02100113 (2) CITY OF CUPER'11NO -" s+He "<,
BUILDING DIVISION PERMIT CONTRAC TOR INFORMATIQN
Buill)OGADOEsIZICHWOOD DR JUST WATER HEATERS INC PERMIT NO 2100113
Dwrf'RAIMBLE J A AND EVA M 1764 NATIONAL AVE APPLICATITVyolDS'y 2002
HONE: 710 293-9901 SANITARY NO. CONTROL NO,
ARCHITECI]ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MEOH
C=
00 LICENSED CONTRACTOR'S DECLARATION gj�ypp
rc�F I hereby affirm that l am licensed under provisions of Chapter 9(commencing REPLACE WATER EA ition
with Section 7000)of Division 3 of the Businessand Professions Gale,and my license is
in fall u.adeffeet. (40 GALLON GAS�'N�L�'®
�� Licenac Class Lic.as
FNFp Dam GnntmCCL 2��3
As shall i used
DECLARATION JANi 0�
�8p� lundcrsmnd my plana shall be used as public rccnrJs
na.0
LLor Licensed Professional
j OWNER-BUILDER DECLARATION
de1 hereby affirm that 1 am exempt from the Cmnratux,License Law for the BUILDING
a n o 0 following reason,(Section 7031.5.Business and Professions Cnde:Any city or county
$ which requires a Permit fit construct,alter,improve,demolish,or repair any.structure $870
F�< prior to its lssiunce,also requires theapplicam for such permino file a signed statement
that ho is licensed mostanfto the prnvisiuns of the Contramm's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
� 0 (commencing with Section 7lk))on>ivision 3 of fire is uelnew and Professions Code)Or 36908028 . 00
y that M1c is exempt them and Ian basis for the alleged aadarmion.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy e
not more than five hundreddollars($500f 502 - FINAL PLUMBI G ENERGY p YTYP
❑ I,res owner of the property.at my employees with wages as their sale compensation,
will du the work,and the structure is not intended m offered for sale(See.7044,Business ��(�st�t�s��a
and Professions Code:The Contractors License Law dors not apply to an owner of 507 - FINAL ydplj$'1'j�>✓"eCtions
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
howevea the building or improvement is sold within one year of completion,the owner-
builder will have Ne burden of proving Nal he did not build or improve for purpose of
sale.).
1,as Owner of be propcny,am exclusively contracting with licensed comncmrs to
construct the project(Sec.7044.Business and Professions Code:)The Contractors Li- .
cense Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contracmrts)licensed pursuant to the Contractors
License Law,
1 am exempt under Sec. .B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consem to sciff m ure for Worker's Compen-
sation,a provided for by Section 371)of the Labm Code,for the Performance of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance,as required by Section
371X)of the Labor Cade,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number arc:
Carrier: Pal icy No.: _
CERTIFICATE OF EX I7M PITON FROM WORKERS'
COM PENSATION INSU RANCE
(This section need not be completed if the permit is for one hundred dollars 151 Nf
ar lives.)
I cer ily that In the perloodance of the work Int which this permit is issued.1 shall not
employ any person in any manner so as m become sublen m rho Workers'Cnmpenaatian
Laws of California.Did
Applicant
NOTICE TO APPLICAm':11.alter making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
OO forthwith comply with such provisions or this permit shall he dermad revoked.
ti .~N.rCONSTRUCTION LENDING AGENCY
(—+ I hereby affirm that there is a construction lending agency for the performance of
p$ 7 the work for which this bran it is issued(See.3097,Civ.C.)
Jt2.tQ Lender's Name /pyo
0 lender'sA
O I verify that 1 have rend this application and sum that the above infonnatian is
� ^F comm.l agree to comply with all city and county ordinances and nate laws relating to
QU building conamelion,and hem by amborim representatives of this city to enter Pon Mae
a7 above mentioned property for inspection purposes.
d (We)agree to save,indemnify and keep harmless the City of Cupertino against
Hy liabilities,judgments costs and expenses which may in any way acerae against said City
U in consequence of the granting of this permit,
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
HAZARDOUS
Signature of ApplicaDate
HAZARDODO US MATE RIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding«cupant.anm or handle hazsrduus material
as defined by the C.;7 on Municipal Cade,Chapter 9.12,and the Health and Safety
C
arie.Secllon zssR(m7
❑seON. All roofs shall be inspected prior to any roofing material being Installed.
Will the applicant or future holding occupant um cyiiipmemm devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hazardous air contaminants as defined by the Boy Area Air Quality Management all new materials for inspection.
7dinsisiana'
@
Oyes [I No
1 have read the hazardous materials mquiremmas under Charter fi 95 of Me Gthfor,
o Ikill&Safety Cale,Sections 25,505,25533 and 25534.1 understand that if the building
not currently have a nand,thud It Is my reagm msibility nifty the occupant of the
quircments which must to met prior to issuance of a Cenificate of 0.cupani Signature of Applicant Date
Guide,Oraathu v,cl agent Date All roof coverings to be Class"B" or better