.not apply ,,an owner of prnlwny who build,or intprnvcs thereon.
and who coomwo,for such limpets with a ennrni licensed pursuant to the
Conti ctn.'s License Law.
❑lam exempt under Sec. ,Ll k P C for this noon
Owner Dane
WORKER'S COMPPNSATLON DECLARA'I ION
I hereby nfhnn Order pettily of pc,jury ane of he followin,dedumtian,: O/
f7 I have and will urainralo a Cel d,na,of Consent as 1clbin.mrc lin Worker
m 's ^
Compensation, as prided for by Section ?7ql of the Lalwr Code, for the V
performance of the work for which this permit is issued. /
❑1 have aced will nwintain Worked,Campcnxndun Lnsuntnce,as reyuind by Section ,
37110.1 the lalaa Code.lin the perlimnan,,ret ms woo is,which his pamth is
teed My W..kc,Compensation Imunnce r Brier and Pahey namhcr arc:
Canner: PolicyNn:
CI?RTI IICA'I DON OF HXEMVI ION FROM WORKERS'
COMPENSSI ION INSURANCE
(Thi,scnion need Col Me cnmPlced if the permit i,Ibr one hundred dollars -
o100)orlcned
I coni fy that in the perfnmwnce of the work or which this permit is issued,L
shall not employ any person in any toaster sat as to became subject go the Workers'
ComPemaliun Laws of California.Done
Aptui, I
No DCP T(I APPLICAN 1:If,aIle.tulkln,anis C•enincare or Hsengnion,)tie should
become subject to Ilse Workers Compensation provision,of am labor Code.you must
Q Q forthwith comply with such Provisions nn he,firman shall be domed revoked.
^ CONS'FRUC'I'ION LEN DI NO AGENCY
tl ' 1 hereby a1Rnn that there is u onxwclu leading,agency far the Iedinda uce
of rhe work Ing which this permit is issued(Sec.YXD.Civ.C.)
L Q Isnder'x Name
Z Lender's Aides,
U Q 1 unity that I have read this apolicadon and,tate that rhe.bolc infuriation is
cored.1 agree to comply with all city and county aNinances and state laws relating
Q C.1 as building contraction,and hereby mahorize representatives of(cit city to enter upon
r ill, h,,c.nmatlnned prnpeny Itnmpecl a purpose'
y (Wu)agneln,ttvl.ind,7nnit, ,keep lnno1c"doe City of Clpuntm,a,uitt.l
ZI liabilities,juditrem,211,11 and expen.ws which may in any way accrue amell said
U "!_ City in ctmmyuence oI he granting of this pe emit.
OURICANTU NDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S
Signal of Appdcanecomrac or Date Re-roofs
HAZARDOUS MAFERIAIS DISCLOSURE
Will the applicant or future Molding rmcupant sone or handle hmaamm maredal Type of Roof ,
as deposit by life Cupmline Municipal Code Chains,9.12,and the IL AL trod Sadny
Code.Section 2553200"
0 Yes 0N All roofs shall be inspected prior to any roofing material being installed.
Will Ithe ampbettnorfar arebnildin,occupantuse clojunentatits ices which If a roof is installed without first obtaining an inspection, 1 agree to remove
null hamnlous it c11ntunlnand at dined by the Buy Area An Qr.11lty M:ma,antma
Owren all new materials for inspection. Applicant understands and will comply with
ones 0N all non-point source regulations.
1 be c read the h:vardous tnutcrial.rey.iommmtl mulct Chapter 6.95 it rile
C:dilontin Health N Salcy Code,Sections 25505.25533 ill 25534.1 r detxwnd that
if the building duet not currently have a latent that it is my respmlibilily It utility the
ecult nl of the yuimmenls which[trust he met prior Bs issuance of a Cenircalt 111
Occupant, Signature of Applicant Date
Owere"nottonealagent Dare All roof coverings to be Class"I3" or better
OFFICE