02070132 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: .......18930 TUGGLE AVE HOT WATER INC 2070132
G I0ICE LARSON 2531 GRACELAND AVE APPLICAbIlY1Yj' 2002
0-11 ONE: (650) 298-8494 SANITARY NO. CONTROL NO.
O o O ARCHITECTIENGINEER: BUILDING PERMIT INFO
iii:r 1r BLDG ELECT PLUMB MECH
t.<ian. u c_I
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ZLZ`n LICENSED CONTRACTOR'S DECLARATION 6
Ihereby affirm that l am licensed under provisions of Chapter 9(commencing REPLACE WATER H�kTERrij]��. ption
:Lt.:Lm with Section 7000)of Division 3 of Butimessand Pmfessionsf e,and my Been.
m�� is in full force an «t. ^0 i
s�< Lironu CI Lic.x i�
O o.O Date D LA
wo .I-i ARCHITECrs DECLARATIO
g I undemm�d DIS plans shall W uutl es pulite meats
aOO Licensed Professional
OWNER-BUILDER DECLARATION
.-4
to 1 hereby affirm that 1 am exempt from the Contractor's License Law for the 5 O 0
I-Z< following reason.(Section 70313,Business and Proreuiom Code:Any city or county
Y
.EQ which res ias a permit to conswn,alter,improve,demolish,or repair any structure
63$-Ep:rlefs ismence_alm requirs the applicant for such Permit Bk a d'oed statement 'g. ��--.n1
met he.islicinudpunudnito WepmesbmoftMConmioe.Lic«ulaw(Chepta9 ...,3'O§._g-i. L' a-:v Valuation
(tmmmehig wit,Section 7000)of Division 3 of the Business arM Professions Code) i,' T.. - •.r- r- ��,
or that he is exempt therefsdn and the basis for the alleged exemption.Any violation
of Senlm 70313 by any applicant for o permit wbjm[me epplieant his civil penalty- tY y Typ
of not more ten five hundred dallan(g500). Flrl Occu ane e
506 - GAS TEST
❑1,d oche-of the and he structure
t a my employees oy«a wit wages ercttheir r sale'mpcnsation, --�
willdo the-work,and tc oxi Th is not ctor'&d ore Law for snot apply
7040;
Business and Professions Code:The Contractor's License law dost not apply tom $peCt10I15
owner of pmpeny Who builds at improves thereon,and who does such wank intended
or ,t
o erred h his own however.
provided that such improvements an na intended m
g J
offered for ole.IL however,the building or improvement is that whin one year of
completion,the owner-Wilder will have the burden of proving that he did wt build m '
improve for
purpose,of sal'.).
0 e[awmr of the
propMy,am Buxin exclusively d Profs si n&Ccx :)The contractors to
_ -
construct the Pmjat IStt,7044,Business and property
who
Codes The Improves
tenors
License law docs not apply to an at,w th pmpeny who Wilds s improves lash,
_Co who License ee Lowch-proj«u.wim e.contr«mrtsl licensed punumt us the
_ _-- 01 ons nc License Law. -
_ ❑lam exempt under Sec. B@PCfor iia reason
Owren - n •- `Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury ane of the following d«laetiom:-'
Ihave treat will maintain a CertiOcate of Ganser to til&insure for Worker's
:ompenwion, as provided for by Section 3700 of the Lebo, Code, far the
pcAosnutx of the work for which this permit is issued.,
- z
❑ ce eM will moinuin Worker's Compensation Imuran¢,as required by Section
:: -• 00 of the labra Code,for the performance of me work for which tis peen,is
issued,My Wark d C pcnu'pNmurence curia uM PoPobcyy number ire: _
Carrier.
Y' CERTIFICATION OF EXEMPTION FROM WORKERS'
- ,(POMPENSATION INSURANCE " s
mos section nett not be completed if the Permit is for one hundred dollen
($100)aleu.)
3 certify Net in meperfoany in of the wank for which this ct to tin fisted,I
shut]Crim not employ,any person in any manner t u to Wcame subject to me Worker'
Caries,%,on laws of California:DateAppl
:b,,..,TOAto the oftese(tcrmokingtis Certificate OfoeLabor Exemption,you uhmulst -
0z become so amply it Workers Cortins or tion Provisions Of the Labor Coda you must
0 fonhwim comply with tch provisions or tis permit shall W domed revoked. 't
CONSTRUCTIONLENDINGAGENCY .W
I hereby aMcor that!here Ia it construction lendingy agency for Ilii kewo sett
y.Gof to ors for which th ,p mer iuueQ(Sc 3097; iv.
-Lembo s,Name-" ..... .._.,. - ..__ .. .._ ..... ..... .. .._.
r7:2, LeMe_r's Addneu
t..3 � 1 certify tat 1 have mW tis application and nate tet the above information is
IT+_F•r cemeet.I agree to comply with all city and county ordinances and time rows existing
CST) to Wilding tmtmtidn;and hereby ammonite iepresemdiva fthis city toentarupon
tg7 to abovementomed property for inspection nirpmes. , .
A. (We)agr&to sev4'Indemify ad keep humlesn,heCiiy Of Cupertioo igeimt
fn liabilities,judgments,costs and eapmns;which may in my way seems against said
U City n consequence of the joining of this penin[ Wte
APPLICANT, ULATIONS 'IUNDERSTANDS,AND WILL COMPLY•WITH ALl NON-POINTSOURCE'REGISSlled by.
re
ctser
Si aNWillfine'alidanAZARDOU MAT an t ,.Dete' Re-roofs
,HAZARDOUS MATE RI ALS DISCLQSURE ""
pp g pant store oehandle haiudous onamid Type Of ROOF -•' " •- - - -
as defined by the Cupenmo Munwtp 'Code Chept 9 Il and me Health ad Safety
Cade Sicnon 1553Ma
❑Yes l r Na,,l. All.roofs shall be.mspected�prior.to.any.roofkng material.being.installed.-.. .. ._
will th applicator tons building occupant.use equipment odrices;which If a roof is installed without first obtaining an inspection',I agree to(ieinove
-it hezudous ter caress ants u def ed by me Bey Air r Quality Management
!tet all new materials.for inspection. Applicant understands and will comply with
g °Yes all non-point source regulations.'
' dshe bmldln tlon Ne hoer vex meroHels .tamest under Chapter 6.9!of the
g Y P d15534 hlilyt.suif that -
Occu J m responnb Lty to noti(Y the
laezad
Ctdomu Health di Safety Code Sections 15505 15533 an
cY ^ Gem of l �A,e l-'C•�e - e�'-�
O sumonzc 1 tenant the t rs
oecupan[oereGduio mtefn"tsnthQ¢'hm}�-�`t/fby.te•! nrto i S'IgnatUI�an Datt/
.` '. Y`✓ Ylssuana of a Ceni
�-- All roof coverings to be Class "B"or'.better
g
Data
' OFFICE ' -