00100227 (2)CITY OF CUPERTINO
DUD_DING DIVISION PERMIT CONTRACTOR INFORMATION:
I BUILDINGADRll4lS:,5 PARKSIDE LA I HOT WATER' INC IPERMITNO.ID0100=27 I
OWNER'S NAME:
LIANG MAYLING
PHONE:
2531. GRACELAND AVE
(650)298-8494
IIN SIZE DATE
10/31/2000
NO. CONTROL NO.
ARCIIITECTIIiNGINBIiN: I µLQ IWII .DING I`'RM511INFO
RI.FCI MI_I
I-IC17NSED CONTRACTOR'S DECLARATION
I hereby abrin that I am licensed under prevision. of Chapter 9 (commencing
with Section 7(XXE of Division 3 of the Business and Profession, Cade, and my license
Lin full fora and effort.
iccme Class Lick
[la, Convenor
ARCHIF]'C'r'S DECLARATION
I underewnd my plate shall be used m' puhlie record,
Licensed Professional
OWNER -BUILDER DECLARATION
I hcrehy Indictor that I am '¢ nip, from the Contractor's License Law for the
following mason. (Section 7031.5. Business and Professions Cade Any city nr county
which requires a Tarrant to convect, alter. improve, demolish. or repair any "trvetum
prior to in issuance, also ryuim, the applicant for such pamniuo file a signed our ememl
n han he is limm,.I ps,o,ane I,, he pre sof the Commebn's 1.'a
mn, I.aw(Chapter 9
vision:
(communing with Section therefrom
Imofhe ha is 34 the Business and Prohxny vi Gdc)
or thatheis 5 Th zany applicant
and the kava for the alleged exemption. Any violation
of Section 7ohan v any applicant for a p,nnit subjects the applicant m a civil penalty
of not mom Than five hundreJ dollars (SSW).
❑ 1, asr of the property. n my employees with wages as their sale compensation.
will doethe work, and the ewcrose is not intended ser offered far sale (Sec. 7()W.
Business and Professions Cada The Contractor's License Law dna,, not apply to an
r of property Who builds or improves thereon, and who docs such wort: himself
owner
his non entpbyces., pmvnded that ,Lich improvememu am not intended or
offered lar .sale. Jr. however the building or improvement is sold wlllin one year of
impletion, the owner-huimer will have the human of proving that he did not build or
improve for p,ryme of salol
p 1, a,, mmus, of the property as exvImimly common, with licensed cimricvrm m
,muacn the pmjcn (Sec 7foll Business and Professions Cadcp 'Ilse Contractor's
Li came Law drcs nal apply to an owner mf propcmy who builds or improves baseen.
and who contracs, far such projects wlnh v sintracmr(sl licmunl pennant m the
Conuactors Licenso Law,
C,I nn+ exempt ,coder Sec. . II & P C far this mason
Owner Date
WOR KF.R'S COMPENSATION DECLARATION
1 hereby aftm+ under penalty of perjury one of the following declarations
❑ 1 hove and wise n bolos a Cri inCale of Caawar m srlsin,arx for Worker',
Contpetnation, :Is provided To, by Sotlmn 3700 or tl, Labor Coda for II+e
(Performance at work for which this Nom+it is i ... ad. _
❑ 1 have and will moinmin Work,,', Compem:aion Insurance, as marmot by Section
37W of the Labor Gde, for the pefrormince of the work for which this permit is
issued. My Worker's Conipenvtion Insurance carrier and Policy further art:
Carrier: Policy No
CERr119CATION OF CXEM 1'f ION FROM WOR K 17RS
COMPENSA'T'ION INSURANCE
('Ibis seen I Lived nm be completed if the permit is for one hundred dollars
($110) or has.)
1 artily, that in the performance of the work for which this Permit is issued. I
shall not employ any Person in any member so a,, to become subjects to the Worsen
Cmeba lion Laws of California. Dale
Applicant
NOTICE TO APPLICANT: If, after making IhN Cenibea, of 11' ,upse. yen should
becamesubject no the Workers C... "a'atlnn oro of the l.abmr Cole. you as
visite+,,
finnwiln eennnply w'tro,acn provi,innx or Ibis unit hall be, deemed reeeked.
CONSTRUCTION LENDING AGENCY
I Worry afirin that dare is a nomvuctinn lending agency fill the petfommnce
of the work for which this permit is issued (.tier. 3097. Civ. C.)
Lender's Name
Leader's Address
I'roily That I Luer mad Ili,, upplimninn and stale that the above information is
contact, I agree m congdy with all city and sourly ordinances and sure laws rcladng
to building construction. and hereby mmbnriee reprmenfatives d this city to enter upon
the abovcmendnned pmpcny for'mspection parposs
(Wo agree loosest. indemnify and keep nameless the City sof Cuper ism against
liabilitics.judgments, costs and expenses which may in any may accede against said
CityinCANT gracing oftuipe CO
APPLICANT' UNDERSTANDS REGULATIONS. AND WILL COMPLY WITH ALO. NON POINT
SOURCE REGULA'fl(INg. '
Siguatera ter AppLemtVConlrann Date
HAZARDOUS MATERIALS DISCLOSURE,
Will the applicant or future landing awcupaal store or handle hx,,sml material
as defined by the Cupertino Menicip:) Cade. Chapter 9.12. and the Health and Safety
Gde, Section 25532007
❑Yes El No
Will The applicant nr fate. h ulding occasion use e9nipawin or devices which
mil haroloi,sir...mmbtin:nns m all by lm [say Are, An Quality Mena,a art
District!
❑Yes Cl No
I have mad the haeamnve materials requirements under Chapter 6.95 of the
California Health k Safe,, Cope. Section, 25505.25533 mal 25534, 1 mdordwnd lel
if the building docs not cumndy have a mtmnl, that it is my re,pnnsihiliry, to notify the
occupant of the requirements nmch muse be trial prior to issuance of a Certifiable of
Occupancy.
owner or auto 'ad apart Dae
Issued
Re -roofs
Type of Roof
Job Description
REPLACE 75 GALLON WATER HEATER
36904053.00
Required Inspections
502 — FINAL PLUMBING ENERGY
506 — GAS TEST
507 — FINAL PLUMBING
Date
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection. Applicant understands and will comply with
all non -point source regulations.
Signature of Applicant Date
All roof coverings to be Class `B+' or better
OFFICE