01050075 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
19842 PRICE AV JUST WATER HEATERS INC 01050075
OWNER'S NAME: - AI111LICADON SUIT LAIB
CUPERTINO UNION S D 1.764 NATIONAL AVE . 05/08/2001.
PHONE: SANITARY NO, CONTROL NO.
1510) 293-9901 "
AIiCHI"fIS'I'IHNGINtiHlt BUILDING P M INFO
CLBCI' PLUMB MLCII
y6�
F _ LICENSED CONETRACI OR'S UECI.ARAI']ON Job Description
O%n C I hereby a1Brm that I am licensed under provision of Chapter 9(commencing
FyC J wash Section 7000)of Division 3 of the Bu.cincm and Profssiodw CNG,and my license
ayF� is in fall faccam.ficct' REPLACE 50 GALLON GAS WATER HEATER.
c n m 6 license Clmx Lir.p
O R u Un. Comvac,,a
to ie a.H ARCH1 UTC1"S DI CLARSHON
EE:ih O g 1 understand my pI...hall be used as public record..
are an i p�O Licensed Pracssio..I
.OWNER-NUIhDIiH DECLARATION
a 1 hereby affirm that I am eacnpt from the Candmctnr'.c License Law for the
t-Z following reason.(Section 7831:5,Bucincas and Profeoione Core:Any city or county
I:E n1lich nandef,aProut Co.,, t ha P dratolikii.ar,pTai,anysteel C
h
pr t t a1 q 'm apPl tf r p itt b d't tc wt
math fpm. t' p ,� l he c t ' Lifica,.Lf.(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Se"inn 7fxx0 of Domer 3 of he Bmc nerd sad Profen.ono CNet $825
.,,hot he is uenpt thcrefmth
m and the basis for e alleged csInniume.Any violation
of Section 7831.5 by any applicant for a sernat subjects the apprcaat In a Civil penally APN Number Occupancy Type
of not mom than five hundred dollars 155110H.
❑I,as owner of the property,or my cnployces whh wages as their sole comPens6tion. 369 41,713,3. 00
will du the work,and the sticture is not intended or alfemd For sale(Sec.701.,
Inn.-nm1 Prcfc. x Code.'Ihe Comit.,nr.Ll"no,Law doe,not apply m a Required Inspections
r of pmeny pWho mild%or ampowes thence.and who docs-such work hlmwlf -s
ormmugh his own cdnployees.prinided that such mrpnwcmcros are not intended or 502 — FINAL PLUMBING ENERGY
offered for sale.If.however,he budding or improvement is sold union one year of
completion,the nwnerbuilder will have the burden of proving that he did not build or 506 — GAS TEST
improve for pura%c ofnmej. • 507 — FINAL PLUMBING
❑I,acof dna norayu xdusivcly—it une,ing with licensedcommmorsm
mnt01 tire prolce,thea.7044.Ilse. C,, nd Profen. a CnlC'.lThe Contractor',
I�iecnne Law does not Imply loan"was,A ,rupeny seta,hnlldx a improvos Ihmnon,
and who contracts tar such projects with a contractors)licensed puwuma e,the
Contractor's Uccesc Law.
01 an esmnpt mulct See. .B R P C far,hiss reason FINALE O
Owner Ume
WORKIB'S COMPIiNSNHON Dr.CLARAI'[ON MAY 2 9 2001
I herehy tdlinn under pcnahy of perry juone of the following dadaranners
D 1 have Ind will maintain a Cedai,ale of Consent to ell-in...C for Worker's
Comprn.cation, a" provided fm by Sectioa 3780 of the Labot Code use the BUILDING
performance of the work for which this permit is issued.
❑I Fave and will maintain Workers Compensation Insurance,as required by Sectio
3700 of the Umor Cede,for the raftermance of the work For which this permit is
sped,My W..Eon',Cnmpce,atien Insurance caMur'all Policy mandate am:
Carrier: Policy Na.:
Clint IFICAI'[ON(ll'[EXEMPTION]'ROM WORKERS'
COMPINSAI[ON INSURANCIi
(Thin action need not be c,,m,lc,cd if he permit is far are hundred dollars
(SIM)or lms.l
I certify that in the pertonnance of the work lot which this 1'emat is issued,1
d:all not employ any Mason in any manner I,as n,become"abject of the Worker'
con,ptn.wioo Low.of California.Date
Appliaam
N(yfICE'IU AI'1'LICAYT:If,altar nmking his Cenilicale of Boreption,you should
aewnw.ubjecno the W'orker's Compensation provf.cione of the Labs Cede,you must
Q O forthwith comply with such provisions or this permit shall see dreamed revoked.
F h
CONSTRUCTION LENDING AGENCY
^' I hereby affirm mut thurc is const (Seen Iendlmg agtnty for the perfonnaiwr
111 de,work for which this permit Ix.ix"ucd(Sm.30],Civ.C.)
Lead
G Q Lendcr'c N; se
M Z Lcndcrs AJdre"c
V Q 1 Cerny that I have read this application and s,air that the Itij information is
:z F'
correct.I agree to comply with all city and county ordinances and state laws reining
Q CJ mbaitting Construction.and hereby authorize representatives of this city m enter upon
thibdproperty f Mt pHx. :
} y
(WI) LEENIC n one.irdenaniry I If keep h ml as he City ofC pcnino a,amsl
� N Iihlfl Ig O 't. ' 1'ns 'unit way'ecmc e'adn"mid
(�
City inaI.Wu frite 6funding ,fll Irent.
APPLICANT UNINiRSTANDS AND WILL COMPLY WITH ALI.NON"POINT Issued by: Date
SOURCF.REGULATIONS.
Slgnamreof ApplicandCommtor Date Re-roofs
HAZARDOUS NExTE RIALS DISCLOSURE
Will the applicant or future Emitting occupant store or handle be<:woux material Type of Roof
as de8md by the Cupertino Mnnicipul Code.Chapter 9.12.'md for Health and Snfcty
Cndo. LDI tv 25532(0? p No
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant of future building occupant use equipment of de,Cr%which If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air contaminants as defined by the[lay Area Air Quality Management
D�,r;c,n all new materials for inspection. Applicant understands and will comply with
Ove. 0 N all non-point source regulations.
I eme read fun hvanlnus tmnenid,requircmcnw under Ch:ptcr 695 of the
Culifuniu Ilydd, ,Sal"coyCole.Scmlo.1,25505,25937 um1255.14,I Ind....; Itun ,
if the hadding dors not carrcn1ly hoe s Icnanl.'hot it is my rexpomibility m notify rm
cupant of the n'qulremenu which must be pmt prier to issuance of a Certificate in
Occupancy. Signature of Applicant Date
Owner or authorized agent, Date All roof coverings to be Class"B" or better
OFFICE
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
19842 PRICE AV JUST WATER HEATERS INC 01050075
OWNER'S NAME: - AI111LICADON SUIT LAIB
CUPERTINO UNION S D 1.764 NATIONAL AVE . 05/08/2001.
PHONE: SANITARY NO, CONTROL NO.
1510) 293-9901 "
AIiCHI"fIS'I'IHNGINtiHlt BUILDING P M INFO
CLBCI' PLUMB MLCII
y6�
F _ LICENSED CONETRACI OR'S UECI.ARAI']ON Job Description
O%n C I hereby a1Brm that I am licensed under provision of Chapter 9(commencing
FyC J wash Section 7000)of Division 3 of the Bu.cincm and Profssiodw CNG,and my license
ayF� is in fall faccam.ficct' REPLACE 50 GALLON GAS WATER HEATER.
c n m 6 license Clmx Lir.p
O R u Un. Comvac,,a
to ie a.H ARCH1 UTC1"S DI CLARSHON
EE:ih O g 1 understand my pI...hall be used as public record..
are an i p�O Licensed Pracssio..I
.OWNER-NUIhDIiH DECLARATION
a 1 hereby affirm that I am eacnpt from the Candmctnr'.c License Law for the
t-Z following reason.(Section 7831:5,Bucincas and Profeoione Core:Any city or county
I:E n1lich nandef,aProut Co.,, t ha P dratolikii.ar,pTai,anysteel C
h
pr t t a1 q 'm apPl tf r p itt b d't tc wt
math fpm. t' p ,� l he c t ' Lifica,.Lf.(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Se"inn 7fxx0 of Domer 3 of he Bmc nerd sad Profen.ono CNet $825
.,,hot he is uenpt thcrefmth
m and the basis for e alleged csInniume.Any violation
of Section 7831.5 by any applicant for a sernat subjects the apprcaat In a Civil penally APN Number Occupancy Type
of not mom than five hundred dollars 155110H.
❑I,as owner of the property,or my cnployces whh wages as their sole comPens6tion. 369 41,713,3. 00
will du the work,and the sticture is not intended or alfemd For sale(Sec.701.,
Inn.-nm1 Prcfc. x Code.'Ihe Comit.,nr.Ll"no,Law doe,not apply m a Required Inspections
r of pmeny pWho mild%or ampowes thence.and who docs-such work hlmwlf -s
ormmugh his own cdnployees.prinided that such mrpnwcmcros are not intended or 502 — FINAL PLUMBING ENERGY
offered for sale.If.however,he budding or improvement is sold union one year of
completion,the nwnerbuilder will have the burden of proving that he did not build or 506 — GAS TEST
improve for pura%c ofnmej. • 507 — FINAL PLUMBING
❑I,acof dna norayu xdusivcly—it une,ing with licensedcommmorsm
mnt01 tire prolce,thea.7044.Ilse. C,, nd Profen. a CnlC'.lThe Contractor',
I�iecnne Law does not Imply loan"was,A ,rupeny seta,hnlldx a improvos Ihmnon,
and who contracts tar such projects with a contractors)licensed puwuma e,the
Contractor's Uccesc Law.
01 an esmnpt mulct See. .B R P C far,hiss reason FINALE O
Owner Ume
WORKIB'S COMPIiNSNHON Dr.CLARAI'[ON MAY 2 9 2001
I herehy tdlinn under pcnahy of perry juone of the following dadaranners
D 1 have Ind will maintain a Cedai,ale of Consent to ell-in...C for Worker's
Comprn.cation, a" provided fm by Sectioa 3780 of the Labot Code use the BUILDING
performance of the work for which this permit is issued.
❑I Fave and will maintain Workers Compensation Insurance,as required by Sectio
3700 of the Umor Cede,for the raftermance of the work For which this permit is
sped,My W..Eon',Cnmpce,atien Insurance caMur'all Policy mandate am:
Carrier: Policy Na.:
Clint IFICAI'[ON(ll'[EXEMPTION]'ROM WORKERS'
COMPINSAI[ON INSURANCIi
(Thin action need not be c,,m,lc,cd if he permit is far are hundred dollars
(SIM)or lms.l
I certify that in the pertonnance of the work lot which this 1'emat is issued,1
d:all not employ any Mason in any manner I,as n,become"abject of the Worker'
con,ptn.wioo Low.of California.Date
Appliaam
N(yfICE'IU AI'1'LICAYT:If,altar nmking his Cenilicale of Boreption,you should
aewnw.ubjecno the W'orker's Compensation provf.cione of the Labs Cede,you must
Q O forthwith comply with such provisions or this permit shall see dreamed revoked.
F h
CONSTRUCTION LENDING AGENCY
^' I hereby affirm mut thurc is const (Seen Iendlmg agtnty for the perfonnaiwr
111 de,work for which this permit Ix.ix"ucd(Sm.30],Civ.C.)
Lead
G Q Lendcr'c N; se
M Z Lcndcrs AJdre"c
V Q 1 Cerny that I have read this application and s,air that the Itij information is
:z F'
correct.I agree to comply with all city and county ordinances and state laws reining
Q CJ mbaitting Construction.and hereby authorize representatives of this city m enter upon
thibdproperty f Mt pHx. :
} y
(WI) LEENIC n one.irdenaniry I If keep h ml as he City ofC pcnino a,amsl
� N Iihlfl Ig O 't. ' 1'ns 'unit way'ecmc e'adn"mid
(�
City inaI.Wu frite 6funding ,fll Irent.
APPLICANT UNINiRSTANDS AND WILL COMPLY WITH ALI.NON"POINT Issued by: Date
SOURCF.REGULATIONS.
Slgnamreof ApplicandCommtor Date Re-roofs
HAZARDOUS NExTE RIALS DISCLOSURE
Will the applicant or future Emitting occupant store or handle be<:woux material Type of Roof
as de8md by the Cupertino Mnnicipul Code.Chapter 9.12.'md for Health and Snfcty
Cndo. LDI tv 25532(0? p No
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant of future building occupant use equipment of de,Cr%which If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air contaminants as defined by the[lay Area Air Quality Management
D�,r;c,n all new materials for inspection. Applicant understands and will comply with
Ove. 0 N all non-point source regulations.
I eme read fun hvanlnus tmnenid,requircmcnw under Ch:ptcr 695 of the
Culifuniu Ilydd, ,Sal"coyCole.Scmlo.1,25505,25937 um1255.14,I Ind....; Itun ,
if the hadding dors not carrcn1ly hoe s Icnanl.'hot it is my rexpomibility m notify rm
cupant of the n'qulremenu which must be pmt prier to issuance of a Certificate in
Occupancy. Signature of Applicant Date
Owner or authorized agent, Date All roof coverings to be Class"B" or better
OFFICE