01020107 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: -
BUILDING ADDRESS: _ PERMIT NO.
?i `11713 FENWAY CT WATER HEATERS ONLY 01020107
OWNERSNAME - APPLICAT'ION SHE DATE
SOLNIT KENNETH T AND DEBORAH P 500 AIRPORT BLV 02/20/2001
PHONE: SANITARY NO, CONTROL NO.
❑ Z ARC111TELT/ENGINEGR: —
{sl O O 747 BUILDING PERMIT INFO
Fs EI.DO ELF.Cr PLUME MECH '
ys 'r,w �1 1=1
O h j LICENSED CONTRACTOR'S DECLARATION Job DCSCPIpt1o0
T G 1 herehy affrm Iha11 ran licensed under no,kiutool'Chaper 9(con menciny
�E� with Section 900(p of I)ivlaiolt Jnl'the Busincs call Poleeaxin.,Cn Joe and at,Incense
all Xis In tall rota and chlet
Oce Laca`°Cla.ss 13,.4 REPLACE 50 GALLON GAS WATER HEATER
3Date Gtmmnnr
ARCHI'TECT'S DECLARATION
O g 1 undersiand'my plans shall be used m,public onoN.
T
w n O Licensed Profc,,roa 1
a.S e� OWNER-BUILDER DECLARATION
to I hereby uffimt that 1 ran exempt from the Contractor's Licenu Lew for the
C fnllnwiny reams.(Section 7031.5,Bksinas and Professions Code:Any city or county -
O which require,o Perini(Ia Colonna,alnq impose,deloo0h.vlt,lir«pair any strucnre
al pr's ( t .-. I' d oppl'a (I r. I I T( M 'g d,no nen -
m'tn . tip t( III is of c i ollodew(Chapter9 Sy. Ft. FloorArea Valuation
lu 't6 w th Sdunclo N and he nealone lium nd Pra(c ny l mimr '
lir that he 7031.5
exempt(any apple unit the basis far the alleged exonant to Any violation
ms«Anm7on say am applicant flora petntit.knieelane applicant tnacivu penalty - 8700
lir nn(mare man fxe hamrea dnuare DSW). APN Number Occupancy Type
°I,ns owner of the progeny,ro am empnoytts with wages a,(heir sale compensation.
will Jn the wod.and the Cook:
Th i,not chs', or LicenseoffictedLaos for sane(Sec 7lIlJ, 3295
Imsineof and Pmderty W ioa Cdc:Thc Cnetmcmrs, ndvlaw Jces not apply lit an Required Inspections
(notice nl property Who hnilds or improves thereon,and who Jnex such work himself
or nagh bls own entpinyaa.pro,oded bar smooth improvememn are ran intended m 502 — FINAL PLUMBING ENERGY
nflurnl fr sane.If,hnwavea the holding lir imp rotactical is sold within one year of _
lon"Plefnn.the-omallhnader wed haveliebook,,of prod.,that lte did not luld ar 506 — GAS TEST
improve for Putpu,c al sale.). -
111,as owmeronhe properly.am exrw,i.enr cammeting with licensed crntmctmon, 507 — FINAL PLUMBING _
un.amct the pntjem(See.70,14,Business and Pmfessboom C(xle:)The Camme or's
License Law does not apply to ua owner of progeny who hold,m imptotes thereon.
and who contracts for such projects with a cumrsctortsl licensed pursuant to the
Contractors License Law.
❑l um exempt under Sec. ,B&P C for oris reaxnn
Owner Umc �G /
W(IRKIiR'S COMPENSATION UIiCLAIt A'I'ION -
1 hereby affirm uproot pc alky of perjury ane kf the Idlowing declarations: /
1 have and will maintain u Cenifcatc of Consent ut self insom for Worker's
Compensation, as provided far by Section 3700 of the labor CWe, ror the
performance of the work for which this permit m ismcJ.
°1 have and rill maintain Wader's ComPenm(ion Insnnnae,us required by Sermon
370(1 of the Labor Code,far the performance of he work.far which this permit is -
iswed.Sly Worker's Con,pensa(Ion Insurance carrier and Policy military are
Carrier: Policy No.:
CERTIFICA')'ION Oil EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE '
(This section need not be cnmpneted if be proud is far one hundred obllars
($]W)m less.)
1 mmfy that in the performance of the work for which this permit is i,,kcd,1
shall not employ any pers(m in any manner so as m become subjoe(to the Wurkeri
Compensation Laws of Caliberia Dae
Applicant
N(TI'ICE PO APPLICANT':IL afar making this Cenilicam of 17emption,you should
z tunnm subjectm the Worker',C... commotionprnvislons of l hel.ohn Codu,ynu nmM
O O forthwith en.aply r0i aneltpowisinosor its permit shall he deeored rooked.
F ti
CONS TNUCTION LENDING lending
ageAGENCY
Wa 7 1 hereby affirm than there is skilled err. lending agency for the performance
of the work for which this permit is issued ser.4097,It,C.)
W Q Lcndds None
= z Iwnder's Address
V O 1lenity(hat 1 have read this application and state that me above infcera(ion is'
W E.( nnest.I agree m comply vim all lily and county mciameov,spnd satw
e las relating
O C.7 mnuildingconssucl4m;;aIhkrahy akthori..e represemativesofml,city n enter carat
;m Gy the above-location l pruOny lir inspumlon purpnaem.
E.I W (We)agree to save,intimately and keep harmless the City lir Cupenioo agents)
W Iiabili(itn,judgments.costs and cxpenne.c which may in any way mn'mc madam,sail -
C.1 Cay in emoofaeale of the granrm,lir this perno.
Iti SOU� ANTUNERSTANDSANDWILLCOMPLYWITHALLNON-POINT
CIssued by: Date
Signamn or ApphcunVComrstor Dam Re-roofs
HAZARDOUS MAIT3RIALS DISCLOSURE
WN the applicant lir future building apant stow or handle hmvdous mamdul Type of Roof
no defined by the Coleman Municipal Cole,Chapter 9.12,unit the Health and Safety
Colo.$canon 25532(m)7 - y
°Yw ' °No All roofs shall be inspected prior to any roofing material being installed.
Will he appfc:mlmrink,lading occupant me equip,tent lir devices which If a roof is installed without first obtaining an ins ection, 18 ree to remove
clni(ha,vrdolmonrrtnmmimam,usdelined hYm,Bay Area Air Quality Management g P g
')"tdm?
°Yv's ON. all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
limo mol the hmCrale. m tion%x re 5,25533 a nada 4,1 un 6.95 of the
Cilie knia Health&Safety Ghli, Semina gal,that
t itis t and"mo,o try mond mut
ifthebuilding Acesnminnentybaroast he monitis mynspm,ihil iD tenmify(he
onenpum of the,quiremen(s which must he met prior In issuance ol'a Certificate of
ceupamcy.
- Signature of Applicant , � Date
0.rental milam,edagent nate All roof coverings to be Class `B" or better '
OFFICE