01010103 (2) CITY OF CUPERTINO "
nUILDING DIVISION PERMIT CONTRACTOR INFORMATION: . _
BUILIIINGAIIDRF.SS: ' - - - PERMIT NO. - -
6365 BOLLINGER _ RD -JUST, WATER. HEATERS INC 01010103
OWNER'S NAME: - APPLICATION SUB DATE" r
-JARAMILLO ANGIE 1764 NATIONAL AVE; 01/23/2001 . •
'PHONE: SANITARY NO. CONTROL NO.
(510) 293=9901
❑ae Z ARCIH IT:CUENCINEF.R`r. - � - - BUILDING PERMIT INFO ,
O 2 ' 1 - BLDG ' ELECT PLUMB Int
-
Z o H NZ. LICENSED CONTRACTOR S DECLARATION Job DCSCC1pt1On
Z t. 1 hereby aThr[list I figu l pun ns or Chapter 9(ao nine e
r„C° with fullforcerola If�t. 5 rme❑u v JF ,maea na coca,ane„yr
�sis < is tofLicenucchtee a REPLACE 40 GALLON`GAS' WATER HEATER ”
�'O V Date - Coundat, - Y . .. ,
ARC1F1I..CT'S DHCLARATION 4' r ••' •• b
W� < 1 and e..tend my plmm hill be mud as public openeds
g Q License)Pmfevsiunnl
Mo�
xm iw552�Iuuuh����diildce I
OWNER-BUILDER DEION'
I nearby u d pt l nbe Centt -
I r he
roll B .(S 7011 B d Profession,Code: y city
which rc. ni te I ,h p Lh repair nY.t. Ire
poort I cIsorq
• _ "
- -
.. 111 I I a L d a t ,t
d thou 1 with
r 0 poccurm c d i f I (cbplr9 Sq:-Ft. Floor Area ' Valuation
(en..news p.rd,ScW nn]00(1)afid ba,, 3 tireaBus,eaeadd lro4ai is AGxle)
nr Ihal he is exempt ahrefmm mW the aaeis or ubc subjects
the exemption.Any viPenalty ' 593
of a,,, i 70315 iv any d red doll for a permit snb'Iwta iho npplicmn .it civil Penalty
of nal...brc man five ltutfera dollar,fESEm. APN Number ` Occupancy-Type
❑Lar.owner of the prz,perty,or ley emplu,ca,with,rages as their sole wlnPelirnddn, 369 19604, 00
will do the k and th .....catop....... t t J or oficaed Fill sale(Sec.7044,
Business and Prefiessionis Code I he c :Liecutp Law does not apply to air - 'Required Inspections --
rfP ,s n,Wh b Ie p sd Iod k .elf
or through bhhis own caplane.,promdedIng suchinmravel,eneare tire intended ar 502 — FINAL• PLUMBING ENERGY'
offered for safe.If,however.the bbdding o,Impowemenl it sold walen one rear of - -
..nkidion it cer-builderwill,avcdnlnlNr,ofprnvh, grathedidetahaildor 506 — 'GAS TEST.
,prove ror parpnee nfealc)- .( If - 807 — FINAL PLUMBING
❑1,as owna,of the pn.peVy,ar exclusively umw up,with Veronal cnnvaahro to
,...Iran the protect(Sco:9844.Btoinars and Profession.Col,:) m
Tar'Cnmclnr'e
L;an.e 1-ew does not apply to an owner of property who build. it improve.thercae.
and aho contracts far h products w tl mlyrl licensed prourat up.the
Coo u t it L nso L
-DI a.r.ai niSee R&PCT this r"x '
.Ow Date
v -
' WORKR'S CONI I NSATIUN UI U ARA91ON
I h -by itifirad underpernally if perjury fah following d i r `
❑
Ihilvi,and will r t C f he of Cii or elf-irourepar Weak,,,
Carl
o print 1 'd I for by Section
77W I thelabor Code for the
pert of the work for hhah'.p J.
'0000
Olh J 111 annitania W i Courpencroad I tofu t race,Is I equiradby'S tion a/
370()of line Labor Code.far the pc,f..... a nt the.work for ehlh di s pe ,r t ix
suet My W..was Cnmpenna0nn[a.0nmce wtrier.nnd Policy nature,ri - -
Darier:' Policy Ins, -
•-CERTIFICATION Op EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE,
9;is section need nm be mmpletea if the permit is Enc one hands)dolls ,
$100)art less). t .
I curfl y that in dhe perk not ace of if,,work f r w6 h this pr am a,su d.I q' _
shall not ntnple,airy......f a vny neande,so is to twenmo v bye to fle Rockers'
coca, all i.awsor ,Califreraity Dam -
.Applicant .. - ,
NOTICE TOAIIIICANr iffI k ,tl Cn'f't N n.. yor should -
bee..re'alacida tleW ce, le,youna,
forthwith conply with s .or s p,rmu shall be decowal nevoked.
z
f~' ror CONSION LENDING AGENCY -
.� I h m thater,isa by I r
tl construction leading agency for the performance
of iak for- "hthis Prr t'. s.ucd(See 301] C'v.C) -
(z Lend N" re
5 z Le 1 aAldien,. _.
O O .l or
Iths application and that h t "( - - -
ror t 1 b a ply llall ity I y N an d.l l 1'r g - -
[�
Io building construction, dluebyatW< epu..cntarvas el tins a'ty to anc'tp el v
iy1 W 'the above-nmntinned properly for'mspeeuon purposes. + -
ty 24 (We)a,a.loarle,inferiorly arld keep h" rale he Cu) itCdp in ag inet
-.r h had I f p,dgnems, is oid e,drw, h,,h tit) ,airy any ne,one d,cart avid
G z City in consequence of the granting of his permit.
'APPLICANT UNDERSTANDS ANUWILL COMPLY WITH ALL NON-POINT Issuedb , Date
^• SOURCE REGULATIONS. Y•
Sigaomt<afA,ficonoCaat,neaar Date Re-roofs '
HAZARDOUS MATERIALS DISCLOSURE -
cwidthOrppimantorfuturebuildingaceupate'to"ar hi lwtrmeur matasal Type ofRoof
os def red by the Cupertino Municipal Core.Chapter 9,12,and the Health and'Safely n -
Code.Section 25532(;1)?.
0 Yes , p Nn - - o
All roofs shall be inspected prior to any roofingmaterial being installed."_--Will dhe ii,pluar, Earn,building s p a use p,ri,aaca or device,wh ch If a roof is installed without first obtaining an inspection, I agree to remove'
.all in J t.react as J head by tireBay Are.A Corny M u ge lent
Dist - - all new materials for inspection. Applicant understands and will comply
Basin, with
I
r: ❑N all non-point source regulations.
1 have read the Ini Inago,annen.1, emcnts under Chapter.6SY,ot the '
Untifiania Hwlth a Safety Codes Sermons 255115,25533 and 25534.1 undemand that -
ifthehuddingdoesnotcurm 11,1cve againaLthat it is my,rcsponsibilitytanotity line -
ceupom of requirments which road he met pdorm issuance or,Cend.on of
Occupancy. . ..
_ ,'Signature of Applicant � Date
owner.1samnraedigglat Date All roof coverings%to be Class "B"or better .
OFFICE