02110045 CITY OF CUPERTINO s- ��' -'
BUILDING DIVISION PERMIT �CONTRACTOR�INFORMATION
BUIBX?OA3'oRPUMPKIN CT JUST WATER HEATERS INC p"RMI'rNO2110045
owHAY9ENLOCHER WILHELM A AND HE D1764 NATIONAL AVE APPLICAT11311SNU1'Y2002
Ak
orZONE: (510) 293-9901 SANI'T'ARY NO./ / CONTROL NO.
ARCHITECT/LNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MEC(
1400 LICENSED CONT'RACTOR'S DECLARATION I�h
u I hereby mlirm that I am licensed under provisions of Chapter 9(commencing REPLACE WATER HB'�rI'�vuon
�¢U wth Section 70opof Division 3 of the lboare.vsand Prnfeesinns Cadeand afrAcense is
< in'full force and effect. (4 0 GALLON GAS)
p? License Class Lie.If
I—h—S Date Comncmr
ARCIIIT ECI'S DECLARATION
I understand my plans shall be used as public records
OU
E, a. Licensed Pndc,....a l
d OWNER-BUILDER DECLARATION
zaP I hereby affirm Nat I am exempt from the Cnmmaor's License Law for the
,u 00 following mason.(Section 7031.5,Business and Pndemions Carle:Any city ar county
e $ which meal.a permit to contract.alter.impowe,demolish,or repair any suuc,ure $750
poor m its iemance,also requires the applicant for such permit to Glc a signed statement
that he is licensed pursuam to the provisions of the Comeactor'x Licence law(Chapte,9 Sq. Ft. Floor Area Valuation
CC0 (commencing with Section 7010)of Division 3ofthe Businesand Podr.Woms Core)Or 36202043 . 00
a 3$ that he is cacmpt therefrom and the basis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to is civi l penalty of APN Number Occupancy Type
not mom Nanfin hundred dollars($5an. 502 - FINAL PLUMBI G ENERGY
❑ I.m owner of the properly.or my employees with wage as their sole compewtion,
will do Ne work,and me,structure is not intended or offered for sale(Sec.704,Business 586 SA9
and Professions Code:The Contsecmrs Liceme Law does not apply to an Owner of 507 - FINAL T djjQ&ections
property who builds or improves thereon,and who dnessuch work himself ser through his
own employees,provided that such improvements arc not intended or offered for sale.If.
however,Ne building or improvement is said within one year of completion.the owacr-
builder will have the burden of proving mut he did not build or improve for purpose of ��pf
I,as owner of Ne property,am exclusively contracting with licensed ennracmrs m -
construct the pmject(Sec.7144.Best..and Profession..,Code:)The Contractor's Li- 7�
2 O �oo�
ceneLawdaesnotapplymanownerof property who builds or impoon,thereon,and n
who contracts for such projects with a ntm
nremr(s)licensed pursuant to
Nto Ne Cnmracmr's NOV
License Law.
I am exempt under See. .B&P C for this reason
Owner Dam BUILDING
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the following declarations:
I have and will maintain a Certificate of Consent m.elfinsure for Worker's Compen-
mtion,az provided for by Section 3701 of Ne Ia tar Cade,far the pertmntarec of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance.as required by Section
3701 of the Labor Cade,for the performance of cite work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Cadeec Policy Na:
CERTIFICATE OF LX EM MON FROM WORKERS'
COMPENSATION INSURANCE
(this section need not he completed if the permit is farm¢handrail dollars($lap
or less.)
1 cer ify that in the performance in the work for which this permit is issued,I shall not
employ any person in any manner all as uo bexame subject Io the Workers'Comproaminn
laws Of California.Dale
Applicant
NOTICE TO APPLICANT:It,arm,making this Cenifeam of Exemption,you should
become subject to me Worker's Comp,notion provisions of the Labor Calc,you must
O aZ, forms ith comp)y with such provisions or this Permit shall M deemed tesolod.
z O CONSTRUCTION LENDING AG ENCY
[-. .N. I hereby alfirm that there is a construction lending agency for the arlormance of
y > the work fof which this permit is issued(Sec.3U97.Civ.C.) /)
1a Lender's Name
0, z Undeis Address i �fiJ
U C I v'enify Out I bare read this application and sate.,bar the aWn irdone ion is
CA P correct.1 agree to comply with all city and county ordinances and state laws relating m
C)U building congmction,and hereby aifiraw aTowenonivexnf this city,,more upon the
>a W above-mentioned propcny l nr inspection purposes.
(We)agree m save,indemnify and keep hafmlen the City of Cupertino agaimt
f-'y liabilities,judgments.costs and cap,nscs which may in any way acerm against mid City
U Z in consequence of the granting of this permit.
r. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature nfnppliaaamm DoleIIAZAR
IIAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
Will NO applicant or!Muni building e,Chapter
r 9.1 or handle IIcardnus material
at defined by Inc Cupertino Municipal Cork,ChaPkr 4.11,and the IIcaIN and Safety
axle, ❑ScemYes on 25532(x) ❑No' All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or fmure building Occupant use equipment or devices which I a roof is installed without first obtaining an inspection,I agree to remove
it harardoos air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
70.
srict,
❑Ycs 0N
I have read Nc Miamian;materials requirements tinder Chapter 6.95 of the Carlin-
HcldN&Safety Cok,Sections 25A)5,25533 and 255311 understand Nat if the hudding
unot currently have a tenant,that it is my me,sawlblllty to notify the occupant of me
irements which must loc met plan ta issuance of a cemrcm,of Occupancy. Signature of Applicant Date
nermaumnmucd,genl Date All roof coverings to be Class "B"or better