03030039 (2)CITY OF CUPERTINO
!CONTRACTQ,R`'INFORM
BUILDING DIVISION PERMIT
n
BUILDING ADDRESS:
JUST WATER HEATERS INC'
PERMITNO.
OWNER'S NAME:
PAUL MARrT4
1764 NATIONAL AVE
E`
(510)293-9901
SANITARY NO. MOL NO.
ARCHITT=IENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 bemby affirm that l am licensed under provisions of Chapter 9 (commenting
With Section 7M)) tuoheidon 3rf NC Business and Professions Code, and my license is
F� IV AI_ED
in full
class and erten LIe.♦
REPLACE WATER HEATER ,Y G
Dam Contractor
ARCHITECTS DECLARATION
(4 0 GALLON GAS)
AUG4 2003
1 understand my plans.ball he used u public mcorda
,7
BUILDING
Licensed Pntfesinnal
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from tiro Contractor's License law for the
following mason (Section 7031.5, Business and Professions Code: Any city or county
Which ".I.. A permit to most rucL .her. Improve, dmudixh, or repair any strucmm
PH., Ill its Ifs...CC..a. requires the applicant for such parch t0 file a signed uammCnl
that he is licensed pursuant c the provision. of the Contractor', License LAW (Chapter 9
SLI. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 or the B.smassand Prolmhout Code).
Net he Isexempt usemfrom and Ne buts for the alleged eaemp 1. Any A.lation of
AIAN Number
Occupancy Type
Section 7031.5 by any Applicant for a permit subjects Ne Applicant to A CIA] penalty of
Am mom Nen five hundred dollen ($SWk
❑ I, u sewer of the properly, m my employcea with wages a Heir sele wmPewdon.
36220011.00
Required Inspections
q P
will do the w.,L.nd Neawclum ts noUntended oroQered formic (Sec. 7Wl, Business
and Profession, Code: The Conuactort License Law dors set apply to in owner of
pmpenywho buildaor impmws thereon, and whodues suchworkhimselforthrough his
502 - FINAL PLUMBING ENERGY
Own employee., pmAded that such improvements are not intended trachoma for sale. It.
SO6 — GAS TEST
however, the building or improwment is sold within one yew of completion. to owner.
builder will haw Ne burden of proving that he did not build or Improve fur purpose of
507 - FINAL PLUMBING
ulc3.
❑ 1. as owner of Ne properly, am exclusively contracting with licensed contractors to
-
construct the pmjCCt (Sac"7W4. Business and Rolaslars Code:) no Contractors Ll -
mote Law don, not apply Ir an ownm of property who builds or improves Nemon, and
who contracts fm such p ajecu with a eontractor(0 licensed pursuant to the Contactors
Liccn,e Law.
0 I see exempt under Sec . B& P C for this moon
-
Owner Data
WORKER'S COMPENSATIDNOECLARATION
I hereby a@rm under penalty of perjury oro Of the following daclAntkat.
.
haveand will maintain a CCrOEn,te of Consent to self -insure for Worker's Compen.
'.tion. u provided for by Section ]700 of Ne labor Cade, fm the performance of the
-
work for which this permit L Issued.
1 have and will maintain Womeri Compensation Insunnm, u required by Section
3700 of Ne labor Code. for the performance of Ne work for which this permit is issued.
My Workers Compensation Insurance carnes and Polity number am:
Cartier: 'Policy No.:
CERTIFICATE OF EXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not howmpleted I(Ibe pesmh is for one hundred dollws($100)
nr ICAL)
- I certify that in the performance of the work for which this permit Is issued. I shall not-
emptoy any pcnon in any mannerso as4l become subject to the Workers' Compeoution
Laws of California. Data
Applicant
NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you should
become subject to the Worker's Compensation previsions of Ne labor Code, you must
forthwith comply with such provisions or this permit shall be deemed mvoked.
i
CONSTRUCTION LENDING AGENCY
I henhy Art. that Nen les coutrmfon lending agency for den performance of
Here murk for which this permit is issued (Sm. 3097. Civ. Cd
Lamun'.Name
Lcndeh Address
.`t�/_1./'I(I` U`1•V��—
/-j'/ -
1 certify that 1 have read this application and sues Nat Ne above Information is
Il V
COrtCR I agree to comply with all city and county ordinances and Nle laws ne.dng to
building construction, And hereby authorise mprucnlatiwa of this city to enter upon Nc
l above-mentioned pmperly for inspection proposes.
(WC) agree to save, indemnify and keep hwmlew the City of Cupertino against
j liabilities judgments. cosh and expenses which may in any way .Came against aid City
in i
APPLICANT UNDEanco of -the RSTANDS AND DS WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS,
Re -roofs
Type of Roof
Signature of Applicanl/Conuaclor Dem
HAZARDOUS MATERIALS DISCLOSURE
Will Ote applicant or future building Occupant Nm or handle harsrdous material
As denned by the Cupertino Municipal Code, Chapter 9.12. and the Health and Safety
da. Section 25532(a)?
All roofs shall be inspected prior to any roofing material being installed.
❑Yes 0 N
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building Occupant use equipment or devices which
It hrarri air contaminants u dellned by the Bay Ares Air Quality Management
all new materials for inspection.
❑Yes ❑Nn1
I,—C-,wner
have read Ne hnardmumaterialsmquimmems under Chspw,6.95 ofNe Calif..
Hcaldo&UfinyCode.S,xdoru255fi5. 25533 and 25531.1 umcrtund NatirNc blding
es not currently haw A tenant. Nal it is my respmuibility les Artily Ne OCCUPanI Of Ne
uirements which must be met prior to issuance of a Certigale of Occupancy.
Signature Of Applicant Date
I All roof coverings to be Class "B" or better
or authorized agent I Data