02050037 CITY GDIDIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10465 BREWER AV JUST WATER HEATERS INC 02050037
OWNER'S NAME: APPLIC4TION SyB DATE
GOWEN WILLIAM R AND MARY N 1764 NATIONAL AVE 05/ 07/ 2002
PHONE:
(510) 293-9901 SANITARY N0. CONTROL NO.
0 0 ZO ARCHITEC-PENGINEER: BUILDING PERMIT INTO
k1,'an
t- BLDG ELECT PLUMB MECH
S h z LICENSED CONTRACTOR'S DECLARATION
5 Z=G Iherc70 of Divisihat I on
3liccnutunderp and
Pions.r Ch Coca and(commencing Job Description
„F, ,vitnfallir,neuro)efect. .n3.nneansmettanaPr.ret5mnsenae.andmybLenm REPLACE WATER HEATER
lr mu mc,,dna erred,. (5 0 GALLON GAS)
o w U License Class Lie.a
Date Contractor
7 u.O rn ARCHITECI'S DECLARATION
S 1 understand my plans shall be used as public records
or
L 6 C O Licensed Professional
usien OWNER BUILDER DECLARATION
so1 hereby aRmm that I or exempt from the Convaaor's License law for the
C?_ following reason.(Section 9031,5.Business and Professions Cade Any city or county
re F o which malifirs,.permn ., n 'Ite,Imports,dralolikh,or repairor,structure
e,3 Prior, , .. I 9 ,he appl ,f such a fl ash ed statement
that is httnscdpursuant tthe provisions ofth Connownur a License La (Chapter 9 S .FC Floor Area Valuation
(commencing ,h Sea 7000) fD' 3 o meB c and Prof Coae) �,1 ^i;';9 fl ;dt },sy-p -'ti '
or that he a exempt therefrom and the bass for the alleged exempfon.Any v uleuon '
of Section 9031.5 by any applicant for a permit subjects 0e applicant m a civil Penalty
'.fuel m.rc then five hundred dollars(Se(n), APN NumberOccupancy Type
01,so or,.nhe pmlico,or my empleyas with wages a5 their tale mmpentmlm, 502 - FINAL PLUMBIN ENERGY
will do the work,and,he structure is not Intended or oRered for sale(sec,T}ey- 5 0 6 - GAS TES
Bounce and Professions Cole:The Cnmraremr's License Law docs am apply,o an rRe uired Inspections
owner of property Who(wilds or improves domain and who does such work himself 5 - FINAL PLUMBING
or through his own employees.provided,hat such improvements arc no,intended or
.offered far sale.If,hbw24c, he Wilding or ilnphivement is sold within one ye Q�� �'-"
cnmpleiim,dr,owner-builder, will have the burden ofproving that he did notbuil �'WJ1 - ^
impr.ve for purpose of Sale.).
,a " i o - M 2002
a'CWs:)nhromracmau--MAY
3 0- .. . —._.. ... ...-- ..._.._- ..__ .._.
- .Dl;as owner of the propenY,am exclusivelycommaing " -- - -- -- -------- -
License,the project(Sec.70Y44,Business and property
whiob Code:)The ve,un em. '
License who
Law tact not apply to an owner of property who builds or sed purse S Herron,
and who contracts for such r. , wi,h.a comme,orts)licenses.pursuant bribe ..._ .
BUIL—
Owner
p jcc s
EIIa
Contractors Licenselaw.
EI I am comp,under sec. � ,B&P C for,his rtacon
.. Own Out
WORKER'S COMPENSATION DECLARATION
' 1 hereby alimm under penalty of perjury one of)he following dedaratiom:
❑ 1 base and will maintain a CeniGcme of Consent to self-insure for Warker's
Compensation, as provided for by Section 3700 or the Labor Code, for the -
Perfommnce of the work for which this famni,is issued,
❑1 have and will maintain Worker's Cumpehscomm Insurance,as required by Section
3700 of the Labor Cade,for the perfcauance of,he work for which this permit is '
towed.My Workers Compensation Insurance Lanier and Policy number are:
.. _ . . .-. ..:. ._ .. ..
Couren .he,No
CERTIFICATION OFEXEMPTIONFROMWORKERS't !. cf v.tl< m'�, ',t'MjfG,r f.S,; fQ} •�.7 '•
COMPENSATION INSURAnCE '` '
"(This section need m,be completed if the parrot is for one hundred dollars 1' --
D$1009 1CSi) `
I c n fy that in parr an l r k for which 0s i s lssoce,l
shale , Person
inpl y any Y u,o become subject
ct,o,he Workers
Compensation Laws of California.Darc�n
NOTICApplicant.
NOTICETO APPLhe Work 11,Compensation
this Cemf aofthe become Compensation cmption.you should
Z provisions of e denotedabor mocked. must
� O f.nhwitM1 comply with such provisions or this permit shall be deemed rtvokN.
a 'CONSTRUCTION LENDING AGENCY
a'� of hereby affirm,ha,thea its consm'ai . 097.lending agency for the performance
96 .. Linn work for which this permit is tdsuea(Sec.3097,Civ.C.) `
6. z 'Linder a Name- ..__ ... ._ r _.... - -. -........_.. ... '_..._-
D.z Lend .Add
U�� In' that h al a t tl scale e,he bo information is \j
n agree
C+ [-t correct I g to con with ply II city
ty fid co ordinances rd d slate rclet ng U/w((-7✓f_i`}^/ �NWf..• r
W m building aboswe-m m.' Y d h by h erepresentatives of,jus city, der upon
he d for
y t (We)agree to sat;ndinspection p purposes,
emmlyand keep Wmdns the Cly of Cupertino against
V] liabilities,judgments,rose and wmay in any way accred against said
City in consequenceof he griming of
this permit.
APPLICANT SOURCE REGULATIONS.
WILL COMPLY WTTH'gLl NON-POINT Issued by: 12Date
Signature.f ApplicanUConvmon .-v,Dole Re-roofs /
HAZARDOUS MATERIALS DISCLOSURE'..
Will HAZARDOUS
or future building ommicnt more or handle hazmdout material Type of Roof._
as defied by,he Ct pen' Municipal uC d Chapter 9.13 and'he Health and Safety
Code Sectin o2553Na1 ,,: - r. -
El Yt, No
-.
All roofs shall be ins ected prior tearly roofin material being installed.
WII to pplicm f t b Id 5 p pg
B p ' If a roof is installed without first obtaining an inspection; I agree toremove
mit ha b c time t ermnym ByA 4qF Quality tt.6eh h
District? all new materials for inspection. Applicant understands and will comply with
or on
lall Tion-point source regulations; - - - -
4dL
1 have read the hoza d s ma¢nals requ rements under Chap ar 6 95 of the
.Healt&Soley Cox,Sections 25505;25533 and 255341 understand that
building does notcurrently have a tenant,,Wt it is my«.sponsibility ns notify theam.f the r nmo mems which must be mei prior,o issuance of aofancySignature of Applicant Date
r.praimoramagen,. Date All roof coverings to be Class "B"or better