02030150 OF
CITY ILLDIING DIVISIONNO CONTRACTOR INFORMATION:
_ PERMIT
BUILDING ADDRESS: PERMIT NO.
10.436 COLBY AV JUST WATER HEATERS INC 02030150
OWNER'S NAME: APPLICATION SUB DATE
GAXIOLA RALPH 1764 NATIONAL AVE 03/26/2002
HONE: SANITARY NO. CONTROL NO.
(510) 293-9901
7�u
ARCNITECf/ENGIN[ER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
.'+ ... : . . . LD O LICENSEDCONTRACT'OR'S DECLARATION Job Descri tion
1 hereby aBirm that I am licensed under provisioru of Chapter 9 tcommcncing PwithS«titn9000)ofDivision3oftheButmovom,dPmfessitodCodeendmylicense REPLACE WATER HEATER.
in full force and ellen.License Corsa Lie.a (40 GALLON GAS)
Date Contractor
LL O y ARCHITECT'S DECLARATION
1 understand my plans shall be uxd as public r«oNs
i Glp p Licensor]Pmfevsional
OWNER-BUILDER DECLARATION
I hereby affirm that Iran aacmpt from the Commacmr's License law for Ne
baa following moved.(Section 7031.5.Business and Professions Code:Any city or county -
Y"G
which mqviz es a permit to construct, he improve,demolishor repairy stractum
a. that
tot ' w alsorequirestheuppl nt for such Formal to flsignedtmmem _,_
troth heeosedp ramont Inprovisions of he Contractor sL . La (Clmpmr9 , S EL.F1oorArea,
n-- Valuation
(comm« g NSection 70ao)of Div.on3of the Bps«u and Pr feu Code) fF' ? s v- 4it ),
.or Not he is emm rNciefmm and the basis for the aIle ed de y violation f - ' r`r' - k i).:\. 1 `t F"V:Y.
p g manta.An laton
M Section 9031.5 iany applicant for a permit subjects the applicant to a civil penalty
or not mare mfive r hnnarm dollars essDOLA N Number Occupancy Type
❑I.as owner of rhepopcny,or my employees with wages as their sole compensation. _ FTNAT. PLIJMRTJG
will do he work.and he'armsme is not intended bre offered for sale(Sec.7111
'Business and Pmfiossiom Cade:The Common,:License Law does not apply in an 506 - GAS TESH'equired Inspections
owner r of propcny Who builds or improves thereon.and who does such work himself
or though his own employ,.t provided Na such improvemems all not intended or 507 — FINAL PLUMBING !
";cRered7on,the I[hobui ldethebu Idnge mpr6 chin so1E to scar of - - --' "-'' ""-'-. - _ ....._ ..
imp..0 for
theawnermuej.w11 have them d fp proving that he del not build or t
improve for puryose of sale J.
❑Las owner ofrhe grape..am exclusively commning with ode:) d Coadars 's
;:ni'alie.
License
construct the project(Sec.704,f,a Business and property
who
CMe:)The Contra thereon,
���� ® 1 '
License Law tract not suchmmi owner of progeny who builds seimproves thereon,
and who.contmets for such.prohns.with a conmanorts)licensed Pursuant m.Ne. .__.-_....__._ ._._. -.
._. ❑nt m enc Piecrum taw, .P C for this reason s ---__.-_...__.._.--.......... .. .. .. .-
Contractor's
mtandrg«. ' B.& , APR 1:.p.,2002.:;,.,,
Ow Dam
WORKER'S COMPENSATION DECLARATION
" I hereby affirm under penalty of pe jury one of the following declarations: BUILDING UI l DI p G
❑ I have and will maintain it Certificate of Conant to self-insure for Worker's L• g\�A
Compensation. as provided for by S«tion 3700 of the Labor Cadc, for the
perrorma«e of the work far which this permit is issued..
❑I hove and willmainidin Worker's Compensation Insurance,as required by Section
3700'of Ne Labor'Cab%for he perfprma«e of the work'for'which Nis permit,is
island.My Worker's Compeniadon fusee uce<ariel and Policy number am:
Carter s i 11Policy I. lv . i 'f k W t ,...
CLRTIFlCATION.OF,EXEMPTION FROMIWORKERS,� E 4 t: r. .. i "
COMPENSATION INSURANCE."
............
` '(Tri n nneed nm be complcieddNe permitis for onehundred dollars 'I+ t' ...,. r
IS 100)or less:)j - -
r. I carit'iy:daid in&Pertorrraninf the rk for ivitich this petro tis ssued.I "_` - -, - - ,. -_:. ` . •,
shell am employ any pc in any manner so as to become subject to the Workers _..
Compensation Laws of CAmmia.Dam
Applicant f .. .
NOTICE TO APPLICANT:If ft kid,thra imfsof tof he
youshould -"--' - "--
Z becomesubject
comp y the Werke Compensation or this
p , shall
of e d lame Code you must
Q fdnhw ih ply with such Provisions- or th Perron hall bed d revoker.
rt .ke.d.
..L_
OUssSN
ft Ihy that thre aswconlendgency,for the performnce
owork fe �ch did, ad( C,C.
'
W 0 Lenders Name-
_ . .. ... t ,, .. _.... .. .. . .. .. .. _._
p"" Lenaars Address - __._.. .... _.._. .__._.._.... -. .. __ .
app
U I serrify N cora din city
and It Nat thebo laws
mien is !�W✓✓` �,
W E., correct 1 g , comply with 11 n o d re ordinances d state 1 relating
O k
to
building
it ed p!openyf bin pectionpze t t_aa or this- Cyt corer upon
tiy (We)agree to save.indertimry aria kap hmmlexs Ne Cay of Cupertino against
.� liabilities judgments,costa and expenses which may in any way sector against said
'U.4' City in consequence of the granting of this permit. '
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT'''
SOURCE REGULAnONS) - Issued by: Date
Si ort Will
. FPfoHAlARDOUS MA"1'E :L:. '..Dore`• .'
s of" 1 Re-roofs
Cupcn rfutm:cbial Cone CIu�DIboreor RE ;... . :t ad
'-W II Nc haidle Han th to al
as defined iby mNe pal p d N Health ;d tar y Type of Roof .. _ . . .... .. .. . . . . _,_ _
Cad;Sm 2553 O7 a - _� +'f -
t ,.t I ., lti� a 'e l ' t a k �,;
. ore ❑N < r; _All_roofs shall be inspected prior[o.any,roofing material being installed.
wd NS ppl cant r t rel.,holding«apant ase w7mpmc t devica,which If a roof is installed without first obtaining an-ins ection I"agree to remove
amt hazard a,rcontaminants defined by due Bay Area Air Quality Management g p
D9n-Oyr, ON.-, all new materials for inspection..A licant understands and will comply with
all
no i=point sourceregulations. Applicant
' 11 h va read Ne h rad s renals req merits under.CInt1mi 695 of the
Califum a Hcaltn&safety Cade,Sections 25505.25533 and 25534A undem and Net
tphe LN11ding docs not commonly have a tenant,that it is my responsibility to notify the
bccupthe'requirements which must rte mei prior m issuance of a Canificam of
Occu ' ...
'- Signature of Applicant
S PP -.- . Date
".. owns,
or.mmprrepa emroof-coverings. . . - ... ........
All to be Class "B"or'lietter
OFFICE