02040009 CITY
UOPERTONNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0,
22742 MAJESTIC OAK WY HOT WATER INC 02040009
OWNER'S NAME: APPLICATIONS BDATE
_t
MICHAEL BODO 2531 GRACELAND AVE 04/02/2002
iI PHONE: (650) 298-8494 SANITARY NO. CONTROL NO.
O O ARCHITECf/ENGINEER: BUILDING PERMIT INFO
F BLDG ELECT PLUMB MEET
LICENSED CONTRACTOWS DECLARATION
'S� l herb affirm that 1 am licensed under Job Description
j Z—C >' Orovisions of Chapter 9(commencing
„t:� with S<aioo]11W)ofDivision3ofthe
m< vin roll Wfs and A'leL
REPLACE WATER HEATER.
SOE,
aU
D.vd canto
l LL a.v ✓ ARCHITECT'S DE - RAI N
O u d...(.ad my plans shall be used us public records
i Six
p 00 Licensed Pmfe simul
e OWNER-BUILDER DECLARATION
y
I herby offinn that I ran exempt from the Contractor's License Law for the
follof which ingsnesit ection7031.5.B construct,chrtimpr Professions Code:Any city orcounty
which its issuance,
s a permit to construct,alcor,improve,demolish,ore pair vny swctum 5 0
i3$ prion sulso n to res the applicant for such he Contrar»tmfl ywLaammcm .. .. _ _. ... __ __ _
don n , «nwitp pursuant do the ofDi Division
of of the Business
Contractor's License Ir ons(ClCode)
(commencingwms tionmoand the also theaBusnewand Pmless vi Cada {;ih.'F t:3 $• r l'Yr.R�T®?^?y j_;'l a Valuation
or thathe7 exempt zany applicant
and the bans for the alleged cxnnpnop Any violation
of Section]031:3 by anyuppli<am finepermit subjects the applicant toacivil Penalty ,.p ni 7�tf�ayph
of not more than rive hundred dollims SSW). 5024PN4"TOA1 PLUMBIN ENERGpccupancy Type
D I,as owner of the property,or my employees with wages as their sole compensation,
'rill do he workend the structure is not intended'.o (Set
sale(Se
: w
r '
Business and Professions Cade:The Contractor's License Law does not apply to an 507 - FINAL P cEdalrMspections-'d"
os nc
r of propcny Who builds or improves thereon,and who does such work himself
or througyh his awn employees,provided mm such verve tis col arc not ImmndN or .-
-offcicB riot sale.If,however,the Wildin improvement is
within one are of
gar tmanofpcn Y
Iompleti for the owner-builder will have the Wodea of proving tWd he did not Wildm •' '" " '
mprove na pudpn.e ofode.). '
D L as owner of the p(St 7W4,exclusively d Profesa g-sions
with licca The Contractor
o azwte m • .._; -� - -- -construct the present(Sec.]Baan Business and Professions ills or The improves
aao n, F �y
License Law Joe..not apply m an owner of property who builds tr improves hto the FINALE Y. .
-> and who commits,for Las, with a canvaam(z)Bccmw.pursmm m drc _ -_. _. ._.._..- __ _ .. _.____.-. .-._-.. ..
Contractor's License Law. .
Dlameaemptundcr Sec s ,B&PC for his reason
APR 16 20OZ
OwnC IF P Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under pcnahy of pc jury one of,me following declarations: BUILDING
p ❑ I have anJ will maintain a Ceniricme of Consent to self-insure for Worker's
'�. Compensation, as provided for by Sectinn 37W of the Labor Code, for the
'performance of the work for which this permit is issued.,
D I have and will dnxinmin Worker's Compensation Insurance,as required by Section
37W of the Labor Code,for the performance of the work for which this permit is
,saved My Worker's Competl I dcarrier Policymbera ,
c T Po ) 4< ATa_WOR EMPT0N t
COMPF,NSATION INSURANCE` t•• ••5a, ( .. ,.. - _ -
` t" '(This action need not beemnPleiN if the permit is for one hundred dollars {' ''• -
(EI W)or less.) -
7�1 ctmiI6 that in the pc;Ramfi.4hccjof ib' � pc
rk hbeco eM1 t issued,l k,i -
ih611 d mploy any p<rw n any manner so a to become subject t the Workers'
Compensation laws of Cdlifomie.Dam' " '
Applicant. -. CA
NOTICE TOAYatio Worker's
flat Compimilimip Cenonsoof Exemption, mur....sash
become subject y the Workers Compensation period Shall the Labor Code,you must
Z 0 forthwith comply with such provisions or this permit shall W deemed revoked.
.If "'"; 'I "CONSTRUCTIONLENDING AGENCY
'' 1 hemtiy droit.that heir is a construction findingagency for the performance -
this ramm, .sued(Sec 3097 Civ C)
frM1e oa h h_ ... .. .. ._. ....... _.._...._.. . _.-... -. ... _ __ -. _.
a:Z Lcnc a
dAddrss .,
V Q 1 ccnify that I have read his tpplicilion and state hat he abuse information is
ko-F. correct.l agree to comply with all city and county ordinances and sum laws sitting ,
�.V w Wilding uaion.and hereby truhorize rpre$ntativa of iii city to enter upon
� W tconnr
he above m,.y far inspection purposes.,, _
[n:P. (We)agree msove!indemnify and keep harmles,"the City of cupe:iino against
-V] liabilities.judgmems.costs and expenses which may in any way acerae against said
V ► City in cot equence diagraming afthispenmr. n O
APPLIc U f B,TANn"D WILL COMPLY WITH ALCNON O
Sr ukCE of T1 S. I sued by: Date 7�
sgnawre or eantra<mr.....' '- Date Re-roofs
HA4RDOU9MATERIALS DISCLOSURE d
"' W II he appliiznt'w fumy W dd ng a p nt scar or candle hazardous maicnal ..Type.of Roof
as defined by the Cupertino Municipal Code.CTpt r9.12,and the Health and Safety -
Code,Seci n25532( )4 : .,. .. o j � f t ` .',.`�)., `•'• '
❑Yes o 1 t dy,a!r 'All roofs shall,be ins4ected riot to an .roofin material barn installed.
P P Y g g _ __. _..
W Iltdcappli5arat.mfmumbuadingercupamaxequil!mentordevjceswhich If a roof is installed'without first obtaining an inspection;I agree-to-remove
amid hazardous air cnum omen,as defined by the Bay Area Air Quality Management
Grano? \doo _ all new materials for inspection. Applicant understands and will comply with .
t - all non=point source regulations.
'as' '1 h 'e'orad the hazardous materials requireniams under Chajmr95 6f me
California Health&Safety Code.Sections 25505:25533 and 25534.1 understand that
the Wdd o cuiii���eeentlyhaeatenam tit t' my''pons bl tY to otify me -
Occam o th q [dt{ h h mu t be t p' to usuanc f a ricam of
p VrL Signature of Applicant Dale
d All roof coverings to be Class"B" or better
oan< aumd pegend
Data g
'- OFFICE