02040014 (2) CI BUILLDINDON
PERNO
G PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10472 SCENIC CL HOT WATER INC 02040014
OWNER'S NAD1E: APPLICATION SUB DATE
ZIMMERMAN TED B AND SUSAN B 2531 GRACELAND AVE 04/02/2002
^HONE: SANITARY NO. CONTROL NO.
(650) 298-8494
ZOE ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w BLDG ELECT PLUMB MECH
1::a I_._1
LICENSED CONTRACTOR'S DECLARATION
ej Z I hereby Birth that 1 am licensed under a of Chapter (Commation Job Description
Z O Y a provision P 8
t
with Section]OppJofDivisinn3ofth<Buninessand jot` �amyranx REPLACE WATER HEATER.
[m .'ai is in full ionic a If of
z z< LicenseClLic.r
O u Data Comouam
5 LL 0 IHTECf'5 DECLAR T ,
1 understand or,plans shall be used as public records
T
s
.EAC Licensed Pro&asional
OWNER-BUILDER DECLARATION
u� a 1 hereby firon(Sect that 1 1. cmmpt from the Cnnions Cos c:Any
Law for the
F•Z CI fallowing reason.(tomit t ]031.5,Busltcrs and Professions Code:Any city at county $500
Z ec which requires n e.also re tures the,ober,improve,for such
demolish,or rtPan my slimchunumma d
n 3=° ' prior to t Isar q the applicant for such perminoflea signed smtemem - --- - - --- ----.-- -- — -
tluihc tlp :aorta Chep sof theCunlragorsCce .etaw(Chaptcr9 „�„_,• p ,�f, J�rr]sga3 ] �., Valuation
(commencing with S-ctio 7000)of Division 3 of the Business Phil Prof ssiom Code)
or that be is exempt therefrom and the basis for the alleged crampoon.Any violation
of Section 7031:5 by any applicant for a permit subjects the applicant o a civil penalty
of not more than five hundred dollars($500) 5024PN�*�FL PLUlsi ENERGYOccupancy Type
01,as at of the prepcdy,o my employees with wages as their sole compensation,
will do the work.and'the"m uclumt,an intended or offered for sale(Sec.]Olio
Fiction,and Pmre.ainna Cede:The Contractor,License Law does nut apply to an 507 - FINAL P06WIMspections 1 ”
owner of ptopcdy Who builds nt improves menton,and who does such xnrk himself
or throwgh his own employees.provided that such improvements ort not intended or
offered or dale.IL however,the building dire- - t is sold within one - f -' - - --- - ��- -- --- ------ '---- ---"�----------',` ---- -- - -
B Pn of pro yearo
ntnplai fin the owner-builder will have the burden of proving thin he did not build or
improve lin puB,o,a of salt.).
OLasowner ofthe p(Sec.7,ore eaclusfvelycomrofessi with licensed The ontraaorsm - ., _ a
Liconcense
the does
in (Sec. to a ownBover o and Professions Codes The vesContractor
remi, ,
,. Llcanse Law docs not apply m an owner of a Coronations)
who builds se improves thto the --
.. ; and.who.mntnets for such projms.with a conwmorts7 licenses-pursuant m the
Contractor's License Law. _ - . 0 IA ,A.LE
S
01amncmpt ._ ._ _. _. ... .. _. .. . ..
under Seca ;� .BAPC fur this reason .. ..
Owner '' Data APR 2. 9 2002
-- WORKER'S COMPENSATION DECLARATION
> 1 hereby offrnt under penalty of perjury one of,the following declarations:
,A 0 1 have and will maintain a Cmifeate of Consent to self-insarc for Worker's BUILDING
st` Compensation, as provided for by Section 37W of the Labor Cade, for the
performance of the work for which this permit is issued.
01 have and will no mam Wooer's Compecomimilmurance,as required by section
3]00'ahha Labor Code,far the Peiformanc<6f Na work'foi which this permit is
seed My W k CrimP�' a t o�I s ace timer anJ Policy number ore "
coulterI is, 7
CERTIFlCATION OF E%EMPnON FROM WORKERS'( ••' B ` -S 1 s r-` ' z 9 - .
' (Tho uaion'need no tie<o . .. . ..—._.._ .._._.__._..__._._.._—_.__.._.-_...--...._...._—�._.______—_.._.._._.. .__.._..
mpleied if the Permit is for one hundred dollars `s 'n
(S 100)or less.)
I cialify mut in the performance mann the work for which object tto t e issued,1 „
shall notation L'ws i person in any manner so as to become subject m the Workers' '
A filunin,tion Laws of California.Date'
Applidam - -
NOTICETOAPPLICANT:IL after making this Cedilicam of Exemplon.you,hould
become subjecto the workers Compensation provisions of the Labor Code,you must
Q
forthwith comply with such provisions or this Permit shall be deemed mainland.
C . .. _. -
IhertbYa -. ... . . __
l
y "` CONSTRUCTION LENDING'AGENCY "
a } air,.that there is a Conswction lending agency for the performance
lzof the work for which this permit is issued(Sec.309].Ci¢C.)
LendCLI er's Name
z Ltndar'a Address . . ..
C _ I codify that I have mad N
is application and state that the move information is
W-E.. collect:1 agree to comply,wmh all city and county ordinances and state laws relming
0,U m building constrbetion,and hereby outhorize representatives of this city to enter upon
}.,Wthe ahoccmantioned piopeny for inspection Purposes.,,
0. (We)agrae mmse;indemnify and keep harmless the City of Cupertino against
-(A liabilities,judgments,costs and expenses which may in any way attme against said
V.z Cit in conse9L.nce of tingofmispcnnit.,
'--' APPLIC ie U, D STATtkS AND WILL COMPLY MTm ALL'N'1N 1' ! (J v
souac IONsJ n'-' /�I-f � r Issued by: Date
sigmaturco mmcmr f: . ..u,Dole.L.� Re-roofs
AZARDOUS MATERIALS DISCLOSURE '
. Vill m'applicant or farmfarme building campant store or handle hainnskew material .. Type of Roof -
as'defi ed by,ma CuPcoirm Municipal Code Chapter 9.12. nd the Health and Safety
Code Section25332(e)? -�. j ' ( ls� A'Lr sin ` IJ.
. ❑rad: '` " ;�, "-1, :. i _ AIl_roofs.shall be..inspice Lip ior_to.any.roofing.material being installed..__ _ _
B W equipment T If a roof is installed without first obtaining an mspection,'I agree to remove
a,. Will the applicant or future Wilding Deco nt use ui Quality
Management
emit M1azataoas air mmnminants m barred by'the Be,Arei Air Quality Manegemcm
m:aima all new materials for inspection, Applicant understands and will comply with
by. - all non-point source regulations.,
1 M1 'e'read the h z do. materiali, qtdrcmcrts under Chapter 6.95 of the
California Health Sa Safety Code,Scmin 125505.25533 and 25534.1 understand that _
ifthe building docs not currently have a tenant,that it is my responsibility to notify the - - .. ._. ...... -. . _
occuffhe�gdocments which must b,ma poor to issuance of a Certificate of
•QUIZ Signature of Applicant _ Date . . .
'': ownerPr.amntizedngent•' 1 Dam All roof coverings to be Class "B"or better
'-: OFFICE