03030016 CITY OF CUPERTINO - gg;; �• 'r"•'�v°"'�.�"g�.1`•- �'" t��r°yy��"f,;'v'?//y�y � y�
BUILDING DIVISION PERMIT kA � l;QTI�l\l'.SJ � Qr '
BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT NO.
OWNER'S NAME: 1764 NATIONAL AVE PERMITISSU6DA7E
JEFREY GUS
NE: (510) 293-9901 SANITARY NO. CONTROL N0.
ARCHITERIENOINEER:
BUILDING PERMIT INFO
BLDG s PLUMB MECH
Z EQ '
app
LICENSED CONTRACTOWSDECLARATION JobDescrition
1 Mmby aElnn IMI 1 am licensed under provisions of Chapter 9(Commencing P
With Section 7000).f Division Sof the Bustnesa nd Profetaimns Cade,and my license is
In full in=andef1CCL REPLACE WATER HEATER
License Class LIC.N a
B Dam Contractor (50 GALLON GAS)
ARCHITECTS DECLARATION
Iunderwnd my plus shall he mind u public recuts t) 'ZOO']
Is Licensed Professional
OWNER.BUILDER DECLARATION p
.�� 1 hereby affirm mel 1 am exempt from Bre CamnwoYa License LAW for the BUILDING
Ofollowing mason.(Section 7r31.S,Business and Profession Code:Any city or county
$ which requires a Permit in construct,alter,Improve,demolish,or repair any atrommre
a� prior in lin WUNCO,elan requires the applicant for such permit to file ulgned ttstemem
< thuMhllanudpuruanuotheprovisionsoftheCowrecter'sUaveLaw(Chapter9 Sq.Ft.FloerArea Valuation
(Commencing with Section 70DW of Division 3 of the Business and Prafuslmu Code)Or
that he Is ammpt tMmfrom and the bub for the alleged uemplion.Any violation of $1005
Stern 7031.5 by any applicant far a permit ubjects the Applicant In a civil penalty of APN Number Occupancy Type
not mom man fin hundred dallus($300).
O 1,as aweer orum lnopmy,w my employno with"gnu dmh ane emnPe reader. 34245033 . 00
.little the work and thestmciumb nwiummod wanemel(.ask(Sec.7044,Buainela a aired In
and Prolamin Cade:The Conaanmrt Licerm law dal met apply m an Owner or 502 - FINAL PLUMB I s ENERGY
propertywho buildsarimproves throe nand whodeuuch work himselfwthrough his
Own cmployeu,provided that such Improvements are notlnlmuled onRered forum.if. SO6 — GAS TEST
however,the building or Improvement is sold within am year of completion.the owar-
builder will ban mebuNmofproving that he did not Wild orimprove far purpose of 507 - FINAL PLUMBING
uleJ.
❑1,a ower of the property,am a¢Iabody eantracdng with licensed eewwan in
comm et the projeen(Sec.7044.Euieela and Profeadons Code:)The CW 1mCWA U- '
muse LAW deal not appy m an owner of property who bdI&or Improve desmon.and.
wine conwea Its such pmjeem with A contraClm(s)licensed pursuant m the CmmanWa
[Acetum law.
❑l am exempt under Sec. ,B B PC for this nose
1'3700
wer Dam
WORKER'S COMPENSATION DECLARATION
1 hereby alarm under penally of perjury one of the following declarations:
I ban and will mainWn a Centrale ofCoruent to self-Iuum for Worker'sCompen-
lon,ga provided for by Section 3700 of me Lahr Cade,for the p ufnes a of the
mic for Which rob permit is issued.
1 Mn and will maintain Waiter's Compensation iuu ince,u required by Section
ofIM Labor Code,for the performance of the wok far which this permil is Issued.
y Worker's Compensation Insurance arrive and Policy number am:nter. Polley No.:
CERTIFICATE OP EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(I'hb seclon need not he completed lith pemtitU fm ons hundeed dollars($100)
ar mu.)
1 antfy that In the performance of the work for which this permit Is island,l shall not
employ anyperson In any manor an As An became subject to the Workers'Compengatie
LAM of Calif lmia.Data
Applicant
NOTICE TO APPLICAT:If.after making this Certificate of Exemption,you should -
become subject 10 the Worked Compensation provisions of the labor Code,you must
O O forthwith comply with men provisions o this permit shall be demand mveked.
r~�a CONSTRUCTION LENDING AGENCY
F 1Mr which
tat them b•comtruerin lending Agency for the perfmmanttor n n
Ni a theLt work(w which this pemth b Wood(Sec.7097,Cir.CJ
W� lender's
;D z Lender's Address
U O 1 unify that 1 haat read this application and sum that the shove infomnade is
lL!' emrm"I"re"m comply with dl city and county aNlnaeenn0 tau haw inning b
O rV^ building Construction,and hereby authodm mPmsenuOns of mitt city m enur upon the
G57 above-mentioad property fm inspection purposes.
(We)agme m gave,indemnify and keep harmless the City of CupcnmO against
,..,y liabilities,judgment,cerin and expenses which may In any Cosy wane against laid Chy
U 7 In consequence of the granting or this permit.
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of AppliunUConwmw Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant stem or handle hauNom material
IDdemrd by the Cupertino Municipal Code.Cbapw 9.12,and Oso Hulth and Safety
e,Section 2557:(.)7 All roofs shall be inspected prior to any roofing material being installed.
ED year ON.
1 WIII the applicant m(atom building acupanl use equipment or devises which If a roof is installed without first obtaining an inspection,I agree to remove
dhaudau alrconuminanu u dcMcd by that Bay Ama Air QuWly Management' all new materials for Inspection,
trla7
❑Yes ❑Nm
than read the halasdma malenal requimana under Chapter 6.93 of meCIilw.
Health k Safety Code,&Co.23505,25577 and 2553/.l uedemend sen lithe Wild'mgs nm currently Mn a ananl,that it b my responsibility m angry io orcupmi of the
uirements which must be met prim m)auance of a Centnate of Occupancy. Signature ofApplicant Date
ner ormthmindagent Data All roof coverings to be Class"B" Or better