02110036 (2) CITY OF CUPERTINO tip
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BUIrp)(rygAS@ZESS STELLING RD JUST WATER HEATERS INC PERMIT N02110036
QWMASlYANMROY H AND BEATRICE H T U1764 NATIONAL AVE APPLICATIP11Syq1)61y2002
ONE: (510) 293-9901 SANITARY NO, CONTROL NO.
ARCI IITECI'IENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
00 Lm that I LICENSEDCONTRACTOR
orders DECLARATION
I bei 7( affirm that 1 am licensed under m isinna nI Chapter 9lcommencin n00
wirhseenmrnik)mroivianld3mrmenasmewaa�drmrew.amnwemae,ademyfCenae a REPLACE WATER rI'ff0
I.oflnroenndeffeCl. (30 GALLON GAS) ''�pq�
Ola z Lfcense Class Lie.g
Z—o Data Contractor
F�££8 ARCHITECTS DECLARATION
l understand my plans shall he used as public records DEC b 2 ZOOZ
X�dV
art Licensed Pralessinnal
OWNER-BUILDER DECLARATION B�I��i�V�
��Pyt QJ 1 hereby affirm that 1 1. camps from the Conon C's License law tar me
w�a§ followwhichingrealtfir.a Section])mane..5. met. and Profusions Code:Any cin or roomy 894
s�al(L which reyufres a permit re[noosed plots improv[,demolish,or repair any uareare
'hath In its cense ce,assn nt 10 the me applicant f or such permit ra files signed smmmem
alpoor
'hat wJ pursuant m00)ofDisionsnt tf the Buanessan Professions
Core) Sq. Ft. Floor Arca Valuation
ase $ (a announcing with Section 7000)mf Division Sof the Business and Professions CnJe)nr 35922060 . 00
e Nal he I,exempt dterefrone and Ne basis for de alleged eaemptiun.Any violation of
Seefmn 7031.5 by any applicant for a permiuubjects Ne applicant o a civil penalty of APN Number Occupancy Type
amtMo.thmmehundred dollars(S50)). 502 - FINAL PLUMBI G ENERGY P Y YP
I,as owner of the properly.or my CMPlnyecs with wages as their sole compensation.
will do the work,and the structure is not intended or offered for sale(Sm.704,1.Business 506 GAS TE
��yD'�{,,�ss,�p
bad Prooksm ns Code:The Contractors License Law does not apply to an owner of 507 - FINAL p*Rdr]lg7 y ectlons
propcny who builds or improves Thereon,and whodma such work himself or Brough his
own employees,provided that such improvements are not intended mroffered for We.If,
however,Be building or improvement is wild within one year of completion,Be owner.
builder will have the burden of moving that he did not build or improve for purpose of
.[a)
❑1,as owner of the propc ry am exclusively contracting with licensed contncars to
construct the project(Sec.70,4,Business and Professions Code:)The Carapaces Li-
cense Law does not apply to an owner or property who builds or improves thereon,and,
who contracts for such projects with a comractor(s)licensed pursuant to the Conoacmrs
License L.
❑I am exempt under Sec. .B&P C for this reason
Owner Data
Ak WORKER'S COMPENSATION DECLARATION
I hereby efrom
under Penalty of perjury one of the following declarations:
1 have end will maintain a Cerdfcate of Consent to self-mame for Wmkeri Cmi
.far.as provided for by Section 37M of the labor Code,for fee performance of the
work for which this Permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this Permit is issued.
My Worker's Compensation Inmrance carrier and Policy number are:
Cartier: Policy No.: _
CERTIFICATE OF EXF.M PfION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed if the permit is rorone hundred dollars(Saco)
nr less.)
I cenify that in the mcrformmce of the work for which this Permit is issued,I shall not
employ any person in any manner so as to become subject n the Workers'Compensaion
Laws of California.Date
Applicml
NOTICE TO APPLICANT:If,after making This Cenilicatc of Exemption,you should
become subject to the Worker's Com penmonse previsions of the Labor GNC,you must
OO forthwith comply with such provisions or this permit shall be deemed invoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that mere is a construction lending agency l or the Performance of
C the work for which this permit is issued(Sec.3097,Civ,C.)
1 Lenders Name /f @
z Lenders Address
V 0 1 cenify that 1 have read this application and sme that the shout information is
(rs (.. correct.l agree to comply with all city and county eminences and state laws relating to
0 U building construction,and hereby Mahone,representatives or his city to enter UN.the
D.1 tmew.meminned property for inspection purposes.
G (We)agree to save,indemnify and keep harmless the City of Cupertino against
N liabilities,judgments,costs and expenses which may in any way accrue against mid City
U f a consequence of the gaming of this Farm it.
'-" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of AnPlicaData,HAZA
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the a Cu,pam or IMuni building e.Chapter
sore orhandle Health
material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the HcahA enJ Safety
Cube,Section 25532m)? All roofs shall be inspected prior to an roofing material beim
❑Yea ON.
P P Y g g installed.
Will Bc applicant or future building occupant aria quipmcnt or devices which If a.roof is installed without first obtaining an inspection,I agree to remove
tt huenrdmuv air contaminants as defined by the Bay Area Air Qual try Management all new materials for inspection.
District'
❑Yes 0N
1 have read the hazardous materials requirements under Chaptcr 6.95 of the Califa-
nia Health&Safety Code,Sections 255)5,25533 unit 25534.1 unlbrstand mat if the building
rocs not curtcmly have a tenant,that it is my respaosihil ity a amity the Mariner of me
mquiremcros which must to mm poor'issuance of a Ccnifleare or Gcupmcy. Signature of Applicant Date
Owner or uothtumod agent Data All roof coverings to be Class "B"or better