03030096 (2) CITY OF CUPERTINO r 's°••x�". t^ry°'.�}�"' -- 'gp09,
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BUILDING DIVISION PERMITs �y ; '"^"^ Q O�ayg'q�Q -
BUILDINGADDRESS: JUST WATER HEATERS INC PERMITNO. -
OWNER'S NAME: 1764 NATIONAL AVE PPAMIT u DATE
ONE: - SANITARY NO. CONTROL NO.
(510) 293-9901
ARCHITEC IENOINEER; BUILDING PERMIT INFO
BLDG 0 ELS PLO : O .
3o LICENSEDCONTRAC1ORSDECLARATION 7obDescri tion
1 1 heroby elflrm Net 1 em Recnted under provisions of Chapter 9(commencing p
with Section 7M))of Division 3.f the Busincesmd Professions Code,and myliceruc is
in full forts and dffeeL y�
License Claes Ue.is REPLACE WATER HEATER Ij�Q��Q, 9 _
Dam_Conuctelor
ARCHITECTS DECLARATION (4 0 GALLON GAS) p 99
I Iunderwm
ndmyphsha11Wtiredaspublicmemrm APR O 3 ZOOJ
`oS Licensed Professional
OWNER-BUILDER DECLARATION -
gZ I hereby afar m that l am exempt from me Contractor's License Low for the BUILDING
O O following mason(Section 7W I.5,Business and Profeasions Code:Any city or county
9 which raqulra•permit in commet,aImr.improve.demolish,m mpsir any auvnum
1„n prior In its iutumcc.area acquires hcapamott pouch permit to file eaignedneumeni
0 that he 1,licensed pursuant In the Provision"or the cmuncetursUccnxLaw(Chapur9 Sq.Ft.Floor Area Valuation
27, (commencing with Section 7")of Division 3"r the Business and Profcssmns Cade)or
` that he Is exempt therafrom and the basis for the alleged camption.Any violNon of 8864
Section 7031.5 by any applicant for permit subjects the applicant to.civil penalty of APN Number Occupancy Type
not mom than In hundred dollen($500).
01.as owner of the property,or my employees with weges as their sole ampeissimn, 31621084 . 00
will do the woh,and theswcwm isnot bounded or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Convenors Liana law dace,Wt apply in an p
an owner of
property who build,arlmprowa thereon,end who doessuchwarkhimxlfarthrough his 101FOUNDATION
own employees,prodded that such improvements the notintended proffered forasu.If, 102 — PIERS
however,the building or Improvement a sold within ore year of compledon,ma
e owr.
builder will have me burden of proving that he did not build or Impmee for purpose of 103 - UFER
said.).
❑I.n Owner of the property.am exclusively contracting with licensed contractors;to
10 4 — REBAR
contract the pojecl(sec.7044.Buslnm and Profession Codw)The Contrcursu. 105' - ANCHOR BOLTS .
cave law time not apply to an owner of property who bolds orImprovas thereon.and B 106 — SEWER & WATER'
who contracts for such projects with.contractor(s)licensed pursuant Cannotthe Cantn
Lkenlaxemw - 202 - UNDERFLOOR PLUMBING'
❑Ian ept under See It this mason
203 - UNDERFLOOR MECHANICAL
owar woRKea7;coMPeNsarloNoecLARData 204, - UNDERFLOOR FRAME
Iherby.M. ads,penalty ofperjury"aofthe following declarations: 205 - UNDERFLOOR INSULATION
I hew and will maintain a Cenlfiam of Covent to xlr-lasuw for Warleer's Compen. 301 — .ROUGH PLUMBING
anion,ae provided for by Section 37M of me labor Code,for the Performance or the 302 — TUB & OR SHOWER
work for which this permit B luued.
❑1 haw end will maintain Worker's compensation lnwrma,u required by Senion 3 O 3 — ROUGH MECHANICAL
of the Labor Code.for the performance of the work for which this permit is Issued. 304 — ROUGH . ELECTRICAL
crime,Compensation insurance,csniar and Policy number em: - „
305 FRAME
cr. Policy No.: =
CERTIFICATE OF EXEMPTION FROM WORKERS 306 — HOLDOWNS
COMPENSATION INSURANCE .307 _ INSULATION - . .
- (Thusession need not hecompleudifihepermit refmanchundred dollm(SIf10) 308 - SHEETROCK
m lets.)
—'— 1 cenify that In the performena of the work for which this permit is lured,I.hell not -- 309 EXTERIOR LATH' -
employanypersonlnanymementsoashr bccme.ubject to the Worker'Compensation 310 — INTERIOR LATH'
Laws of California.Data
Applicant 311 — SCRATCH COAT
NOTICE TO APPLICANT;If,after making min Cenilicam of Exemption,you should 313 ROOF NAIL
become subject the Worker',Compensation provision,of me Uhor Code,you muff
ZZ forthwith comply with inch provisions or this permltaMllbedecmadranked. 501 — FINAL ELECTRICAL ENERGY
z per . CONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY
tet••+ Ihembyallirm that there 1,Ren.toaction lending agency for the performance of SO3 - FINAL MECHANICAL ENERGY
til the work fm which this permit 1.issued(Sec.3097,Civ.C.)
Wo Lenders Name: 504 - FINAL BUILDING ENERGY
�Z Lander.Adams 505 - FINAL ELECTRICAL
J t7 1 cenify than 1 have reed this application and state that the above Inrom sten is —
yt-+ correct.Iagree to comply with all city and county oninavxs and.tau laws rotating to 506 — GAS. TEST
•)U building tmnanrnction,and hereby sumoria rtpmaenmives of this chymentu upon Nc FIN PLUMBI G /IA'QA.� ��—
above-mentioned pmNrty for inspection purposes. //�lvv�w`"'
(We)agree to an.Indemnify and keep harmless the City of Cupdrtino egaWt 08 FIN L
fag liabilities,judgments.costs and expenses which may In any way amme&Saint mid City
JZ in conxgncnce of the Fonting"f this permit. 5
t-+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 NG Date
SOURCE REOULATIONS,
Re-roofs 514 NAL PUBLIC WORKS
Signanure of Applicam/COntnnor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant or handle hanNous materiel
as OeOned by the Cupmino Municipal Code.Chapter 9.13.and the Health and Safety
aJc,Section 25532(x)?
Dyes ONO All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant use equipment or dcvime,which If a roof is installed without first obtaining an inspection,I agree to remove -
;Owner
hava,dnus air contaminants as defined by the Bay Ara Air Quality Management all new materials for inspection.
ier?
❑Ycs ON.
IhawmWi ehvndousmeurialsmquimmcnuunderChapmr6.95ofthe Califor. -
vbhg:SafciyCodc,S=U=25305,25533end7S53e.i.l muotheirIM Wilding
not currently haw a anent,Net it is my responsibility In notify Ota aseurant of ft
mannuwhich man Mmetpnmm lruantsoracOmficacofoccupency. Signature of Applicant Date
or authonaJ agent Data All roof coverings to be Class"Bat or better