02100169 (2) CITY OF CUPER'I'INO
BUILDING DIVISION PERMIT ;CONTRACTOR INFORMATION:I
BUIGP01110111RESPARK CIRCLE EAST JUST WATER HEATERS INC PERMrrNO2100169
owBi1,Iss1dPE& PAT TSAI 1764 NATIONAL AVE APPLIcnrll)tD5 B214T.2002
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ZONE: SANITARY NO. CONTROL NO.
ARCHI'JECTIENGINRER: BUILDING PERMIT INFO
RLDG ELECT PLUMB MEET
0 0 0 0
w00 LICENSED CONTRACTOR'S DECLARATION
�I, Ihereby affirm Out l am licensed under pro,isitmaof Chaptcr a(c,mm..em, REPLACE WATER .� � rglj�q�LE®
with Sccoon 700(A of Division 3 of the Business and PrnfcasionsCwle,and my license is -P"i�V
Z. inm11huseandeffect. (75 GALLON)
Date cGlxaa Liem DEC 0 3'2002
oZ—° Dam Lic.# nr
,� ARCHITECT'S DECLARATION
sSy¢a I understand my plans shall be used as public mcoNs
3LLr LicenuJl'mfcssinnzd BUILDING
FLL°� OWNER-BUILDER DECLARATION
�yy I hereby alarm that I am exempt from Bat Contractor's License law for the
w 6 C 0 following reason.(Section 701.5.Business and Prafesxions Code:Any city or county
`X m which requires a p nand it)construct.alcor.improve.demolish,or repair any abortion, $1259
ZZsprion,its issuance,also requires the applicant lnrsuch petmiuo File a.vigned.amemenl
thalheislicensed pumuanftolMprnvisinnsoflhe ConlnclorSL,cense l.aw(CbaprerY Sq. Ft. Floor Area Valuation
cam° anmmnaemgwllhsrrdan7lxgll,Orvislon3oftheBu.sinessand prafca.ionsCare)(it 36932007 . 00
cat_
$ that W Is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a armor subjects the applicant to a civil Penally of APN Number Occupancy Type
not emrethan r.<handmd dollars($900). 502 — FINAL PLUMBI G ENERGY
❑ I.as owner of the property.or my employees with wages as their side compensation, S06 GAS
will do the work,and the stmnure is not intended or offered for sale(See.70,14,Business
and Professions Codi Tlm Con racmrs License Law does not apply to an owner of 507 — FINAL YteeW'jScj J�Uections
property who builds or improves purcon,and who doessrch work himself or through his
awn emplawcs,provided that arch improvements we nal intended or offered for sale.If,
however the building or improvemern is sold within one year of completion,the ownmr
builder will have the burden of proving Nal he did not Wild or improve for purpose of
sale.).
[D 1,as owner of the progeny,am exclusively conning with licensed contractors to
consumer the project(See.TW4,Business and Professions Code:)The Commerce's Li-
cense Law docs not apply m an owner of property who Wilds or improves Iham on.and
who contracts for such pmjem,with a contractors)licensed pursuant to the Comm ctor'a
License Lnw.
❑ l am exempt under Sm. ,B&P C for this reser
OwnetDale '
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally or perjury one of the following decdaratioos:
I have and will maintain a Cenilcate of Consent m self insure for Worker'sCompen-
sation,as provided for by Section 3701 of the Labor Code,for the performance of the
work for which Nis Peoria is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
3710 of the labor Code,far the Performance of the work for which this permit is issued.
My Worker's Compensation Insumrce canier and Policy number art:
Carver Policy Na.:
CERTIFICATE OP EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This.cnion need not be completed II the permit Is for onchundred dollars(SIM)
less.)
I mainly that in the performance of the work for which this permit is issued,I shall not
employ any person any manner so as it) subject Become subjeco the Workcri Compensation
laws of Cal ifomia!Dale
Applicant
NOTICE TO k r after making Nis visio.ate of Exemption,you should
must V
NOTICE
C TO APPLICANT.to the Worker's Compensation provisions le the Loden Code.,you mus
0 ,Z, forthwith comply With such provisions or this permit shall N deemed mvoked. /
zO CONSTRUCTION LENDING AGENCY
l.. N. I hereby affirm Nal there is a isnswnion lending agency fit the performance of
�i 7 the work for which this pe.,I Is issued Ism.3107.Civ.C.)
{!] Q Lender's Name
z lender's Address
U Q 1 mainly Nat I have read this application and ante But the above information is
G. P conect.1 agree of comply with all city and county ordinances and state laws relating to
QU building concoction,and hereby authorirs representatives of this city,,carrupon the .
wovomcminncd property for inspectom purposes.
(We)agree to saw,indemnify and keep harmless the City of Cupertino against
HN liabilities.judgments,costa and expenses which may in any way amen,againslsaid City
U z in consequence of the granting of this Permit.
r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by: Date
SOURCE REGULATIONS.
RC-TOOTS
Signature of ApplicaDate.
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WilltheteCuranlor future building occupantstore nr handle Health, malarial
a de0ncd by the Cupeninn Municipal CIWc,Chapter 9.12,and the Health and Safety
code,Seca,,25532(a)P All roofs shall be inspected prior to any roofing material being installed.
�Vcs ONO
Will the applicant nr(.thre buildingnccupanl sex mutinied,ordcviccx which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as dcfincd by the Bay Arca Air Quality Management all new materials for inspection.
Dimrict7
El Yes ❑No
1 have read the lba.vb us noacnals requiremrnks under Chapter 695 of the Caldor
nix IIcahn&Stan,Code Sections 25515.25533 am125534.1 understand Ihd if the budding
does not cumnlly have a tenant.Nat it Is my responsibility In and ly the rtcupant of the
requirement.which Muanemet prior toisuanceofacenmcateofOccupancy. Signature of Applicant Date
owner or arm,rbed agent nate All roof coverings to be Class"B" or better