01080111 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: C.a—t,
BUILDING ADDRESS: .. _.. .. PERMIT NO.
19986 BEEKMAN--PL HOT WATER INC 01080111
OWNER'S NAME: APPLICATION SUB DATE
WILLARD OWYEUNG 2531 GRACELAND AVE 08/21/2001
HONE: SANITARY NO. CONTROL NO.
(650) 298-8494
a e
�0 ARCHITECT/ENGINEER: PO
'r �' 'j'a
E T INFO
ca- e 4 BERG N P B MECH
u
to a L r ,." I- LJ
y u , LICENSED CONTRACTOR'S DECLARATION r
z 5 1 hemb firm that I am licensed.neer m 1 Job Description
Oit-w with Section of Division 3 of the Business Prefasons CWe9and my license GE PROFILE SMARTWATER WATER HEATER
c m Z st is in mu force aria effect. ) .
m i 6 Date Class Lic.tr
u,LL G Dal[ S DELLA
tri ARCHITECFS DECLARATION
�t=O
'a 1 understand my plans shall be used as public records
�
dp O Licensed Professional
OWNER-BUILDER DECLARATION
e 1 hereby affirm Nal I am exempt from the Contractor's License Law for IM1e
[- a fallowing reason(Section 70315.Business and Professions Cale:Any city or county
i=0 which reclaims a permit to consumer,.loll,improve,demolish,or rtpah any occome, - $500
Prior
'ts'.s c,alsortquiin Ne applicant fmsuch pertnits fl aligned summem. _
3 m Nm he e licensed pato anti I the p.(vj.ions of Ne Creno-mor:License law(Ch rpm,9
(co mina lhsen ]000/pfDviaonJoftheBusmcs.andPofgssionsCode) E;a';1.3;1: CJ,IlI �QPr -e,a .4. �,., Valuation
or Nat 1 e I<exempt Ihercfrom and the basis for the allFged exemptba.Any violation
-of Seem,1703 L5 by nay up pliant for n pelmil xubjecls rhe applicant Io a civil pcnahr-
tof mam..than frveIt named do[ars(s500). _ 502APNEyffj'lE PLUMBIN ENERGY Occupancy Type
❑Los owner of Ne property,or my employees with wages as their sole compensation, snr _
-will do the work:-and IM1 .I tare snot irmnded-or offered for sale(Sec'70 , - - -Business d e r ai n Coade:Thc e.stcmrthereon, anw Law s su ria orkapplyhi Im an 5 0 7 - FINAL PL@f$F3iI4dC�+fspections(
0and
wrier mf property who to Ids or improvesat.suc mprwho docs such stunk intended
or
or through his own employees provided that.such iemememenrs arc not imener or
i
,c mind ion,'he:IL Howevd;rhe bolding or urden a Prov n sold within not year or ---
omplelions Nrpose of
will have the burden of proving Nm he did not build or ""' t" `""''-"'
improve for Purpose of salc.l. '
• romra pro . I -sly 1 i g -Id .I J t tors Io
i.1Professions
con trIM1 p j t(Sec 70 B .' and Pmf s Cod )ThCo tractor's p ��
art
Lic 1 d I apply to net fp pvriywho) ice improves Merton
_and ,1 ,Liman for s ch p ams wish a wmrvnor(s),Im riled pursaant lm the - _ e'Qp pr+► _,
12
Co r a t L arise La
nr
0 1 ma,exFoopt neerSa.- ;' � +"B&FGfor rhis rcasmn _MAY 2 9 2002 .r',,,,'
�, .. Dare ,..
_- WORKER'S COMPENSATION DECLARATION
I"0 i hereby aRrm under pcaaly or perjury one ofam following dechmlionsr- BUILDING
f 'D 1 have and will ranouin 5 Certificate of Consent m self-insure for Worker's
Compensation:as provided for by Section 37W of the Labor Codc, for the
_ performana of the work for which his pmrmit is issued.
❑I hack and will maintain Worker's Compametion Insurance,as required by Secdrin
3700 of the Labor Code,for the performance of he work for which this permit is
Issued.My Workers Compensation Insurance comer and Policy number art:1 1.4 `
Cam l .F )', R Polley No.
lis "CERTIFICAT'ONOFEXEMPTION'KUM"ORKERS-1` s,J:' ; ° , a �ili ��•,J � 44. A_'�?'r{j;+;; '
COMPENSATION INSURANCE �•1 't I
s;1 s (Th'. ' am mind r1 be cmn,I,1M it line proton is for ane hundred dollars -
(4100) -
I mfy N n n Ih perform f IM1e work 4 ewh ch'his pinto t s issued 1 r - ---- ------
shall nt employ mL any person in any manner so a to become mbjcct to Ne Workers - 1 '!• "'
Applicant laws of California.nate
NOTICE __..__ ... _. .. .. .... ..... . .... ......_.___ ._. s__ .._ .. .. . .__ _.__. .
!NOTICE TO APPLICANT If after roulart,Ih ..,i I tae
E e pm y
shouldIJ
QObee m1WorkersC tae tip s sthe M Cod you
nnhwh,comply wis h p nvsons or this p 1 shall be deemed invoked. must
Z ._._...... - - . -- _ . _ _ ' . ._. .
- CONSTRUCTION LENDING
„
AGENCY
1 hereby affair that them coasurection lending agency for the Performance
W_Q of
doL
work for which thi,Ecourit is issued(Sec 3097 Civ C)
0., Lend . N - v ;:,___
=) Laci'Z .,rte
V � y.;,,,. l cn ry don them read chis spplic i on and star.Ihul the ahmve nformat unix
kT+r[-i torten:1 agree to comply with all city and counly,oNmances and state laws relating -
�..(� Jo building construction-and hereby mrhs;am representatives of do;city to enter upon
�„-W the aborm mentioned p peri,for n,fall P Ip
F.'-0.r t We)agree orxo r'inderary and keep hartl �9he Cu,of Capers o agarol
(Ztliab l' g ¢s .t , d which h r y l tiny y grinsr.said
I City i. ) din consequence of the praming of thl p.it. n
APrUCANT UNDARSTA NDS AND WI LL COMPLY WITH GLL'NON-POINT 1 /
SOURCE REGULATIONS. „ Issued by: Date
Sign.tom of APphcem/Ccmrvct.,d . : Date Re-roofs •i
" s{: HAZARDOUS MATERIALS DISCLOSURE "' -
w u N apphca 1 ret Ir n Irving u< past,m ,barrel Nomad- r mammal .-..Type of Roof,.._
.s tas Jef ed byN Cperono Fl, Imp'tL Ch Ple9.12.and the Health it Safety
CnJ ❑Y..2553 m) v1 .❑Nn l a't k( , 1.r J g i I. f� a•v'IF -t'
. _All roofs shall be mspected prior_to atiy roofing.material.being Installed.
Will the app]nc cartor building occupant �ccqu p 1 devices wnm If a roof Is in Without first obtaining an inspection'-I agree to remove
milk ad rconlrt or futuasde0ned by the Bayle Quality Management
•Disl I
0Y„ .,. ..,e _,QNn,- . -. _ all new materials for inspection Applicant understands and will comply with
t . all non-point source regulations ,
I h e read the h i bo s materials 05 rc enu order Ch ymr 695 d the '
if he uil H Ilh s Safety Code.Sevlioos m, that
5533 and S53a.l it,m mind that
'-
ifrhebuil off ,ng snmments whicheon,he.Thal it is lin,responsibility to nmify the'
dccuphnl of Ne iequircmenls which mull b<
.a' a�apaneymer pit.,,.issuance of a r.
'a of
... :
,. ., .
Signature of Applicant
.. ... .,. ._ . .._.. . ._ Date
owner or anlnmi.magenr - Dale All roof coverings to be Class "B" or better
. ,.:,';:
r .. .- �_..( - "OFFICE .. _