0008013110-NFR
CUPERTINO
ING DIVISION PERMITCONTRACTOR INFORMATION:
DRISS: PERMITNO.
7 MYER PL HOT WATER INC 00080131
ME: AFPI.IGVdON SUIT DA E
1.2531 GRACF_LAND AVE_ 08/1.7/2:000
SAN[[,%BY NO. CON'I'ROI_NO.
(650) 298-8494
rc i ARCHITr:C1]IiNGINEER:
BUILDING PERMIT INFO
�00BLDG F.LF.Cr PLUMB MECII
Baa
FFy% hICENur i a CUN'rRA(:rQR'S DECLARATION lob Description
Z O Q toruby x))of rant I an of,heN ander,prod fi ill C',Cod'y(commencing
2m, with
a.1.11in9HXp f1Division Jufmc lLl,inch,nnOtYndissiata Ctdc.modify littnm
es mE flaw am enecl.
�S 0 x< Doeamelasa Liene WATER HEATER
3 LL N Dam S DECLARATION ABCIII'I'ItCTe DECLARATION
I undcmand at,plain shall M used v,public rccoNa
5
e,O LinnscJ
Prole ssinnal
Oit I t rocanoBUILDHu DECLARAdaON
hai= 1 or—o aScIl IM1m a ntpt Eons me Contrun Co License Lnw lbw he ,
Com, 6 followinguimsa (Section 913Lrct,a er,iand Pe,fca.ion,Cnor Ahy city nr county
F O Which reyuirts a permit la mavwcl,ober,intprore.Jemnlisb,or repair any slrunure
a SCa poor to lis is...nee,111.1 requires the applicant lin such permit m file a signed ollement
mat Is,inlicensed forwaaltothe pmvhmn%ofdue communes License Law(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with section 70160 of Division 3 of the Business and prnlhssirms Code)
or that he is exempt therefrom and the ha%i%for the alleged ewnption.Any violation $500
of Section](D 1.5 by any applicant for a permit subjects the applicant to v civil Penally
of mel mom iam Into five mdole.($5a). APN Number Sccupancy Type
Cl 1.a,owner onbe progeny nr aay employees whb wngcs av mor wile eonam swiraa, (�
will if,,Iho work,and if, m,au,Is nol 'mwndcd or ofI'med ILr sack(Sec 71144,
Business and Professions Cow, 'Ihe Contractor%License I.aw docs not apply m all Required Inspections
r of pa,pcny Who builds or improves thereon,and who does such work himself
issuer of
his own employees.provided tient such imps—cmem are not amended or 502 — FINAL PLUMBING ENERGY
offered for sale.If.M1(me,er.the huilding or improvement is sold within one year of
Impletion.theowner-builder will havcthe burden ofprovingthat he did..Wild or 506 — GAS TEST
improve for pumoseof sale.). 507 — FINAL PLUMBING
❑1,a of IDI pmpeny,o xclucosly couriona,with Iieen,cd Bono-ou,to
me
andtc Law project(Sev. ,,a,Ho. .end Pm1cs .ealeo rhe..la,c,nmenarx
e Law tree mo apply lu ro owl�w ll,pmpn ctuu,)lice mrd toluoes, he
and who rs l.i,cn,for such pnt,jml%with u mnlrannrin) licensed pursuum no me
Contractors License Lnw.
❑lam excmp under Sec. .Hkl'C lin this reason
Owner Date
WORKER'S COMPIiNSKFCN DF.CLARS![ON
I hereby aflima under penalty of perjury one of the following declarminns:
❑ 1 hall xnd will ouanwm a Cenllicnle of Consma hs self-insure Iia Worker's
Cumfensmion, as poI,lM ILr by Section 37(k) of the Loan Cale, fnr the
perfortuncle of the work for xhieh this permit i,issued.
t
❑I haul,and will maintain Wader's Compensation Insurance,as required by Section
37W of the Lo1W,Calc.far the pedbrmance of the work for which this peman is
sued.Mc Walker's Compen,atin I Insurance comer and Policy number am:
Carver Policy No,
CI!RI'ItICATION OF[EXEMPTION FROM WORKERS'
COMPHNSSFION INSURANCE
(Ihix section need not he completed if the Ierink I%for one hundrud dollars
(SI00)or less.)
1 tinily that in do,performance of the work for which Ibis pencil is issued,1
shall not employ any person in any manner as,as to become subject to the Workers'
Compenmtiors laws of California hate
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of 17eemptioo,you should
become ob,111a,ma,Worker'%Contponsuhon pro ns of the Labor Cade.you oust _
Q fnnhwith enngtly with ouch pt'n Imm�w tar lhk per nu shall he JwnmJ Ivvokcd.
^F CONS themlI,a c4 N LENDING leading
AGENCY
1 hereoy which mm mere ix a v..ed Olvvn (N7.0 agency In,the perfnmance
of the sol,for which this pemait is issunll&c.3W].Cie.C.)
SC Lender's Name
= Z Isnder's Address
U 0 1 cenily that 1 base read this application and state that the above information is
correel.1 agree h,colonic with or city and county onfinun,es and state laws reining
Q Um
million,cottshu,I a,and hcrchyand iz u,o,cnmtivesuf lu-ity mcnmr upon '
W the nbwo-ntenlloned pro,,(,fur ioup«line purposes_
F•I y (We)ugrccmmvc.indcnail'y 11ltd keep hanalcvemc City of Cupertino against
Vi h,bilid ,judi n Nal..cols and espnues which may in any wily accrue against said
V Z City in consequence of the grnning of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WrIH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. Y'
signwarenf A„pficanvcontml Date Re-roofs .
HA9.ARDOUS MATERIALS DISCLOSURE
Will npp
I mhca c or moare molding acnplml stere or mtmue ho..ardn'mmetial Type of Roof'
o deleted by the Copamoo Mtodcipw code.Chanter o.12 amt lite nnlm and Sway
Calc,Section 25532(11)'1
0 Yes 0N All roofs shall be inspected prior to any roofing material being installed.
Will theappllcvntormtumnnibrngonulaata.wcgaipmcntorde.'iceswhich If a roof is installed without first obtaining an inspection, I agree to remove
omit hamNnus air cnnamimms:ts define l by the Bay Area Air Quality Managenem
Dismm'r all new materials for inspection. Applicant Understands and will comply with
0Yea MNo all non-point source regulations.
I have rctttl the ha,aedoos tmmcdw.a requiretnem,mmcr,Ch11mcr 6.95 of me
CoklSrnw I leullh&Sul'ety GMo,Secllon,^_5,5(15,25533 toad 25531,I nndcrenmd tan
it the belldingdou nn moacnlyhavunmoaot.lhut it la my rest^nibilhy In m.lil'y lou
ncettpno of the reyuiremsnts'lu'll nmel he met prier ,,issuance of a Cenilicwe of
Qccwpancy' Signature of Applicant Date
axneror aumodaed.,car Date All roof coverings to be Class tB" or better
OFFICE