00100060 (2) CITY OF CUPERTINO
xuD.uwc DIVISION PERMIT CONTRACTOR INFORMATION:
RULDINCAODRg59736 VICKSBURG DR HOT WATER INC PERMII NO. 00100060
OWNER'S NAME JUERGEN NEINHAUSEN 2531 GRACELAND AVE APPLICAHONSUP05y106/iE!000
KINE: _ (650)298-6494 SANT IARY NO. CONTROL NO.
n ce 7. ARCHITEC(ENGINEER: BUILDING PERMIT INFO
w— 81.116 ELEM PLUMB MECH
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Ciy
N LICENSIIU CONTRACT(llif Di .1ofCh.' '
I huhuhy nlYnn thus I aha Ilccnecd under'Pruvisiunn of Chupa'r 9(mmmendng Job Description
F�tw ppn Seettn 7alln)r Dmi,n,naonhe Rnsmex,tne vroreaons este.and ruy peca,e REPLACE WATER HEATER
Y r in full R,mc and cRccl.
z z sc Lcensc Class Lic.I
6 V
Date C.urowl01
g O Alicurrreuse ax(,
E(,+tnnoN /
I undersuuW Illy stuns III I be 'S ux pLAR TION
a o i OLicensed pinfe,onail
N'NER-BUILDER DECLARATION /
1 hereby t(irtm that 1 1. rR.,in from The)onion Co Licensec Law for the
5-Z following hick renaoa(Scdiot TilLARutinos anA Profusions Code:Any city structure county
`F C !)no t,its iilen n c.also re......firs the
6 aper,inlprnvu.Jmnulixh or repair any xtrvaure
a3� but I .. 4u nowimo If 11 'tt II 'y d:ft mut
(eur II I t P fill 11 1 t sl 1'.pChu"a") Sq. Ft. Floor Area Valuali(�Illj00
front nerving wins Section 70011)d the
basis
1 rr the RDI nos and Pmfcan ons Ude)
or mm he is 31.5 by
merefmli and Inc hasi,fur the alleged cxanant In Any violation
of Salmon a than
s any hundred
tm for a pemtit sunjccu the applicant m a ass penalty
nrnmmnrolnanrvehnndreJJnnnRaSool. APN3ixahle0] 0. 00 Occupancy Type
❑Lauownerotthe frofeny,or my employes is it Ovalle,as theinnle cou,jualmJna,
call it(' he work,one In structure : t fl I t' : s 7044,
Bu,l :nulProfession,Cr n c t t , Law d Iapply ,,a. 502 — FMAIL"cLW9if Rb ENERGY
o, r of property Who build ntprovex Ih mrd who does such work h resell
through hi,own etnpwyee..providedmm such intpmvemenl,are not intended or 506 — GAS TEST
offered far sale.If,however.the Molding or improvement is within one year)f
Inmple,oa,mel,canerNtolde,will havethe hadenof pro,;ngmm he did a,,,build or 507 FINAL PLUNKING
mprnm rot Pontus or,ale,).
❑1,as owner oI'the porNriv,am exclustccly cootaeting with Iiceltad contactors to .
construct the project Isle.7044,Business and Profession,Code:)I'he Contractors
iaaa Law roes not apply loan owner nr rrorcnr woo Maims or improves maolt
e .
sad who contracts for such project win,a cnntraandsl licensed Pursuant to the
Comractnr's Liccnu Law.
❑1 ant exempt under Sec. ,R&P C kor this reason
Owns, Date
WORKER S COMPENSATION DECLARAI ION
I hereby dlirm under penally of perjury are of the following declarations:
1 hove ;ad will ruainmin a Cci iticale of Cnn.car to sch-in-re for Wurkcr's
nope ,ufhm, as provided far by Sadao 3700 of the Lunar Care, tar the
Peru... ncc of Ibu week for which Ihix pcnnil is I....d.
❑1 have and will maintain Worker's Comsrnotio i Inxumnce,a,required by Serino
TNIB of the Latour Cede,for the performance of the work for which this permit is
sued.My Wo kers Coruscation).hnumncc carrier and Policy numM,arc:
Carrico policy No:
C17RIIFICAIION Op EXEMP'T'ION FROM WORKERS'
c m vrNSA'rION INSUIdANCC
(This action need not be cmnpleted if the pcnnil is for one hundred dollar
($100)nr less.)
I ceail'y that is the red nrlounce of the work fur which his permit is issue,1
,hull an rnlpiny any purnn In any manna so n,to hecnme object to the Worker,
Cnmpen.'ra i Law,of Cd.J.....ia.Date
Applicant
NOTICE J O APPLICANT;If,aficr making this Cenificme of Exemption,you should
become subject o the workers Cornpensation providn o of the Laban cede.you most
Q forthwith comply with such provisions or this Permit shall rte ranted revoked.
CONS'I'RUC'I ION LENDING AGENCY
CL > 1 herehy ufmm Ihm Iherc i,u cp.oupto n Icnding agency lin the p:donnanre
of the work far which Ihix permit is i...ed(Sec.3097.Crv.C.1
iIM Lender,Name a
Z Lender's Address
U 1 certify that I have read this application and state that the above intonnatin i is
[r a,mTl.1 agree m colnply with ah city and nNnly o da an,c,and guile Inca,retain,
OU
to hadding construction.and hnmby hmmanae efe,ernause,of ed,aity,wmue,upon
the Imove.mcaroned property tar inspection purpose,.
F}„ y (We)agrcelosme.arbitrary and keep harmless the Citynl Curtain.against
CIO liabilities,judgments,cow'and expenses which arty in any way acerae against said
U 7 City in consequence of the granting of this pcnnil.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
Dale
SOURCE REGULATIONS.
Signature of ApplicantlCnntamor Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future rodding rccurant sane or handle hazardous mamtial Type of Roof
as defined by the Cupertino Municipal Calc,Chapw 9.12,and the Health and Safety
Coca.Section 25532(0)7
OY r 0N All roofs Shall be inspected prior to any roofing material being installed.
wllJaCufppeaat or hour,Wilding ocenpnm use e4uipntent or davlecx which If a roof is installed without fust obtaining an inspection, I agree to remove
unit huannlaas air coma ounces as defined by the Bay Arca Air Quunty Man rgemcnl
oratuar, all new materials for inspection. Applicant understands and will comply with
°Ye, ON. all non-point source regulations.
1 have read IM1e ba,ani mate ials requiavmcm,under Chu ptr 6.95.f Chep
C lif unin l le:dm&Suf ely Gd•,Suctions 253)5,25513 and 25514.I mderaand Ihml Ic:dm&Safely Gxl•,S uetions 25315,25533 and 25514.1 wtJeraund Iia
if dm building d)cs..let rrunly hmc a tcnmal,111,1 h iuny regrao ihility a amity the
occupant ,fine ocuhnnenr which mau Iw nml Print a I sion,e or a Cenirr to of
Occupancy' Signature of Applicant Date
ig
owner a,,,h,l,n a,i,.rd, en, fy.,r All roof coverings to be Class"B" or better
OFFICE