01080084 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1514 POPPY WY JUST WATER HEATERS INC 01080084
OWNER'S NAME: APPLICATION SUB DATE
GHANDI 1764 NATIONAL AVE 08/16/2001
PHONE: (510) 293-9901 SANITARY NO. CONTROL NO.
Q x z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
100 BLDG FT Per PLUMB MECH
E_—
U�i L'_1 U L-A I_A
i7 i LICENSED CONTRACTOR'S DECLARATION ]Ob Description
1hereby.)Tumthat1em licensed under provisions of Chapter9(commencing(commenc(commencing=„F wNnsecdonJ(Xwi,io
)oroivnsonneBa,i.es.uPm¢sm
nd .scaae,anemyhanse REPLACE WATER HEATER.
is in fou come arta erre.¢
Lic.g (50 GALLON GAS WATER HEATER)I<� Data Class
%O q.U Data
j 3 C
n ARC( S DECLARATION
''04 Indemundmy pinsshallhatirea
ss public rccomx
iz p, Licensed Professional
OWNER-BUILDER DECLARATION
sa I hereby aRrm N
toot I am esempl from e contractor's license Law far the
F 2< following reason.(Section 7031.5.Business and Precisions Code:Any city or county
E p which requhce o permit to conuruct.cher,improve,demolish,or¢pair any struda.
c3� Prim to ill I,..dao require.the applicant forsucM1 mmit to fileasigrcd ataccoam. - - - — - — — -------- — - - -
NptWisiciipta ittulthepiunssons.(theCoaaacmrsucenselaw,(Chapter9 f .._,>> kSq:•FL:FIoorAreai•s= - r_ • auction
(commencing win Section JWO)yf Division 3 of the Busine4 and Pmfessians Cable)
��. :�^: } y5,:.t, rk'+, I +d
or that he is exempt aherefmm and the basis for the allijed uemptiion.Any violation
' -afsenionJo3lslryamapgieantfmapermitwbjmsaWapphrvmtoaci.;Iperaey '•Px'1r-
tof not nam than five hundred dollars(S.."). Utr}beC Occupancy Type
❑I,as owner oftheproperty,m my employees with wages as their sale compensation., _ ,
warao he work,sad he stroce re is not intended or a@ -70a
PI.
far wIn(Sec.-Jo .
io
'Bmass and Ne ession:Code:The ContractorLicense cense Law does not apply loan 5 0 6 - GAS TES1Required Inspections'(`
owner of property who build,or improve,Nercan,and who does such work himself
or through his own employees.provided that such improvements are not intended or _ 507 . - FINAL PLUMBING_
bffend for sale.If.however,the Wilding or improvement is sold withinoneyear of
lampletion,me owner.Wderawill have the Wal ofpmving that he did not build or .
mpmvcfor,u . fsale.).
❑1 a:' f he p openY n l es ly contract,i with licensed contract t _t tl S�- t
Li
.,.c,N prof t(Sec J1.a B d property f Code 1 The Contract FI
sae 1_, a arapplysue t r aconte W Wilde or sed pursves uant
t r MA L E®
Co who commas.for such projects wiN a.conwuodsJ licensed Wrsuam to the -. .. . . _ . .
Contractors License law.
atn.scmq uMcr ,B&PCfor this reaw
Dara'.
❑lOCT..0.3 2001
WORKER'S COMPENSATION DECLARATION
I hereby affirm underipe..try of pirjury�wie;of Nc follawiall declanhans: BUILDING
❑ 1 have ens will council.'.Circ icaie of Consent m selbi...re far Wader's
Compensation, as providM for by Section 37W of me "We Code, for the
performance of the work for which this permit is issued.,
. 11❑1 have acid will mainlnin Workers Compenwiim4 hisumnci,as required by Section
711X)of the Labor Crile,for the pertormanti of the work',for which this pei.itiis
iuuee:MY Worker's CompeiuuNio„n Inwnrce euiriei sand Policy number arc _
.. .:.: . -... ,.,.
Con uL.tool Y3 r;r••i Policy No_t t -v :r�-FJ s�;,,`.1.5tati.`v s;..a� •,,. J ,_ .
It0',CERTIFICATION OFEXEMPfION FROM WORI{ERSd'`' •' t 's t+ � f F ..}J.' l•
COMPENSATION INSURANCE
1. 1 (Thuanaiin nceenotWconplmcd fmc person isforanehundoddollars ''`I•' •lriUi..•; ,...y`` .111
(SIM Mow I )
)I ,_fy.that
n' peA of the td for HM tM1.pc t sissucd.l ;r .J' I ,•L1 f+.It+t,;1F j . .•_I .—
'�Ioll n n employ 1my,person m any man us to hccom ublen io the Workers
o
Compensviion laws of Cdifomie.Date,
.'Applicant -
:NOTIC'E TOAPPLICANT:ILaper makingihLs,CmiOcac ofEadmption.you should' '. ^' '
fonhwitlt )pet to the Wwk6'a Comgnwuon provisions a the tabor Code,you mull
Q O comply with soon previsions or Nrs permit shall W deeimd revoked. _ ..- __.
z:Vi CONSco Uot'0NLcfimm leading NCY ;1, ..:`.tf •.•'`
1 kfr aRnm dm meta is n toned( g o C) for N6 perfonnence � -
w oftWwwkme”' ch Nis permit is ivwed lSec.J09J.Ci¢C) -„_•_„-„ ,, .. ,_ ..,_
Q Lcnderi Name'-,... _
CLI z Lenders Addre `I 'f.^, 4izd
1 cnufy
cnmtt1 agree
NoactoImM1apl1
cid'.1 city and cy mairance,
ahaaodW laws atiorelating i
mWld timeand hereby an p numots fah city meupon
I�VcgiiaeNe W - ! �� m"mip� s
/ J�
.y rtindemnify ad keehamdrai Ac Ciy 4 Cupertino aganst
L J�
m liabilities,judgments,costs and upenses which may in any way soene against said
V'z City in camcquettce of the gnvning of this picamr..., ”
'•' 'APPLICANT UNDCRSTANDS'AND WILL COMPLY WITH�ALL NON-POI•Yf t”
SOURCE REGULAT1ONs,: Issued by: Date
Signature, fA,p1i,.dC t.cuee - D t - Re-roofs
;. HAZARDOUS MATERIALS DISCLOSURE '!sou Neuppheat rt lulongocePaa treorA dmbeadsusmierml Type of Roof - .....--..-.........-- - ..---...........,'.. -
as del!by Ne Cupcstm 'Mu cipal Code Chapter 9 12 and do,Heahh and Safety ,' :kl i s` •t ,i '�•,I, '.I v
Code Sm on 255J2(a) - i - o > hi
"bN.1% ,- ,.'.. a t�1.. i,. All roofs.shall be.inspected prior.to any roofing material being.Installed. _
Win mearplicatoror:faturebuddingoccupant use equipment ordevices%hich If a roof is installed'withoutfirstobtaining an'inspectiofi;Tdg'r&etir6move
emit haramixt air contaminants as defined by the Bay Area Air Quality Management
District? " all new.P materials for inspection. Applicant understands and,will comply with -
�rea , �N0 I :; : . ' , - +_ - all non- oint source reg ulations:,..
' ;tc.}
J I navelmaWNe havai0ous miiiciids regmremettsl under Chap
the ,
Celifeinm HcdN&Safety Cade:Sections 25505:25533 and 25534.1 understand that: ..
- i(Nabuilding dues not curtemly haves¢num:Nm ii is my¢sponsibiliry to notify Ne ', '
',ecupam of Inc rtyhireme t. E hi nus W m t p "m is. es' f Cenihcv¢of
D"gPwuy • .+ Signature of Applicant _ _ Date -
t.
Owner .Nonzcaege ,,t.,; Datq ;. All roof coverings to be Class"B"or better
OFFICE
L.• I... .,.. r r' f i. i I. .Is,,