03010128 (2) CITY OF CUPEWI'INO
BUILDING DIVISION PERMIT CONTRACTORkINFORMATION
BU I LDING ADDRESS: JJUST WATER HEATERS INC PERMIT NO,
11218 REDONDO CT 03010128
OWNER'SNAME: 1764 NATIONAL AVE APPLICATION SUB DATE
THAKAR ANJANEYA AND KANCHAN 01/23/2003
]ONE: (510) 293-9901 SANI'T'ARY NO. CONTROL NO.
ARCHI'RC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
00
LICENSEDMet I a.licensed
p DECLARATION
U 1 heeby affirm Nat I am f theBJ under provisions of Chapter 9(commencing Job Description
with Section]IXMB of Division 3 of me Business and Professions Code,and my license is
in mu tome and effect. REPLACE WATER HEATER C aya,ay�
�Z Licen.se Class Lica r1NALC■ ■
o�t,o Date Contractor (5 0 GALLON GAS) �/
k'rom q—� ARCEIITaCPS DECLARATION FEB 1 1 2003
K of< I undcrsunJ my plansshall M used as public records
DECLARATION
c0d6
�LLr Licensed Professional
OWNER-BUILDER DECLARATION
al <X 1 hereby affirm Nat 1 oto exempt from the Contractors License Law fm the BUILDING
i 6 CO following reason.(Section 7031.5.Business and Professions Code:Any city or county
S E which requires a permit to nmstruct.alter,improve,demolish,or repair any structure
poor to its issuance,also requires the applicant for such Permit o file a signed statement
that he is licensed pursuant o the previsions of the Contractor's License law LChaper 9 Sq. Ft. Floor Area Valuation
as (commencing with Section 90(j1(B of Division 3 of the Business and I'masion,Code)(it $1017
— that he Is exempt therefrom and Ne basis for dm alleged exemption.Any violation of
Section 7031.5 by any apPlican for a permit subjects me applicant to a civil penalty of APN Number Occupancy Type
not mom than five hundred dollar(ss00>. 35621016 . 00
p y YP
❑ 1,as owner of the progeny,or my employers with wages as Nei,sole compensation,
will do the work,and the structure is not intended or offered for sale(See.7W,Business ¢gpjy,�l,.�$�Q���aTqLT�^T
and Professions Code:The Connector's License Law does not apply to an owner of 502 - FINAL II E Y.71w lllfgct��GY
property who builds or improves thereon,end who does such work himself or through his
own employees,provided that uch improvements am not intended or offered for We.If. 506 — GAS TEST
however,the building or improvement is sold within ore year of completion,the owner.
builder will have the burden of proving that he did not build or improve(or purrytse of 507 - FINAL PLUMBING
sale.)..
❑ I,as Owner of she progeny,am exclusively mnuacdng with licensed contractors to
consumer the project(Sec.7044.Business and Professions Cude:)The Corrector's Li.
cense law does not apply to an owner of property who builds or improve Ramon.and
who wormers for such projects with a wouractor(a)licensed pursuant o the Contractor's
License Low.
❑ 1 am exempt under Sec. ,B&P C for reason
Owner Date
WORK ER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a Certificate of Coment to self-insue for WorkeraCompen-
7C31�1"00
ion,as provided for by Section 371X1 of the Labor Code.for the performance of the
rk Ii,r which Nis permit is issued.
I have and will maintain Worker's Compensation Insurance,as mquied by Section
of Ne labor GWe,for Ne p,rmoom oce of the work for which this permit is issued.
y Worker's Compensation Insurance carrier and Policy number am:
rtier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(-bis section need not be completed it the permit is forme hundred dollars($11X)
orlex"J
1 certify that in the performance of the work for which this permit is issued.I shall nor
employ any gerson in any manner so as to become subject n the Worker'Compensation
Lawsof California.Date
Applicant
NOTICE TO APPLICANT:If,al'kr making this Ccni licate of Exemption,you should
become subject to the Worker's Compensation previsions of be Labor Code,you mus
OO forthwith comply with such provisions or this permitstaff bedeemed revoked. (1
z M CONSTRUCTION LENDING AGENCY / V
[—+ I hereby affirm Nat there is a construction lending agency for me performance of
pi 7 Ne work for which this permit is issued(See 3(N7,Ci,C.)
WWQ Lender's Name
7 M Lender.,Address
U O 1 certify Nat 1 have read this application and some that the show information is
D. P correct 1 agree to comply with all city and county ordinances and sum laws elating to
0 building consuucdon.and hereby auNooe epesenuriss of this city to enter upon the
W above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
y liabilities,judgments,costs and expenses which may in any way accmc against said City
U inconsequence of the graining of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicaDam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the a Cu,pam m fume building e,Chapter
store or handle Health and Safety as defined by the Cugeninn Municipal Code,CM1nper Y.12,and the Health and safety
code,seed'Vcs ❑No 25532(a)'0 All roofs shall be inspected prior to any roofing material being installed.
❑
Will the applicant or future building occupant useequipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
mit hasaNnus air cnntaminanu as delined by the Bay Arca Air Quality Management all new materials for inspection,
District'
❑Yes 0N
I have read Ne humorous mo Trials requirements under Chapter 6.95 of me Cabot,
I
Health&S:defy Code.Sections 255115,25533 and 255M 1 to deOund that if the building
does not currently has a tenant,mat it is my responsibility to nodfy IM occupied of the
mgaiements which most be met pdorm issuanerofa Cenificamonacopaney. Signature of Applicant Date
Dwner or auho o,c]agent Date All roof coverings to be Class"B" or better