01080116 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS, PERMIT NO.
20296 PINNTAGE PY JUST WATER HEATERS INC 01080116
OWNER'S NAME: APPLICATION SUB DATE
CORCORAN SHARON M 1764 NATIONAL AVE 08/23/2001
PHONE: SANITARY NO, CONTROL NO.
(510) 293-9901
C O ARCHITECT/FiNG1NEER: BUILDING PERMIT INFO
k U BLDG ELECT PLUMB MECH
a i L] 1=.I 1--i1=
LICENSED CONTRACTOR'S DECLARATION
i 5''= I nem f m1 fb,,[.in licensed and, - f Chapter 9lrommenem Job Description
'v_-; wit Swim.7001 Division 3ofthe Business and�Profession,Code.and mylicense REPLACE WATER HEATER
in full force and effect.
c z a Lieense Class Lic.N
:O c U Date' Contractor
'3�G ARCHITECT'S DECLARATION
zz0< 1 understand my plans Shull be used as public records
to
ip p Licensed Professional
eLL OWNER-BUILDER DECLARATION
I I hereby aBlrm Ih l 1 am exempt hounds,Conwclor's License Law for the
in< following reason.sinion 7031.5,Business and Professions Code:Any city or county
R $460
F p which requires n permit m comnrief idem
r,improve,deolixhair a
,or repny na
ruure
w=s�._priort t `issuance.alsoy the ppl t ho sucha,nuit or File a signedsta¢ncnt.
e 3
(commencing wit5eak t 17000)rf Divislo he Bus!ne.Land Profession,lCMa '�.J,': i t3.�7 G1•�(J ii 7-f;,uE2$1�{:g ! Valuation
or that he is exempt therefrom and the boas for the alleged exemption Any violation U i 4.T x .
-of Section 7031 5 by any applicant for a,xvirut subjects the applicantto to.civil pooh,
of not mare than five hundred dollars(S500) 502APN Ia PLUMBIN ENERGYOCcupancy Type
NI, wnrof the open,or my employees with wages as their sole,mra,nsmion, l
11 at nn meawtnk, ad the so-: T e n mn intended or a Us., for ono,(set:]Baa, 5 0 7 — FINAL NAL P1RME11TCO P r
owner os property
Professions Code: improves
Commaoro License Law Joss nor apply to en 5 eCt10D5
owner of prnpc a Who builds or improves thence,and who docs such work himself
w iFed f. his own employees.provided that mem improvci,,.I wi not intended r m _ _ _ -
orfcrcd f . 1 If er Ih b have
g pm <t . sold he did mrc y f
improwt un Wewe.1 bile 'llh theburdenfpo ' gthm heddnot build or 1 I
tar f purpose er. I l - 1
01;or oradva,of the p IKnY l Y gwit
ses 1 contractor lhlsed t o t
ConsionuCt the pro,arl Say.]Baa Business d Professions Cude:)The Contractor's
Hee L dos not apply t r fpr pony who Wild, p the l
. and M1h contracts f ch p ut
Js 'rN o t meld licensed p t t the
1Law-
_._ _ ... .. .. .. ... . .._ .. . .._. .-- .
Cot .L L
°1 ptorderSc t B&PCT thinresun '. I'. •.? f •
Owner Dm=
14 D ARECL R 1
WOR ER'S COMPENSA N ATION
I hereby affirm under petWty cd perjury o'ae of rhe following declantionsr
1 ° 1 have and will maintain a'Cenificdm of Consent to self-insum for Worker's
Compmumlon, as provided for by Section 37V) of the Labor Code, for the
_ 'performance of Me work for which thin permit is usuad.
°1 have olid wilf maintain Worker'.Cnmpcarudon lniurance,as mqulied by Section
37M of the Labor Aide,for the riMormance of the work'for which this permit is
sued.My Workers Comperisatin
n lnsuroncc eertier and Policy number tare: "
cv Cnrir ., la r lltsr policy .,., •t t`(e.(..�,I,a. .d . _ ..,. .li _........__
i .•CERTIFlCATIONOPEX S'QNFROM,WORKFRS \ ' (1-k'• ' L\ J '- ' 'gZ I •Fall-�
" COMPENSATION INSURANCE'S -
s ('ITs:earon need not he comil lesed if the Permit is for one hundred dollars ,j P\ \ '' 'r'•' h" �':: 1 LI':: 1 .y Di
IE�WIat
as sub do MeWorkers'
-..•.._. ......... _.— .. ... _.-. ._. _ _.... ... .
I seri loy'at in the perform tt f the ork f which ul pe t soN I
it on,ol employ any per on n any manner les `
A61hatim i. Dam'
Compensation Laws'of Californiaaem ;,..
NOTICE TO APPLICANT:If after making this Cer iGcam of Exemption.you should
ticconsc ebbjccuo the Worker s Compenwtion pmvixions of the LuMa Cale,you most
O,Q forthwith comply with such provisions or penin shall be deemed revoked
e
.. _... ... .. . ... .. . ... . . . _ .. _. _.
'VJ •a•+ : „•'CONSTRUCTON LENDING AGENCY, -' '.' . - - .._. ''I,i .,
n:" pin
1 hereby opine that there is a construction landing agency fur Inc Iicrlommni'e
Wof the work for dM1ich Ihix permit is isxued(Sec.309]:Civ.C.)
:L
Z I<nder's PAddress i;x ;-`II
... . : , ., : 1p
U.O 1 certify that 1 have read this application and state tem Ne above infmmmion is
Cr. p.: amen.I agree to comply with all city and county ordinances and state laws relating
C).V to building construction.and hereby tonWhie represemaives of this city m ewer upon
F
me ammo-mendne
ma.propeny tar m.pe=aen rmrpmaea y es,judgments,
m ssw.mdamnipe and which
h may in iany wa bf Cm cragai st said
W liahil hies,judgmrn¢,of
and expenses his
which may in any way accme against said
to
U.Z City seq nee of theg ing of ihk pe t
APPLICANT UNDERSTAYDS AN WILL COMPLY WITH ALL NON-POINT Issued Date .�.3-'(JI
SOURCE ECplkam 'NS " ' y
spas
Srg
him ofAPcanVContr^cl rte' t Date, Re-roofs
HAZARDOUS MATERIALS DISCLO URE
. ..Wd1 Je eliplicam or.future bwldin6 ottupam nom of hand bnaarchm s mamn:d .Type Of ROOF
as . .oe. Municipal,Y yt o uanm
ttienae oanmr 9.12.and the
Healthand Safety
Code.Seefim.255321e7 -_,
" s 9
. .A1Lroofs shall.be mspected.prior.to any roofing.material.being installed.lled., _
AM .,.wmmeappicorrytumwumng«gupantuaeegtdpmentoraevieeawMoh If a roof is installed without first obtaining an in'spectidn,�I'agree to remove
emit heaaNnus air,'munrnminunts as defined by the Bay Area Au Quality Management
tact p pp and will comply with- -
n all new materials or inspection. Applicant understands
all non oint source re ulations.
r , . t P gt'• 1`.
Calif1 ma a,in&h h s r, e. oaten quitemems u'der Chapter 6.95 of the
if the
ornialHeald&uico Gd hors to mium505at itis ymspa3a.lundenmm tM1at
iphenallofto:mdue,al canis mavenst m.IhmiYiimyrcnnee off Ce ifimihe
of
occ Pam of to:(egoirt t which must tic a p' 1m issuance of a Crndiote-
.. r'.
occupancy ., ..
- •' t .. Signature of Applicant Date
Owneror ulhorisdagmn Date All roof coverings to be Class"B"or better
•.. 1 ;
OFFICE