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03010178 (2) CITY OF CUPERTINO " BUILDING DIVISION PERMIT :CONTRACTOR INFORMATION:,,,, BUILDING ADDRESS: HOT WATER INC PERMIT NO. 21370 RAINBOW DR n'AC)10178 OWNER'S NAME: 2531 GRACELAND AVE APPLICATION SUB DATE VITTAL SPIMUSHNAM 01/28/2003 NI;: (650) 298-8494 SANITARY NO. CONTROL NO. ARCHITECI'/ENGINBER: BUILDING PERMIT INFO RLDG ELECT PLUMB MECH fooLICENSED CONT xACrOR'SDECLARATION T jobDescri tion n I hereby affirm ion that 1 am licensed under proviss of Chapter 9(commencing / p wish Scclian]INNI) !Division 3nf WC Busi unJ Professions CnJc dmyliccnsc is I m nn�redandert y REPLACE WATER HEATER Lirrftsc aa, LIc.N � -..� F=Fr.q• m RCIBTTiLTSD ter 10 ✓ ��� o g� I unticrstand my plans shall M used puhlic records - LLOLicensed Protestations] OWNER-BUILDER DECLARATION ¢� f 1 hereby affirm Thal I am exempt from the Contractor's License Low for the at following mason.(Section 7031.5,Business and Professions Code:Any city or county °• $ which r.yuires a permit to amstrusa.alter.improve,demolish.of repair any structure prior to its issuance,also requims the applicant for such permit to file a signed statement ,.h Z< that he is licensed pursuant to the provisions of the Connector's License,Law(Chapter 9 Sq. Ft. Floor Area $tfg"tion ec l-$ (cnmmencingwithS lion7gk0nf Division3ofnc�BusinmudPmfcssions CWc)or �.- that he u exempt therefore and the basis for the alleged exemption.Any violation of Sadon 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of ¢ 0 Occupancy Type not mom than rive hundred dollars($500). ❑I,as owner of Ne property,or my employees with wages u their sole eompetuxlion, will do the work,and the sanctum is not intended or offered for sale(Sec.7W,Business and Professions Code:The Contractors License Law does Bat apply Io an owner of 506 - GAS TE elgmre nspecFINAt rots 1112 property who builds or improves thereon,and who does such work himelfor through his own employees,provided drift uch improvements a o,not intended orol2md for sale.If, 507 — FINAL PLUMBING however,the building or improvement is sold within one year of completion,the owner. builder will have the burden of proving that he did not build or improve for purpose of sal..). Q 1,as owner of the pmptny,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor s Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such pmjecu with a conmacter(a)licensed pursuant to the Contractors License Law. Q I not exempt under Sec. .B k P C for this..an Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby aBirm under penalty of perjury one of the following declarations: have and will maintain a Certificate of Conenno self nsurefor Worker'sCumpen- ion,as provided for by Section 3710 of the labor Code.for the performance of the work for which this permit is issued. Q 1 have and will maintain Workers Compensation Insurance,se required by Section 31 1 )of the Labor Cede.for the performance of the work for which this permit is issued. My�kma' q Insumnc. erticra Policy numheramCu ]icy N .:IFICATEOFEB 1PTIONFROMWO KERS' COMPENSATION INSURANCE (Thu section need not be completed if the permit is fume hundred dollars($1010 or IcssJ 1 certify that in the performance of the work for which this permit is issued,I shell not employ any person in any manner so as to become subject to the Workers'Compensation Laws of Cioform.,Dam Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compo mation provisions of the Labor Code,you must OO forthwith comply with such Provisions or Nis permit shall W deemed revoked. CONSTRUCTION LENDING AGENCY [..r N. I hereby affirm that from is a consu .tion lending agency In, perfmmarne of y' the work for which this permit Is issued(Sec 3107.Civ.C.) Iql Q Lender's Name z Lender's Address U Q I certify that 1 have read this application and sum that the above information is U F cancer.I agree to comply with all city and county ordinances and sum laws mining to C U building construction,and hereby autharim repmscnmtives of this city to enter upon the Lk7 .hove-mentioned property for ttBpectom purposes. (W.)agree In cast,indemnify and keep harmless the City of Cupertino against f�q Iiabllili(Wdgrena,to case.and expenses and hich kepmayinanyw City agmnino against City V7 in consequence of the granting of this permit. L7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NQQQNP NT Issued by: Date SOURC GULATIONS. Ii � O7 Re-roofs SIS core of ApidirmalCurtinat Palo HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant of future building oecupam sore or handle hazardous material as defined by the Cupertino Mu �ipal Code.Chapter 9.12,and the Health and Safety ,deliVoc..Scmian 25532(.)1 All roofs shall be inspected prior to any roofing material being installed. QYcs 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 nazerdnus air etmlformanx a,dd,'oil by the Bay Arca Air Quality NNusiFment all new materials for inspection. air's QYcs u I have mad the hazardnu nmrerials rec.iremcnu under Chapterfi95of the Cold., niallcilth afcty C, c.Scctiorts25505,25533.d2534.1unJcr that if the building tires curet ly hast a mnan4 Na it is my respmsibility t notify M acupant of the regremcn ichmustri.met poor inissuanccofaCertjfa¢af5yanc➢. Signature of Applicant Date svne,minal dircdogcvat i1 0G 3LAam All roof coverings to be Class°B° or better