02070037 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT rCONTRACT(.1"NFORMA ION: Iran
BUILDINGADDRESS: JUST WATER HEATERS INC P
7720 OROGRANDE PL 02070037
NER'S NAME: 1764 NATIONAL AVE APPLICATION SUB DATE
W
PETERSCHMIDT GREG A AND KAAR N 07/05/2002
ONE: (510) 293-9901 SANITARY NO. CONTROL NO.
ARCHITF.0(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�00 LICENSED CONTRACTOR'S DECLARATION Job Description
U I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing p
; with Seat..7010)of Division 3 of me Business and Professions Code,and my license is
, I.fall to.add effect. REPLACE WATER HEATER.
F?F �? License Class Lic.If
-o Dale Contractor (50 GALLON GAS)
QQ ARCHITECTS DECLARATION
1 understand my plans shall be used as public records
KOyU
Tu3u.� Licensed Professional
OWNER-BUILDER DECLARATIONCom
y 1 hereby affirm that 1 em exempt thept from the Common's License law for the
i a n 0 following reason.(Section 703 1.5.Business and Professions Cale:Any city or county
$� which requires a permit to crmsuucl,alter,improve,demolish,or repair any sound.
F f}^ prior u)its issuance,also requires the applicant orsuch permit in file a signed statement
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that he islicenseJpursuaminthepetvisionsofineConnector'aLicenselaw,(Chapter9 Sq. Ft. Floor Area Valuation
�F$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $250(](](]
�.. Nat he u exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant fora Permit subjects the applicant o a civil penally of APN Number Occupancy Type
not mom than five hundred dollars($500). 36218029 . 00
I,as owner ofthe propeny,or my employees with wages as their sole compensation,
will do the work.and me structure is not intended oraRered forsele(Sce.7044.Business an�eQW�µ,,yariajl$p C�pn$
and Professions Cade:The Connector's License Law does not apply to an owner of 502 — FINAL ft V Iv1D 1 LV e OR 2RGY
property who builds orimprows,thereon,aodwho doessuch work himselfortheaugh his
own employees,provided mat such improvements an not intended oroRered Aureate.If, 506 — GAS TEST
however.the building ar improvement is said within one year of completion.Ne owner-
builder will have due burden of proving mat M did not build or improve for purpose of 507 - FINAL PLUMBING
sale.).
❑1,as owner of me property,am exclusively contracting with licensed contractors to 10
construct Ne project(Sec.7(WL Rm.moss end Porfessiona Code:)The Contractor's Li-
cense Lew does no apply to an Owner of property who Wilds ser improves Nereon,'mtl
who contracts for such projects with a commends)licensed pursuant to N'Contmcmrs'' O,
License Law. Qty l -rye AVS
❑ Ism exempt under Sec. ,B&PCry this reason
ncr Dames t a v
WORKER'S COMPENSATION DECLARATION , k
1 hereby afford under penalty of perjury one of The following decl
❑1 hawked will maintain a Certificate of Consent m self-insure ferWinflin aCompcn-
sation,as provided for by Section 37M of the Labor Code,for me performance of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as required by Section
370 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number on
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
TThu section need not be completed if The permit is formic hundred dollars($100)
or less.)
I certify that in The performance of Ne work for which this Permit is issued,I shall not
employ any person in any manner sac as In become subject to The Workers'Compensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:If,after making this Certilicam or Exemption,you should
become subject to the Worker's Compensation previsions of the LeMv Code,you must
OO fnthwim comply with such provisions or this permit shall be deemed mvnkcd.
z M CONSTRUCTION LENDING AGENCY
[-. 1 hereby affirm Nat there is a Conswction lending agency for me Performance of
ai 7 The work for which this permit is issued(Sec.3097,Co.C.)
W QUnder'a Name
� z Lender's Address
V 0 1 certify Nal I have read this application and stee,that the above information is
W (~ correct.1 agree to comply with all city and county me inances and ata.laws relating to
DU building construction,and hereby authnrive representatives of mis city.enter upmn the
W above-mentioned property for inspection purposes.
G (We)agate,In save,indemnify and keep harmless the City of Cupertino against
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liabilities,judgments,costs and expenses which may in any way accm,against mid City
in consequence of me granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of APplicaDO Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant or future building occupant earn or handle Health and Safer l
as defined by the Cupertino Municipal Cnde,Chapter 9.12,and the Health and Safety
Cnde,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes ❑No
Will the applicant or future building occupant use equipment or devices which If a roof Is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as deaned by the Bay Arca Air Quality Management all new materials for inspection.
District?
[:1Yes E]No
1 have read The harardnus materials requircmcros under Chapter 6.95 of on Califmr-
maHealth&Safety Cale,Sections 25505,25533 and 25534.1 understand mat if Ne building
does not currently have a tenant.Nal it is my responsibility to ready The occupant of the
re,dremeros which most M met pnonoearn..nI a CCNncam of Occupancy, Signature Of Applicant Date
Owner tar anthmrised agent Dam All roof coverings to be Class "B" or better