01060157 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
18455 CHELMSFORD DR WATER HEATERS & MORE PLTJIIBING01060157
OWNER'S NAME: APPLICATION SUB DATE
PHONG LEE 1163 CHESS DR; SUITE K 06/27/2001
PHONE: (650) 525-9287 SANITARY NO. CONTROL NO.
G p zO ARCHITECI'IENGINEER: BUILDING PERMIT INTO
�r pp BLDG ELECT PLUMB MECH
' Fzw L-7 L-7 L_J IJ
LIC
z TION
5 y I hereby ahnEhHSEDmlicensed OOTRACnder DECLA
of Chap er 9(commencing Job Description
with Section7000)o(Divism.3ofheBa,mossaad Professions Code,and any license REPLACE WATER HEATER.
in full fora and eRect.
s a License Class Lic.k
XO3 u,U Date Commctor
F a O i- ARCHITECTS DECLARATION
m m I undim,bo d my plains shall be used as public records
i E g O Licensed Professional
ce� OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License law for the
?< following mosen.(Section 7031,5,Business and Professional Code:Any city or county $332
77 O which nagdoee n it permto coneiroct,uher,improve, m
deolish,or¢port any smucume
to 3- I r -,at'."'am"hit .. & - ..Valuation
(c I enemaawitn,is ice,tsid h Section mulam��00)of Division 3 of the Bus111b isivili,an,of In, iness L d Profess ons Code) " 3 7�0 Lto}�1HOr 6rF 1 or hat tie is exempt therefrom and he basis for the alleged elemption.Any violation D v V. '
of Section IID 1.5 by any applicant for a permit subjects he applicant to a civil penalty
of not more than five hundred dollars.(a5oo), 502APNply PLUMBIN ENERGYOccupancyType
❑1,as owner of the property,or my employees with wages as their sale compensation.
will do the work;and he structure Is not intended or offered for sale(Sec.7044, �y�,;� err., 1, -
'Budoess and Professions Code:The Commcmr's License Law does not apply to an 507 - FINAL PLRN19fpilMospectlons
owner of property Who builds or improves hereon,and who does such work himself ,
or through his ormuoyact.provided that suchimprovements a [intended or __ _ _ _,..___. _._ ... ._..._-... .. ...._. .. _... ..
"off rcd for sale 1(however,the nu lain a cold w thin one f
he
burdeoof Yemo ,
opi
improve
for
the ase of sudej,will have the buNen of proving that he did no,build nr
improve for purpnsc of sale.).
❑I as owner of the i mexdus vel- - _ - '"
P e 7 y d Proct si ry th licensede Contractor's
-
construct the pmjcct(Sec.]044,Business and Rofessions Code:)The Contractor's '
Creme Law tines not apply m.m owner with
property who halide se Improves thereon, "' ` `
::. and win'sho contracts for such projects wilM1 a.comrvctngs)licensed pursuant to the
El I am
Licenselaw.
_ ❑I exempt under 5 � B&P C forIhsreas°n
O Et S
' WORKER S COMPENSATION DECLARATION !
Ihereby mffirm undo, f,ajnry mic oftbef 11 ng declarations /
. El I have and will'maintain a Cemificitte of Consent to sclf�mwrc for Worker's
Compensation, a. provided f by Section 3700 of the Labor Code, for the
permunison,ofthework fI h this tprmti '...cal.
,,
1 have and will maintain Worker's Compensation Iasureace,as ruluime by Section /
3708 of he Labor Cade:fur he performance of he work far which this permit is
issued.My Wmkers Cpe tion Ia, an
Brand numb
Policy ernrt
`-;CERTIFICATION OF EXEMPTION FROM WORKERS',!'
COM
PENSAATION INSURANCE
((nilectmi neednal be coin letcd if he UnNtis for one hundred dollars
f31001orlessJ
shell not employ on er5on'nimmune, e '1 "lh ` •
P y. Y P any o as In became m the-Wmkerd
C pli fon LawsafC 11 'a.Dne
APPI coal .., _: ... .
NOTICE, APPLICANT It of ` C t fE p pt y should
z orth
become subject
m the Worker Compensation p do F the e h Code,you Host
fo
C Q th comply with such Is,,ions immix permit shall b J e ed evoked
CONSTRUCTION LENDING AGENCY
1 hereby affrou that thabei,a construction crte ig agency far the'p Ffbrmance
WQof the workfor which thcommit s issud(Sao 3097,Cis.C.)
Leader's Name..:. _..
a.�
Leader's Add ..,.,
UIQ l eufyiharlh ti: �`,r L.:fdh�] anellagrcemc° d0hdthl,clt al na i ya,m..m.riewhn uhadbo"tadte nlf wrsreiCU rob Iding construction.anh ebyandze representatives oRh ty to enter
upon
the he- tioned pampodyFoF inspectionP P s
I agree t6 save,
aderfyc dk h rn : tCtyf p n. .againsgt
tes, t 1 xpturn m y inany y cue again. amid
U-Z City in conosquence or ihcgrunting of this act unit.
t-
��.
'
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO00IN'T
- > SOUHICEREGOLATIONC Issued by: Dale
millennia°fAppIwam1Comranor_ '-: 'P "� "Dom Re-roofs
l HAZARDOUS MATERIALS DISCLOSURE
i
` will the appha t or future building«e p m Flare nl handle h.reardnux material .. . Type.of-Roof . . _. .,.. -..._. ............ .._.
as diedJ by the Caperton.Municipal Code Chapter 9.12 d the Health and Safety _ t
Code S❑Yiam
25532(0) l ❑N e, n rr .. P '<
All roofs shall be Inspected prior,tourly roofing,material being installed. __- ...
wuh ppcoca t I t n M p nn�eey p i a h h If a roof is installed without first obtaining an inspection;I agree,to'remove
D I thz d sn t 1 a defndbytheHayAieaA Q Iryhlanae em P b
>•.- I all new materials for inspection. Applicant understands and will comply with
°Ya. "° all non-point source regulations,.
1 have read the hvallous mar rill¢«yuiremenls under Chapter 695 of the
California Health&Safety Code.Sections 25505:25533 and 25534,1 understand hat
ifuno b 'Idinge does at currentlybaseat be
l' peof Ca 'ti(y heGroups.,para f the reyun m to which roti t b met prior to i,"ounce of a Cenifcme m
Oc pancY. ..., ..
Signature of Applicant Date_„
mnndeea gentDate
All roof coverings to be Class'Bit or better
t OFFICE. .. . .. _. .. _ _ ..
a I : - e. 7 4'rIf ,i13 ,