14090037 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 8011 PUMPKIN CT CONTRACTOR:FAST WATER PERMITNO: 14090037
HEATER
OWNER'S NAME:
BOTHELL, WA 98011 PHONE NO:(800)454-8955
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT+ PLUMB!
License Class Lic.# (`
MECTI RESIDENTIAL COMMERCIAL.
Contractor Date JOB DESCRIPTION REMOVE&REPLACE WATER HEATER IN THE;SAME
LOCATION
hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area:0 Valuation:$1292
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:36202044 00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION PERMIT EXPIRES IF WORK IS NOT STARTED
I certify that I have read this application and state that the above information is WITHIN 180 DAYS OF PERMIT ISSUANCE OR
correct. I agree to comply with all city and county ordinances and state laws relating 180 DAYS FROM LAST CALLED INSPECTION.
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Issued by: Date:
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section RI;ROOFS:
9 18. All roofs shall be inspected prior to any roofing material being installed. If a roof is
Signature Date installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑
OWNER-BUILDER DECLARATION Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044, HAZARDOUS MATERIALS DISCLOSURE
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the
construct the project(Sec 7044,Business&Professions Code). California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I hereby affirm under penalty of perjury one of the following three Health&Safety Code,Section 25532(x)should I store or handle hazardous
declarations: material. Additionally,should I use equipment or devices which emit hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Compensation,as provided for by Section 3700 of the Labor Code,for the the Health&Safety Code,Sections 25505,25533,and 25534.
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by Owner or authorized agent: Date:_
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
I certify that in the performance of the work for which this permit is issued,l shall CONSTRUCTION LENDING AGENCY
not employ any person in any manner so as to become subject to the Worker's
I hereby a
Compensation laws of California. If,after making this certificate of exemption,I affirm that there is a construction lending agency for the performance of
work's for which this permit is issued(Sec.3097,Civ C)
become subject to the Worker's Compensation provisions of the Labor Code,I must Lender's Name
forthwith comply with such provisions or this permit shall be deemed revoked.
Lender's Address
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter ARCHITECT'S DECLARATION
upon the above mentioned property for inspection purposes.(We)agree to save I understand my plans shall be used as public records.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Licensed Professional
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
Signature Date