02020126S
OFFICE .. _
CITY OF CUPERTINO, ..,,iyn%•' ' -]' `-
. BU1LD1NG D1VVn0N`t 1" �' . _ , PERMIT'-'
i CONTRACTOR.INFORMATION:
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BUILDINGADDRESS: .,
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PERMIT(i,`-.•.
.10833:NORTHFIELD SQ
__JUST-WATER'_HEATERS`INC '
02020126
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OWNER'S NAME: ' - _
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APPLICATION SUB DATE
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KATHERINE,WAGNER
1764 NATIONAL AVE'
02/28/2002
PHONE:
SANITARY NO. CONTROL NO.
(510)293-9901
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ARCHITF.0 (ENGINEER: -
BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
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hemby affirm that I am limned under provisions of Chapter 9 (commencing
x9msah.n7000)ofDivisis.3.fm<Basines:andPrnfc.aimoCme,andmylieeme
REPLACE 40 GALLON WATER HEATER
is in full force and effect.
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ARCHITLCf'S DECLARATION'.
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- 'I unacmm�d my plans shall be used ea public rtcoras
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LinnmJ Prnlcssinnal
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Om I .. exempt fr meCa DECLARATION
1 affirm [hat 1 camp[ Law for the
the CSsimes Any
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s an Code: Any city sr county
LS. Business and Care: : C
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following massa (Section
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to col
ive, demolish. wt
xhrch quo pe n construct. v} p ve eqI s h p r
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t[ a Bd m I< [I .n .
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Jsat s vactort to f l
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ValUall011
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use soe (Chtemem
e 1 nod once to die n ons of fh C s l; le (Chaps 9
richt 7000) of he 3 of B s Cade)
dfAny
(commencing a err on mon
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violation
p� g uamptwp Any viol t on
(c that en is cum t therefrom and the bars for the all6 •id
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6fSection 701P.5 by any applicantf r a pates subjects the applion to a civil penalty-
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mtmrt[ngEvennnacaan_a(ssoo) ,. ..
5024PN PLUMBING::tNEROC',",ancyType'
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OLa own fN p pcnY YcmPloy<cth Be. stM1cinole compenm[on.,
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5 0 7� - FINAL PE@ MjnU(gspections' " -
wJI J Iliak fid th .t t is tet deJ ff red for mlc (Sha ](114
Business and Pmfc>u ns Carl,. no Cont License Law ane. fuel apply to an
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dune, of pupeny Who builds or improves them, ad who docs such work himself
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or his own employees. provided that such improvements vat not intended or
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Jff=ma l., awe. H. n.wev<r, me Wildingrir� improvement a.la within ons year o
erad fo cl, I pin
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e of pro
Completion h hlJ will have to n d proving did noto IJ or
'improve
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❑I s owner oftb property, I. ly Counseling withe a Contractorsto'
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Construct ilia pualcor (Sec. 7044 Business and Prodfiassinins Code:) The Contractor's
an uwnctr .r n n,n
1-n L J t apply 1. an P P y uiltl p Ih ,con
fid. who < Vat f such ens with co tract r(s) 1 d formation to.Ihe
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WORKER'S COMPENSATION DECLARATION-
f) t. I hereby affiml under, pcnaltysfperjuryoneonhefoll wingdeclmations:
❑ I have and will marmot. a Certificate of Con¢nt to self.insum for Worker's
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Compensation. as provided for by Section 3700 of the Labor Code. for the
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parfarmantt of the work for which this peomit is issued, ,
O 1 have and will maintain Worker's Compensation Insurance, as required by Section
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37W of the Labor Cale, for the perfmmxn=e of the work for which' [his pcmnt is-
issued. My Workers Compensation Insurance carver and Policy mim6ei are: --'
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me '.', i 'r,ry Pully N .. -r.•
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"CERTIFICATION OF,EXEMPDOY.FROM WORKERS
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COMPENSATION INSURANCE
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(TI is sect nnnaJ not bC'Cmrr,leacd done Permit is for one hundred J.Ilan
v . I certify that in the performance of the wmtk for which this permit is issued. I
,hall not nnpldy any ,,an in any manner so as m became subject [0 the Workers
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"i"I taws of Californiv. Uam
Compn
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. Applicant _
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'NOTICE TO APPLICANT: IL after making this Cenificam of Exemption you should
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Wchwithcsubjectply the Cmu,sm pmovis ions of the Labor Cale, you must
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comply with r, or perm)
forthwifh4om 1 th sdch r tnis t shall be deemed revoked.
such
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CONSTRUCTION LENDING AGENCY
1 hereby affirm that them is cimstractiOn fending agency for the pc 8ohninco
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'of th k for which mM1 pc 't' sued (Sao 3097, Cis C '
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Lenders Name `-.. .. ., ... .f .'
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Le ider's Adaiess
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I ccuify that I have read this application and stale that the above information is
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mortes. I agmen) comply with all city and county ordinances, and state laws relating
rebuilding conmruniomand hereby hudlorim representatives ofthiicity[center upon
aborcmemionW property for inspection purposes.
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' Wit) igme1. save. indemnify and keep harmless the City of Ctipsnino against
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liabilities, judgments, costs and expenses which may n nay way accme ogalnst said
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City in consequence of the granting of this permit '
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APPLICANT UNDERSTANDS' AND WILL COMPLY WITH ALL NON POINT
Issued by: Date
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SOURCE REGULATIONS.-
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Re -roofs
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Signature of AppucantlContramor ' .• , 'Dad'.:"'
HAZARDOUS MATERIALS DISCLOSURE t
pJl Nc applicant of food. Wilding.ecpant stare or handl 1, Silisat [mal
Type Of ROOF'•-
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as deified by,the Cupertino Municipal Cad Chapter 9 13 and the Health d Safety
CodelSen on 25532(e) f h
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shall be mspected_pnorjo�any.roofing material, being installed.. .. ._.
Will the applicant or future building occupant use equipment or devices which
.pll,roofs
If a roof is installed without first obtaining an inspection+4 agree to remove
em i hnnrdous air conmminoms as defined by [he Bay'Area Art Quality Management,
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all new materials for inspection,._ Applicant understands, and'will comply with
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all non -point source regulations.
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rials requiments ronder'Chapmr 6.95 of the
I have mad'the 'hhmNoue fna<'re
California Health'& Safety Code. Sections25505,25533 and 25534. 1 understood that
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if the Wilding does not currently have a tenant. that it is my responsibility to notify [he-
occujuam of the requirements which must be met priot 1. issuance of v Cenilcam of
(Occupancy.: "'a
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Signature of Applicant Date .,
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All roof coverings to be Class "B+' or better' •'
Owner or authim<ga agent .Dat=
OFFICE .. _