02090133 (2) CITY OF CUPERTINO
BUILDING DIVISIONPERMIT CONTRACTOR INFORMATION:
O.
@UIi"91g19YR:FFORD DR JUST WATER HEATERS INC PERMIT02090133
tCi l.,ki!-1KL CHUNG 1764 NATIONAL AVE APPLIC TlQNgt�e 75002
PHONE:
(510) 293-9901 SANITARVYyNO.. 1 y/ CONTROL NO.
G aeZo ARCHITBC(ENGINEER: 'j. - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LI U
dad
Z S y,- LICENSED CONTRACTOR'S DECLARATION Jpp�� pp cription
0Z-'a InerebyalRrmmatlan,hreamdunderpm.liom.fCha,m,9uommeming � REPLACE WATER HEHTE�
Fy-a with Section]000)of Division 3 of the Business and Professions Code,and my license
a m is in full force and dries. (5 0 GALLON GAS)
Kod0 6 _Liccnsc Class Lic.p
o IL"u .Dam comranor '•-'G t
a u� ARCHITECT'S DECLARATION
m' 1 undersmnJ my plans sM1ull be used as public rccnNx OCT
rs
1 2 2 2002
w s p'p Licenud Prumitional
OWNER-BUILDER DECLARATION
X R?�� 1 hereby a1Rrm that 1 an exempt from the Contractor's License Law for the
F 'following mason (Section 7031.5.Business and Professions Code:Any ctry Or county SU11IL®'
F C
Which req permit t construct,t It p J m l-h P y s mature
i3 ,pnorm m ssuawaalm reg it pp1 tf such pe nuo fl g d mtement -
@dthe ISl ogdpris htmmepti sl n. fm Contractors rL La (Ch pc'9 Ft FIOOFA ea , Valuation
Team d illi_«t ]IXp) rout. 13&nn ane dl re:.,nacoda ('(;Lti,'dtt iS9l i'tw,. a. d+rt rClt?:1.'i 3ar'r
or that he fs eaedrpf theiefmin and the burs for the alleged exemption.Any violation 3 6 21102'1 .' 00
-of Section 7031.5 by any applicam fora permit subjects the applicant m a civil pevhy
of not more than five hundred dollars ls50(h. APN Number r.<.::'� +: Occupancy Type
°i,as owner of the pr.,ny,or ter cmpmyeexWith.ragera.meir.olc rnmpen.a6nn, 502 - FINAL PLUMBIN ENERGY
-will do the worKnnd'the swemrc is not intended or Offdred mrsale'ISec:70W 50 6 - GAS TESTRe aired Ins ections'
B6anesi'and Prnfe,s ons Code The Contractor's License Lodoes not apply to an p
owner of pmpeny WM10 builds or improves thereon,and woo docs men work himself
507 - FINAL PL I NG
Or through his own employees.provided that such improvements arc not intended or ..,_.,_, _,_.._._ _ ....__._.
_offered for sale'IL howevei:tfie b-kliq or improvement s cold th nc year of ) + , ♦T'a 1. sl
completion,the owner-builder will have the burden of proving that he did not Wild or
improve for purpose of sale).
_.-__ _._.__.-_.._T____.—_.__._._.__._ ___.. ..__.__._._._..._______-.___.__._-_._._.__...._._.__.___..-_.._____. ._-.__.____..._..
°I;as owner of rhe pmpeny,am exclusively contracting with licensed contractorsmn:,.tl t'. it
_
Z. construct the pm ccl ser.7064.Business and Professiom Code:)The Contractor's v.l.::, :ILi 17 1 '.P. :.i,
License Law does not apply to an owner of property who builds or improves Unman.
Y _and whosommcts.f°r_such.projcctr.with.u.comrunut]s).liccnxd.pursuant.m.the. .._ _ _.__.____._..___... .__.-.___..__..___..___-.-._..____.. ._—...—_._...._-.�.
Contractors License Law
_ a ,. t. +t•, .-. !r . 1-+.:„ ,
.: Olamemptudder ,Sec. -''"- „"- s .B'&PCfmuhisrcamnwracr� Date
"LI ' WORKER'S COMPENSATION DECLARATION
r I hembyaRrm under penalty of penury one of��he hdlowingdeclaationst--
`` O l !e,,Pandwill maiintuin a'Cemricam'of'Consent'io self-insure for Worker's
x C mpenmtm., as provided-forby Section 37W of-rhe Labor-Cods. for the
- - 'performanmi
ce of the work for which this pert is issued.,
°1 have nJ 'll"viii m W'rk penr s Cumo I Tne umq 'ed by Sahcon
cm 3700 of-the LaMr'Cwh.,fur the performance of the work for firth this perms,is
iss d,My W k Co pc r 1 . c c d P I' y bar dm
Cartier Y't 1-k' 11 i\!aol yNo. ., A '1 '71L� I.,�f Ltr y 'l --,
tt(CERTIFICATION OCLXEMPTION FROM,WORKERS; - Z-g T, s a 1>.'uC. s t J 4, ] ,L'S I t, s t,j.vh
ra COMPENSATION INSURANCE ....._.............,
_ _ .__._. _._..___.. _-.._ _._.._
'W. ah s mU do need u iu t h,, cplcA r,he perm t isfor one hundred dollars ='V •\.tf"' `O '+•i.'._). . �'.,:
le IY Ili in the laolc
ut,haiakf.: ch 1 p .,. s:_ d 1.. F,t`JII r l '1!.a.
'shall wt employ any person m any manner so as to become,vub)ect to The'Workers '
Co pe
t m W enfC if D-m
..'APP(c .t
NOTICE TO APPLICANT If after making this Cert1 cam ot Exemption.you should
O nc sbj iso thbwokI+sdr np 6s'nfthe Land revoked.
Q r+ forth th ply'wid hp th' Dc t'hull be dm neJ revoke)
z. 1 ;CONSTRUCTION LENDING AGENCY
I hekby IF rtn th nhis t,bmmi lending agency for me per f romance
of the Work for which this perrinit is ismed IS c 3007 Civ.C)
Leder.N
cj Z Lender s AJdra r '
C.7 I rvmty that I base read th s.,lica ion and stem that the above information is
fs',F correct,bagrce to comply with all ciry and county ordinances and state laws relating
;QsV �m building commuctiiiWand hereby auioiimmpmientutives of this city to enmrupon
;. ^rrl the aMno-mmntioned property for inspection proposes. .
g. mo '(we)ugreen mve,indemnifyand lsep harmlcditoe City or CupcninSrl;ia s
4. [Zi liabilities,judgments,costs and expenses which may in any way accrue against said
U.Z City n o.cquence if the litog fth pc n ' t "
APPLlcA\'rU,NDERS1ANDS AND WILL cohIPLY WITH,\LL.N'ON-POhY"f " Issued b DatO
Sf URCE RF.GIILATTONS: '• 'f;'s. i'—
Signature of APPlicardConamwon!, -' "' ""'" ''� Dam'."li Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
1 w u site`pphe t r t re na lamg upanr t rc ur n dl n d va r t dal Type.of Roof - - - .- - - —. •,•---^--^-
..
as defnal by the Cupertino Municipal Code Chapter 9.12.and the Health and Safety
Code Sect .ZS332{ ) 1. t.'- tuI ' f ,
❑re. \ '•.roofs
shall be inspected-prior.to.any hoofing matanal.being.installed. .,,_._.__...
a'.Will the applicant or future building occupant use equipment or devices which If a roof is installed:without first obtaining ali';inspection; I agiee'to remove
emit h izamual air m
ennmlnams as defin@
ed by e Bay Arca Air Quality Management
Dome,?e, 1 --_all new materials for Inspection. Applicant understands and will comply with_,
-,aF El Yes rr, °"°" all non-point source for,
-- I 1
- sl have read the heaeNom materials mquircmenm;Lnder'Cheger 6.95 of pv:
,CNifornin Health&Safety Code.Sections 25505.'_5533 and 25534.d understand that
if th pan:lding dnex nm curtemly have a mwmalite it is my responsibility to notify N<,
bcc pat isthe rcgtoremem,which mu.fbe met Prior m i acts f a Ccni mate of
°" p°"`y 71 a Signature of Applicant Date
- — _
c .
Owner u m imd l Date All roof coverings to be Class"B"o'r better
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.. OFFICE