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02040026 (2) CITY t DING DIViSiO NO CONTRACTOR-INFORMATION: PERMIT BUILDING ADDRESS: PERMIT N0, 11845 UPLAND WAY WATER HEATERS ONLY 02040026 OWNER'S NAME: APPLICATION SUB DATE HARLAN SETETHE 970 E. MAIN ST, SUITE 201104/05/2002 PHONE: SANITARY NO. CONTROL NO. (415) 566-2209 ARCHITECDENGINEER: BUILDING PERMIT INFO U BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION 'S» I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description i=C with Sacd..7000).f Diviaion3ofthe Businessmd Prufaidmos Code.andmylismse REPLACE 50 GALLON GAS gW�ApTpER HEATER is in full forte ane,.(B �r @0 Lf0�� ,w< License Li,. a Z ,`� a.u Date os/A 7 Contracmr �LL ei I ARCHITECT'S DECLARA ON DEC Ora 20 2 „g i undcrsmnd my plans shall be vud as public records 7 S O O Licensed Professional OWNER-BUILDER DECLARATION axi'4 1 hereby u(Srm on 11. exempt from the Contractor License Low for the �I• ® � F?< following reason(Section]031.5.Business and 1'mfessinns Code:Any city or county L I F❑ which requires a permit m construct,alter.improve,demolish,or repair any structure u�3$ .pdonoits issuance also requirts Weapplicam for soh pemniuo Eleasigned"tuarent. that(commencing eith Secmi,70,R of the he Re eat and Probations Cmr9 s' , ' r a Valuation (commencing x'ith5eciion.7(NIO)of Divi>ionJof the Repeats and Pmfmsiona Cale) i a ' 36S�O D Tr6r ,,,tr 1.S It ' or that he is exempt therefrom and the basis for the alleged eiernuion.Any violation " - ` of Section 7031.5 by nny applicant for a mnit subjttta the applitant me civil penalty .f not more than rive hundred dollars($500L 502APNVINAL PLUMBIN ENERGY Occupaney J P e 01,as owner of the property,or my employees with wages as their sole compensation, 606 GAP M9rT_ '-will"do(he'work:and(be swctute is not intended wr""offered for sale(Sec:]044; Business and Profession.Code:The Cnntmcior•s License Law dna not apply to an 507 — FINAL pl ftggrp fqbspections l' - b;- owner of property Who Wilds or improves therame.and%he Jas such work himrau or throw h his own employees.pe velcal that such imp ovmnems arc not intended or _ _ :6ample or sale.IL ne the building p of Moo n gold wuhm one year of - ` improve for the mvne b 'IJ ill have thehuJ of proving that he did no l build or -' improve for pumnse of mleJ. m l he project r jhe p open),am Basin sely d uun sion, s n.The mumate to nstmct the deal riot (Sec, 10 a Business and Pnt,whob Code:)The Conthe mr's „r License Law docs not apply loan ownwith property who builds or improves t.to the _Comma ce,Lic ns Law,. projttts.with.e.comracmr(s),IicensW pursuant.m the_ Gmmcmts License Law.. - _ .._ . ... _..__._....__...._.... _._._._.__._..._.___l_....._ ___... ..______.. s _ Oµamexempt mderSac. - .B&PC for reason Co . _, stet`•.,'i - ., Date' . WORKER'S COMPENSATION DECLARATION I hereby amrm under paral(y of imrjury one i fihe.(ollowing declamtimm: 0 1 have and will mmntvin a Caribbean,of Coneam'ro s,lf-insure for Worker's Compensation, as.provided for by Section 37110 of the Labor Code, for the performance of the work far which this permit is Wool. . 1 have a d will maintain Wo A s Courn,meadimbestamcii,as regmrtd b Section of the Labor Cod forN Performance.f thework for which this f permit is Cseed MyW kcrsC pen au Incur rice Gamer anUPofcy mbca : � -�: is r► I .'YdlerNn, l.J/6 SGS �% '1 h r tit ,�1 � _.. '.:CGRTI CAI IONOFEXEMPI SATION,INSURANCE10NPROM.WORKLRS', •.I�• I. hl1'i . . .s _ ,.. :.. _.._.__ _............... COMI'ENSATION .. ......._._ "'(This section read out hc'mmplcad if iM1e permit is for one hundred dollars 6100)or less.) I-I can,fy that in the performance n the work for which this permit s issued 1 Comnot employ any person n any man as m become sub3cet m the Workers' - - Compensmion Laws of California.Date,��' NOTICE TOAPPLICANT:the Worker's a tteipen ing tich isew Won,of of Labor(ion,yoou most n . . Z becomesubjectcomply thesuch Crimes or this proruil shall the Leber CotAked, most r mhwilh comply with such provisions or this permit shell be deemed revoked, Q 0 !o "CONSTRUCTIONLENDING AGENCY r , 'heaby ifRrn Ins there is a m.sdunion lending agency for the performance of the work(rn which this permit is iamed sec.3097,Civ.C.) Leder Nam . .. - ••ix .. _ .. _.__ ._ _ . _. ._ ._._ . V�'c 1 Gen fy that I have mail this application and state that shove information is ' I, [r horrecl:1 agree in comply with all city,and county ordinances and state Iowa relating ' �.V to Wildingaastmciion.and hcaby emhorixe rept<sentutives of Niscity tommrupon the above-mentioned property for inspection purposes. . Lia (We) cove ve indemnify and keep Notorious the City of Cupertino against . V) liabilities,judgments,costs am expenses which may in any way secret against said V.z City in consequence of the gnnU- is perml0 r APPLICANT-0NDIE, ERSTAN . NDN ,L CO'MPL hTTi ALL,�ry yTO T ' sip ICEREcuLAnovs a �J Issued b) 21 Date g cauUc t m ? D t " Re-roofs C d Bnedlb�the HAZiARDOUs11ATERIALf DISCLOSURE i at r of Appli /� -•� ni 'plicant been,Wilding occupant sore or handle h" taws ont Type of Roof., Copes o M n c pal Cod Chapter 9.12.and theHealth and Safety Ede Section 2553 (a) ores' t' All reals shall be inspected prior tto_any_roofing material being installed. r Will the applicant.rfuture Wilding occupant use equipmentordevices which t If a roof is instAlled'without first obtainingan'ins ection; I agree td remove emit hazardous air cont o ed by he Bay Area Air Quality Management P g `District, " all new materials for inspection. Applicant understands and will comply with contaminants ,tri ❑Yea Pp P Y... t I. �; �� , ,�,�, , , al]'non-poini'souFce regulations:,. ,. � : 1 h' e rcaJ'Ihe hmallous mmerials mqu mmmIx under Chapter 6.95'of the C fomty Heahh&Safn Code Sections 25505 25533 and 25534::)understand that I fdt illi gdasnot currcanyhave atenam ih t R is my responsblty to notify the - paneofCher mm h¢h'must be ma pot t.tss n 'faC Bc}t f, Coca, � L,L Signature of Applicant Date wrier or thoromd-12 rut ' ' Da/„v All roof coverings to be Class"B”orbetter" n . ...OFFICE -- . .... .. .._. .. . ..