02020122 (2)OFFICE _.
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< CITY O$ CUPERTINOPERMIT,
CONTRACTOR INFORMATION:'
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DIVISION. -
BUILDING D
•.BUILDINGADDRESS:
PERMITNO.' _.
'1`09;12' SWEET, OAK ST;; '.
JUST WATER 'HEATERS '"INC'L
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OWNER'SNAME:. , .... ... _.
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APPLICATION SUB DATE _
WONG MANSHUN AND FLORENCE TRITS
1764 NATIONAL AVE
02/28/2002
PHONE:
SANITARY NO. CONTROL NO.
(510)293-9901
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ARCHITEC"HENGINEER:
BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION-
lob Description
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hereby afEna,Iran I nm Ii<enxm ander pravlr,ona or chaP�er 9 (commencing
widsemmn]IXOlorDitixiop3onneBaamextand nfexxinnxcod.andmYB[enxe
REPLACE 40 GALLON GAS WATER HEATER
is m fall force and after.
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Lic<nu Class Lac. p
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Dam - - Cartoonnr
ARCHITECT'S DECLARATION
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1 unJenmnd my plans shall he axed as puhli<r<coks
Licensed Professional
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OWNER-BUILDER DECLARATION
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i = os 1 hereby affirm than I a amara moralism Contracmr's License Law for the
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z a 1'ollnuinI, anon. (Section ](131.5, Business and Professions Code: Any city or county
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"' " -' "' $1040
� G which quires a permit i construct. nim improve,A ncf. h r repairany structure
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'3-.pnmmi,ourmrea aboum the',umma, for such pe6ml fla[Bedswmmet:
't. (D `J l'U U:7U.U.°��-_['.
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ohm hq Rel nsed p6itslinat to the provisions of the Cramarar Licia. La (Chapter 9
kommercmg.lh S2ct on ]IlIXb of Code).
he basicoofnhelujcd .pdvWfasinds
of h2 is li and for the alleged uemgioa. Cny violation
.li�•;,3' r, di,I;'."
errs
.d Section ]03 L5 by any apPlicam for a permit subjects the applicant io v civil penally -
Sec D 1.5 byanyapplicantfor
infant mornhanfivchundrcddollars(g5W)
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501My LPLMI
ccupancy Type:
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' C1 I 'mila ope.Limy employe th wages as the sale compensation,
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- 5 0 7' - — FINAL pE;jMjggW f ec[ionS
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'will doIhedra dthcamnot n, ded offered for into (Sec.
Business and Professions Code The Contractor x License law does nor apply to an
o sunt of property Wap builds br improve.• Ilmomr. and who docs such work hunself'
or through his own employees. provided that such improvements are not intended or
'.off d'f s5lelf, lio er, the avildin6 orimprovcmwt is: IJ n one yam of
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the owner tmailder will have the burden of proving mm he did not Wild or
iompletion.
mprove far parlwsa of
coIsax ownar hope mope.•am r'
Businessacomramingwithlicensed Connors
(Sec. ]was Business and Pr Contractor's
CMo:) Theimproves
Licim Law ons n y who
ueenreicodoe.n manowner of propertywho Bandaar pursat
(apply
to me
and.who.<ontncu. for such projects with a conva<mgs),licensed. pursuant to me
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Contractor's Licensc Law. ,,,
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• 0 l am exempt under Stt. ,B&PCfor this rtason
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'•_'" WORKER'S COMPENSATION DECLARATION
It PI:Il 'I J. O 2002
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thereby affirm under. penalty of perjury dna of the following deductions:
❑ 1 have and will maintain'a,Ccnificmc of Consent to ulf-imme for Workers
Compensation, as provided for by Section 37W of the Labor Code, for the
BUILDING.
performance of the work for which this Permit is issued.
❑ I have and will maintain Worker's Compcnsauon Insurancerequired by Section
37W of the labor Carl far alre Performance of IhCwork far 1 h this permn is
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issued MyWorker's Compensetiic Insurance came and Policynumber
Cmrri�r: i Policy No.
six:a ty " r a i)
(7,-
.'ii-XBRTIFICATION OF ENP-MPl10N PROM WORKFlRS
COMPENSATION INSURANCE
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(Ths section rte d ad be mmplad if the pertain is for one hundred dollars
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s � 1 «nrfY dui in the perk mmnce x r th work for wM1 ch'tM1 p mit sWokx'1
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' shall not employ any_person in any mannerso as m become subject nhc Workers
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_ Compmartimi Law. of Calificona Data '
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•'! Applicant ..
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" NOTICE TO APPLICAN f:If, after making this CeniGcate of Exemption, you should
. Z become subject to the Warkeres Compensation pros isions of the Inbar Code, you must'
O forthwith comply with such provisions or tti s Permit shall W deemed revoked.
'�. `CONSTRUCTI 0N LENDING AGENCY
consction lending agency for e performance
7 I hereby affirm ,has them is a wN
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of the work for which this permit is issued (Sec. JW], Civ. CJ
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Landers Narc .r ,...-....,. .: ... ..: ..
Land cr'x,Addbar •
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1 certify that 1 have read this application and state that the above information is
comet. I agree to comply with all city and county, ordinances and nate laws relating
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to building construction, and hereby amhomiciepresenatives of this city m enter upon
the abate -mentioned property for inspection purposes. ,
ti p., I Wry agre<to •eve, indemnify and keep harmless the City of Cupenino against
to liabilities, judgmems, cons and ex,e vas which may in any way accrue against said
i.z City in consequence of the granting of this permit'' .
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APPLICANT UNDERSTANDSAND WILL COMPLY WITH'ALL' NON -POINT
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Issued by: Dale
SOURCE REGULATIONS.
Signawrc of Appli< �ai�
Re -COOPS .. .. ... .. ..s. ..
HAZARDOUS MATERIALS DISCLOSUA
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' sum me applicant or f tu Wilding print store or handle waandoux material
Type of.Roof
'as dabbed by the Cupertino Municipal Cd Chapter 9. Q. and the Health andSafety,
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CodeSection 25532(1 QN tI ` 11t
,i]❑Yes �, v
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All roofs shall be inspected prior to_any roofing material being installed
were applicanto,fut eft ldi g P toecap p tordr mei h;cn,
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If a'roof is installed without first obtaining an inspection; -I agree to remove
em t h zvd e r eo n mmam as dented by the Bay Area A Quality Management
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all new materials for inspection; Applicant understands and will comply with
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all non -point source regulations; ,' .
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"1 hove -mad the havtdous materials requirements under Chapter 6.95 of the
.Califdmia HeallM1h Sofey Cede, Scctiims 25505.255]7 and 35574. 1 understand that
if the Wilding does not currently have a tenant. that it is my reiponsibiloym notify the
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dccupmn of the mquircinenp wihich most be met prior to issuance of a Car ificare of
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Signature of Applicant Date _
All roof coverings to be Class "B"or better'
Owner or aatM1orized agent' Date
OFFICE _.
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