03010180 (2) CITY OF CUPERTINO a °--
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: HOT WATER INC PERMIT NO.
10348 STERLING BLVD nini ni Flo
OWNER'S NAME: 2531 GRACELAND AVE APPLICATION SUB DATE
PHIL EULER 01/28/2003
NE: (650) 298-8494 SANITARY NO. CONTROL NO,
ARCHIIEC(ENGINEER; BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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0pp LICENSED CONTRACTOR'S DECLARATION "s J DCS rl II
�i hereby affirm that 1 am licensed under prooiaian,of Chapter 9(commencing
! wSyys�tion70)(E fDivision3of NC Bu' ss anJPrnfcuio sCtele.,m myliccrce is s
SaZ Uwnwree and erzcetL' ✓' 'r 3 t7 REPLACE WAT E�I, ''R. . ,
0th-�Z Llftnse Cl s Lk.g 999///aaa111/////�D`�R
Date C tmnor
� g9 ARCHITIiCI' LA ATI N —
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I understand my plans shall M used as public records
dO�yU.
u rhDy Licensed Professional
5 OWNER-BUILDER DECLARATION
Eu�<X I hereby affirm that I am exempt from the Contractor's License Law lir the
m-0 0 following reason.(Section 7031.5.Ransoms;and Professions Code:Any city or county
o. $fir. which myuire%a permit to mnstrwt altar,improve,demolish,or repair any soactum
prior to its issuance,also requires the applicant for such permit file a signed statement
t-iQ that he is licensed pursuant In Ne prnvisionsof the Conmmo'.License Law(Chapter 9 Sq. Ft. Floor Area $y"tion
$ (commencing with Sectio 78(1(1)of Division 3 of the Business and Professions Code)or
that he is exempt macer on,and the hour for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil Penalty of CIO 0 Occupancy Type
not marc Nan Ove hundred doll..(SSfgD.
❑ I.as owner of Be property.or my employees with wages u their seek compensation.
will do the work,and the machine is not intended or offered for sale(Sac.7644,Business 502 -
and Professions Code:The Contractors License Law does not apply to an owner of 506 - GAS TE utre nspec Ions
property who builds or improves thereon,and who does such work himselfor through his
own employees,provided that such improvements am not intended or offered for mle.If, 507 — FINAL PLUMBING
however,the building or improvement is sold within one year of completion,the owner-
builder will hive Ne burden of proving that he did not Wild or improve for purpose of
sale)
I,as owner of the property,am exclusively contracting with licensed com acro.to
contract the project(Sec.7044,Business and Professions Code:)The Conuacmr's Li-
cense Law deco not apply to an owner of property who builds or improves daemon.and
who contracts for such projects with a coram elor(s)licensed pursuant ro the Contractor's
License Law,
❑1 an,exempt under Sec. .B&P C for Wis reason
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following deal...linm:
have and will maintain a Cer ificate of Conant to mlf-insure fur Workers Compcm
1301.y1.)
n,u provided for by Section 3700 of the labor Code,for doe performance of the
for which oris pcmoit is issued.
haus and will maintain Workers Compensation Insumntt,u inquired by Section
of the labor Code,for We performance of the work for which this permit is issued.
eMyWorkeCs pttmpensatpd�N cltnierand Policy Pol cy No. number ��4
S/J Cr/ERLRTIFIICC_ATE OF(EEXEEMPI'IONFROMW RK1di
COMPENSATION INSURANCE
(This section need not W completed if tlin permit is house hundred dollars($100)
or less.)
1 certify that in the performance of the work for which this Permit is issued.I shall oat
employ any person in any manner so m rs become subject In the WorkersCompensation
Laws of Cdlifnmie,Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worked Compensation prevision%of the labor Code,you must
�Z forthwith comply with such provisions or this Permit shall he deemed muni
zO CONSTRUCTION LENDING AG ENCY
El hereby affirm ohm there its construction lending agency l or the Performance of
7 the work for which Nis Permit is issued(Sce.3097,Co,C.)
WJ Q Lender's Name
z Lender's Add..
U I certify that I have read this application and sum that the above information is
Lks (~ correct.l agree to comply with all city and county ordinances and sure laws relating to
Q U building cunstaction,and hereby authorize representatives of this city to enter upon the
{ra above-mentioned property(or inspection purposes.
4ks (We)agree to sass,indemnify and keep harmless the City of Cupcninn against p
V) liabilities,judgments,costs and expenses which may in any way seems,against mid City S'-']�� '//7
Uin consequence of the granting of this permit /t�V
z
AP PLI UNDERSTANDS AND WILL COMPLY WI 1 AL NON-POINT Issued by: Date
SOUg B UI.ATIONS. 'll At
V�/V _ (/�T — Re-roofs
Si 9pplicandcontraetur r
HAZARDOUS MATERIALS DISCLOSURE e Type Of Roof
Will de applicant or future building occurrent store or handle hvallous material
as defined by We Cupenion Municipal Cade,Chapter 9,12,and the Health and Safely
Code,Section 25532(.)'' All roofs shall be inspected prior to an roofing material bei. Installed.
❑Yesrvo P P Y g g
Will We applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
hazardous air contaminants a defined by the Bay Arca Air Quality Management all new materials for inspection.
Incl?
❑Yes �No
I have read We hamNous nmmrials mquimments under Chapter6.95 uI We Califon
nie Beef"Safety Code,Sections 255115,75533 and 25534.1 understand&mil the building
does tly hew a Want,Not it is my reslonihility m notify he occupant of the
reyu: cu hichmustbemetpdor&issumceofaCenifr of upancy. Signature of Applicant Dale
net orircdagent v7(0/a//s✓� am All roof coverings to be Class"B" or better