01100059 CITY OF CUPERTINO ` ' '"" `•" ` '
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION : '
BUILDING ADDRESS: PERMIT NO.
7585 DE FOE DR JUST WATER HEATERS INC 01100059
OWNER'S NAME: APPLICATION SUB DATE
GARRICK MIYAKI 1764 NATIONAL AVE 10/10/2001
PHONE SANITARY NO. CONTROL NO.
(510) 293-9901
❑O O ARCHITECVENGINEER: BUILDING PERMIT INFO
m{ BLDG ELECT PLUMB MECH
aa I_U LJ IUB L_l
8 m Z LICENSED CONTRACTOR'S DECLARATION Job Description
;M z 1 hereby affirm thin 1 am licensed under provisions of Chapter 9(commencing p
ln wim Sersion7000)of Division 3 ofthe Business and Professions Code,and my license REPLACE WATER HEATER
E'j is in full forte and effect.
•maG License Class Ue.g (50 GALLON GAS WATER HEATER)
7 a O N DateContractor
ARCHITECT'S DECLARATION
Y 1 understand my plans shall be used as public records
OO Liceroed Professional
' o
OWNER-BUILDER DECLARATION
m^_
w I hereby efBnn That 1 am exempt from the Conwcmr's License Law for the
C < toll h gmason permit
]0315 B 'ness end ve derr li Code Anycity st ty
❑
poor
h ts ire.n perm t to construct, her improve demolish, fi e.s r any st t
� •pn t n issuance,also respites the applicant for such Permit to Rleasigned stat mem. ---_
(ho h s 1 arced p e wj mdprd ions of me ha Bt dors L cense Lew(Ch parr 9 C ;•Ft �•1O r Are h ✓'o"n 1 Valuation
or --------
(commencing wish Sece ]m and
Division 3 of the lt,ml a 55 Androp Professions Cod) "h?_}+ j k-A— 11i 11A. !;t e 91..N R.?;1,g t.. '
or flas,h i exempt thehnfrom end the hays for the alleged erFmphdoc Any violation
of Swim 70313 by any applicant for a psmut subjects she applicant to a civil penalty
of bot rime than five hundred dollars 18500). the ., Occupancy Type
°I;es owner of the property,or my employees with wages as their sole compensation,
will do the work;and the structure is not Intended or offend for sale(Sec.7044, payt
Business and Professions Code:The Conamcror's License Law does not apply to an 506 - GAS TE S rIRequired Inspections:` ' '
own
n of property Who builds or improves thereon,and who does such work himself
or through,his own employees.Provided that such improvements are not intendm or 507- .- FINAL PLUMBING-; --
offered for sale.If,however,the Wildingimprovement is sold within-one -
orimprov year of �;"^a \r'• a•
completion,thepose bu Ida 11 have the burden of proving that he did not build or
improve f purpose of ale) 7
._ __ . _ _.. FINALEP
1,asuofine propc.7ft, a fir, I Code:)The
comamorsto 9
License the project(Sec ]044 Business and Professions Code 7 The improves
te o
ad wh Law does note 1 m j owner with
property who builds orthereon,
Comm m`x Licdv for¢ueh nn,with a a�iitnnorts IicenaMmprnves fs1 11 •f ,f qq {.I
Piot ) .pursuant to.the . .. _ .. _ .-_ ... . IY O.V_1 4..L�OI ...._. ..
Contm exempt
amh Law - -,.
0I am exempt undo S "'' "` '" B&PCfm this meson •:.5 ,;+;kqt
own "Dare. BUILDING
WORKER'S COMPENSATION DECLARATION
I hereby affvn under penalty of perjmy one of)he following decimations:
❑ I have and will maintain a'C_ettificeie of Consinn to self-insum for Worker's
Compensmlan, as provided for by Section 3700 of the Labor Cade. for the
- performance of the work for which this permit is issuM...,
°1 have and will'mount ein Work'er's Compensmion insulates,as'required by Section
37W,of the Lud or Code,for the performance of me work for"which this pemtil is
issued .y k'orkefs Comp ht InsurTnce Cartier end Pei cy be pm. u,,:..
n a 1 .. ..._.._..._...._-._.-.. ..,,.. _. . . - ..,..
Csmer ' 'f•1'^ Polic No
CERTIFICATION OF,E%EMPTIONFROM;WORKERS :1' „ ^`- V `}4 a1� 1 �tE u_iM i ,r, 90. t I f r 1 'll
."• a,.,,,_ .COMPENSATIONINSURANCE .., ..._.._.... _._.._.,_.
section mail not be 2ompleted if the permit is for one hundred dollars '" ""'� ter'-'.11?d i•i,:gyp'.I'P .
(SIO%or lexs.)
ehufy mazi dm petfomunce of me woikf wh hmu phot rsiss d,l
shall not employ any pe son in any manner so is to become subject to the Workers' - il'2't• is, '
Compensation Laws of Califomia:Date '
.Applicant
... ._._ ._. .. ... . _.. .. 1.__ _ . . .... .._. .....
" NOTICE TO APPLICANT If after making this Certificate ofExemption,you should � •) ,
bac bject m the Wmket Compensat n p ds of th Labor Code,you muss
z'O f.nhwiwith ns h proisioor thisor
raft i t shall be retorted revoked y
PY
E~+.h CONSTRUCTION LENDING AGENCY •-
a" 1 herebyi affirm mat thereis a laxistracticir lending ag cy for me perfu nee`
of the workf which msoocd(Seb-307,Ci,C.)
hy'(� s Lender N e ., R t .... ... _.. .. __...m,.. - .. .. ..._.. ... . .. _ 5....'_. . ..
V•Z ' Londe Address
h" 1 athat 1 h read this cetyls t d sone
that a 'nlfaolanEcorrect.I egit ply with all My And county ordinances a w'. nigs /�,r/1/ G�p / �✓(,(f�L ^= / ��'
O V.: wo Wilding construction,and hereby authorize representative f m' city to enter upon
;� ry the abov>mcntionrd property far,inspersion purposes.
t,.i Pa'•' (We)agree to s.,a,indemnify and keep harmless the City of Cupemrio age net
V]
liabilities judgments.costs and expenses which may in any ay accru against id
V ' City n co egacnee of th g s ng of Ni perm t' •
- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT ISSUed by: Date
SOURCE REGULATIONS t n
Signatureof ApplicanVContmctor'�" % ."Dam Re-roofs
HAZARDOUS MAT iMALS DISCL95URE
:. Win the eppl caw f t Mh'Idin6 am pe t hare or handl harardaas mstmel- Type of Roof, -. _ _-......,
--------
laid efjre t by the Cupertino Municipal Code Ch pter9 12,and rite Hal and Safety
Cod Scene.85J2f)]h > „ •y.. . t tt 4 7' \T
❑Yes IC]No
aJt "l l m
All roofs shall be sp ected pnor_to.any roofing.matenal being installed ... ..
' Wilthepplicantuftmebuildingoccupaauseequipmentordevices which •. IfaroofisinstalledawitIlbutfirstobtainingatrinspeetioil 'I'agiee.to'r'emove
'
emit h Mous air contaminants as defirtd b me Be,Area A anagement "
Diann ° 1"y Management. . i all new materials for nspection._.Applicant understands and will cotnply_with
°Y °"° all non-point source regulations'„ -
I ha 4r;d'me h"m'outeiixx'r,qmrmmm,ander Ohnpmr 6.955'of mei i
• Cal fortua Health&Sof ty Code'S'tions 25505 8533 and 25534:1 understand that !
iLmebtnldrngdinsnot urtendynavea st tthenl"s, y of.
e fica the' •.,\
`oaupant of,me rtquiremenu which musty be me,pndr no issoence of a Ccn ficem of r
cc �
" 4
ow r um n a ag nt Signature of Applicant Date_
Dere i All roof coverings to be Class "B"or beg ner
. OFFICE.. . . .. .. _.