03010129 CITY OF CUPERTINO a . t3 ice.
BUILDING DIVISION PERMIT CONTRACTORINFORMATION.
BUILDING ADDRESS JUST WATER HEATERS INC PERMIT NO.
11233 LA JOLLA CT . 03010129
OWNER'S NAME: 1764 NATIONAL AVE APPLICATION SUB DATE
PEDROTTI DONALD G AND MIRIAM P 01/23/2003
NoHONE: (510) 293-9901 SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MI'LH
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LICENSED COMRAC1'ORS DECLARAT[ON ZP JobDescriP tion
I herthy affirm That 1 nm licensed under provisions of Chapmr Y(commencing
�< with Section 74kgBnf Division 3 of the Busrtc,., std Professions Code,And my brothers
< nmRnne,Andeffect. REPLACE WATER HEATER
:oq? Date laze Lica (50 GALLON GAS) ���/���®
�Zt-O Date-Cnnvunm
P:m,=u2 ARCHIILCTS DECLARATION
Y s< 1 understand my plans shall be user as public records
LLoLicensed professional FEB '0'5 2003
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's Licc re,Law for the
w_oo following reason.(Section 7031.5.Business and Professions Code:Any city or county BUILDING
e. m which requires a permit to construct.alter,improve,demolish,or repair any svuert
u
nor,ons its ismance,also requires the ap,heanl for such permit file a signed statement
tan un
dooheislicensedpursuantheprovisionsofsheConvawCha
tocaLicenseLa ( pmr9 Sq. Ft. Floor Area Valuation
a (commencing with Scene.7(WXb of Division 3 of the Business and Prolessiom Cexk)or
y that he is exempt therefrom $1017 and the basis for the alleged exemption.Any violation(it Y
Section 7031.5 by any applicant for a Permit subjects the applicant in a civil Penalty of APN Number Occupancy Type
nm more than five hundred dollars($51)(1). 35621045 . 00 P Y YP
❑1,az owner of the property,or my employees with wages As their Aisle compensation,
will do the work.andthe eweure is not intended or offered fonale(Son.7044,Business �{�,p��{{��ggss��[��.n �,{Wp�,
and Professions Cod,:The Conlracmr's License Law does not apply r an owner of 502 - FINAL YL UIIvf l N et` TICGY
property who builds or improves thereon,and who does such work himself or through his
n employees,provided that such improvements are not intended or offered for sale.If, 506 — GAS TEST
however,to building or improvement is sold within one year of completion,the owner
builder will have the burden of proving that he did not Wild or improve for purpose of 507 - FINAL PLUMBING
sale.).
❑1,as owner of Ne property,am exclusively contracting with licensed contmctors to
construct Ne pmjcet(Sec.70,1,1,Business and Professions Cade:)The Col m bus Li-
cense Law does not apply to an owner of property who builds or improves themon,and
who common;for such projects with a contraclorfs)licensed pursuant to the Comment's
License Law.
❑ tom exempt under Sec. ,B&PC for this reason
owner Dau
WORKER'S COMPENSATION DECLARATION
I hereby alarm under penalty of perjury one of the following recreations:
❑ I haveand will muinlam Cartifthrof Cnazenuosel6insurcfmWmker'sCumpcn-
sation,As provided for by Section 3791 of the Labor Code,(or the Performance of the
work for which this permit is issued.
❑1 haw and will maintain Worker's Compensation Insumnce,As required by Section
379)of Ne Labor CmIc.for the performance of the work for which this Permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Career: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(His section need not rte completed if the Permit is franc hundred dollars($19)
or less.)
1 certify that in the performance of the work for which this permit is issued,I shall not
employ any peruse in any manner so as to become subject r the Workeri Compensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:If,after making this Cc nilicate of Exemption,you should
become subject to the Workers Compensxlinn provisions of the lahor Cole,you must
O Z forthwith comply with such provisions or this Nonni t shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
[-+ N lfor whihthis"ntrere isacunsteclinn lending agency for performance of //I\
the work far which this hermit is issued(true.ion le Co.CJ
W Q Lender's Namc
z Lender's Address
C.7 O 1 mnify that 1 have read this application and sum that the Above information is
U. F Camel.1 agree to comply with all city and County ordinances and state laws relating to
O U building construction,and hereby authorise representatives of this city In enter upon the
a own-mentinned property for inspection purposes.
(We)agree At save,indemmfy and keep harmless the City of Cupeninn against
y liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of his Permit.
�r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS,
Re-roofs
HAZA
Signamrc al ApPlicaRIlam
1{AZARDODOUS Mding twALS DISCLOSURE Type of Roof
Will theapplicantnr future huildinge,Chapterreor handle IIcahna material
As defined by Nc Cupertino Municipal Code,Chapter 9.12,and the I Icellh and Safety
Calc. ❑inn 35512(a)?
Yes ON. All roofs shall be inspected prior to any roofing material being Installed.
Will the applicant ear future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit haeerdous air contaminants as dclined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes ❑No
I have read the hamNnus materialsrequircments under Chap erfi 95 of Ne Califon
nia llcalth dr Safety Code,Sertitms35585,MN33 And 35515.1 undersand that BAN,huilding
rest,not currently have a tenant,that it is my responsibility or may the occupant of the
requirements which must the met poor o issuance of a Certificate of Occupancy. Signature of Applicant Date
Owner oraudtorivedagent Date All roof coverings to be Class "B"or better