03020018 CITY OF CUPERTINO -
BUILDING DIVISION PERMITCONTRACTOR INFORMATION:,.
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BUILDING ADDRESS: HOT WATER INC PERMITNO.
22988 CRICKET HILL RD 03020018
OWNER'S NAME: 2531 GRACELAND AVE APPLICATION SUB DATE
DEEFAY YOUNG 02/06/2003
ONE: (650) 298-8494 SANITARY NO. CONTROL.NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
GCZ
I00 LICENSED CONTRACTOR'S DECLARATION Job Description
P I herchy affirm that I an
licensed under provisions of Chapter 9(commencing o
with Section 700)of Division 3Of Ne Business and Professions C.dc,and my license is
of Hf eandeif REPLACE WATER HEATER
Or Lbenm Class
sLiu.»
DaN Cnnlm"or
` ARCHITECTS DECLARATION
e ei 1 undersunJ my plans shall he used as Public records
SLLu.iOyU
0 Licensed Professional
OWNER-exempt frDECLARATION
1 heirchy Ilium on 1 1. cacmnt from the Contractor's License Law for the
00 following massa.(Section]f131.5: t.alter. and Professions Cade:Any city or runty
a x$ which requires i permit minas tha,pplic improve,demolish,or marl,any structure
rift,mits censed e,alstion1.res lM visions mfor mchpermilmrdea Low(srtemem
(that he comme crenwJpuection7 )of Divisionfft ofthe nuinessandPrmlaw(ChaPrtr9 Sq. Ft. Floor Area $ lLOtion
(cat he
seemwith Section7") basisnfrorlbeeged Business enJon.Any violation
the,he u exempt thertfrom and Ne breis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of Br Occupancy Type
not more Nan five hundred dollars(SN10).
❑I.as owner of Ne property,or my employees with wages as their role compensation.
will do the work,and theslrunule is not intended or offered for sale(Sm.70sa,Business 502 -
Rty
and Perfusions Code:The Com acmes License Law does not apply m m owner of 506 - GAS TE ulre nspeC Ions
pmpenywho builds orimproves thereon,and whodceaouch work himm or no hi
own employees,provided that such improvements art not intendedo,.fa.d for sale.l- - FINAL PLUMBING
however,the building or improvement is sold within one year of completion,Ne owns. I
bulltlat will have the burden of proving Met he did not build or improve for purpose id _
❑1,as owner of Ne prapeny,am exclusively contracting with licensed contractor to
construct Ne project(Sec.70aa,Business and Professions Cotler)The Contravenes Li.
cense Law does not apple to an Owner of progeny,who builds or improve the eon,ind, /
who contracts for such projects with a comramor(s)licensed pursuant to the Commothoi
Liccneo Lew.
I P
❑ I an exempt under Sec. ,B&P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hercb.aRrm under Penalty of perjury,am of the following declamations:
end will mintram r Certificate of Consent en self insure for Workei.Compen-
137M
i m,ax provided for by Section 3700 of the Labor Code,for the Performance of the
ork for h this permit is issued.
have and will maintain Worker's Compensation Insurance,ss required by Section
of Ne Labor Coe,for Ne Performance of Ne work for which this Permit is issued.
y Workers pewtian lns�ncec)]vier en,an,Nonumb- aartier. /--Q..�Poli No.:
CER IFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed irthe permit is for One hundred dollars($UXB
or less.)
1 certify that in the performance,of Ne work for which this Permit is issued,l shall not
employ any person in any manner m ex to become subject to the Workers Compensation
Laws of California.Dare
Applicant
NOTICE TO APPLICANT:If.after making this C01firle4h of Exemption,you shou lJ
become subject to the Worker's Compensation pmviouns of the Labor Code,you must
OO forthwith comply with such provisions or this Permit shall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
t-i14 Thereby affirm that there is aconslruched lendingagency lar she perfomrneeof
ai ti the work for which this Permit is issued(Sec.3097,Civ.C.)
w Q Lenders Name,
(�C z Lenders Address
V C 1 certify Nat 1 have mad his application end alae that the above information is
(~ correct.l agree to comply with all city and county ordinances and sere Imaxodating in
CU building construction.and hereby aUMOHMrePMWnWLiWa of this city to enter upon the
anew-memioned progeny for inspection Purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
in liabilities,judgmerox,coati and expenses which may in any way accrue against said City
C.l in consequence of the granting of this Permit. Z
APPLICANT UNDERSTANDS A D WILL COMPLY WITH ALL NONPOINT Issued by: Date
SOURCFj REGULATIONS.
6 "� Re-roofs
Signature of Applicant/ R --7
HAZARDOUSZARDODOUS MATERIALS DISCLOSURE, arc Type of Roof
Will theappliean,or future building &upon,smmorhandle hazardous maerial
as deficed by the CuKr iso Municipal dc.Chapter 9.13,and the Health and Safety
code,se&Bon 35532(ay/ All roofs shall be inspected prior to any roofing material being installed.
aver ❑
Will the applicant uture 'Jing Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air con fusion defined by the Bay Area Air Quality Management all new materials for inspection.
District?
Cl Yes No
Ihavercxl thele,Sections 25Si5,2553i and sints
.1u demanter d et ifthe Calding / -/� /fD �J
not HcalIhAr ave maythehumlcdu,mateerials5,puren 25534.1understandbuilding (/ �uJ/�J 11
Jens not currently have a tenant.th tis my rcaanrmiNlity In nndry occupant Of to _
requi h;rnmust`x o,eriasuan&easncenineamnr ca'sner. Signature ofAp scant D to
/44 �h� �/b`b 2 All roof coverings to be Class"B" or better
Owner or authorize)41eno Data