01030146 C'TY OF CUPERTINO n
uILDINc DIVISION PERMIT C0NPRACTOR `�
INFORMATION
,�43;�a.; Sr ,«'?� x•:.'^t^!;�ueS. ..,v.,, .walao-..tt? '3fss<
BUILDING ADDRESS: ' JUST WATER HEATERS' INC FPEaMIr No.
OwNER'S NAME: 1764 'NATIONAL AVE
BODAPATT SATYANARAYANA F, .7 VAT
E' (510) 293-9901 SANITARY NP. OL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMS MECH
O O O
COG LICENSED CONTRACTOR'S DECLARATION -
I
bemby arnrm that I em licensed under provision,of Chequer 9(commencing Job DBSCfIp[1OO
with Section 70fgB Of Dlvlalon 3 o(the Business and Professions Code,and Any license is
in full force and effect.
License Class Lm.a REPLACE ,WATER HEATER ,
[ Dam coal,.=, (50 GALLON)
ARCHITECTS DECLARATION q
0 all
I understand my plans abet be used u public ramal
>� R 5 ( J
C Licensed Professional pP
OatNEm exempt
DECLARATION
I hereby affirm That I am exempt(rum the COntnetors License Lew for the _ p�(�
cofollowing reason.(Sudan 7031.5,Business and PmresdamCode:Any city orCounty BUILDING
$(L which requires a Permit in crmroct.eller.Improve,dcmoloh,no repair any sten«um
prior In its issuance.also requires dm applicant for uch permit to file.signed statement
that he is liamed purmanl to the provisions of the Contractor',lJatrte Law(Chapter 9 Sq.Ft. FloorArea Valuation
$ (commencing with Sado.70th)of Division 3 of the Budnessand Professions CMe)or
.. Nat he is exempt therefrom and Ne bass for Ne alleged exemption.Any violation of
Section 7071.5 by am•ppn<ant for a permit arab tel.the aPpnmm m a civil Faulty of APN Number Occupancy'Type
not mors than five hundred dollen($500).
01,as own«of the property,Ar my employees with wages as Weir sole Compensation, 36230047 . 00
will do We work.and the.",rare moot intended or offered for sale(sec. Business ,
and Profusions Cod« mes The Conemra License Law donot apply to an owner or Required Inspections
pt
pronywho bondsminn ows thenoa,aad who doessuchwork himsslfor throughhls 502 . — FINAL PLUMBING ENERGY
awn employcra,provided that such improvements art n(Ainumad oroffertd fursale if, 506 — GAS TEST
hwt
over,Wt building or improvement ar vement is sold within am you of eompledon,me Owner.
builder will ban Use burden of proving Wn he did not bund m impmw for purpose of '507 — FINAL PLUMBING
sale.). -
❑1,as owner of the property,am eslusively contracting with licensed cutaOacton to
comuuct the project(Sec.7044,Business and Professions Code:)The Caninct«1 Ll-
come,law dace not apply to an mat,of property who builds or improves thereon.and, .
who contracts for such projects with a eomnctor(s)licensed pursuant ro the Commerce, '
License law.
❑I am exempt under Sec, ,B h P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hemby affirm under penally of perjury oro of the following dalandmts: '
\1 haw and will malntain a Certificate,Of Consent to selFlusure for Workers Comic".
on.u provided for by Section 3700 of the labor Code.fm the Pedomume of the
work for which this Permit is issued.
❑1 haw and will maintain Worker's Compensation Insurance.as required by Section
3700 Aide,labor Code.for the performance of We work for which this permit la loved.
My Workers Compensation Insurance eerier and Policy number am:
Cartier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
mus session need not becompleted if the permit is fmone hundred dollars($100)
or ins.) .
1 aNfy that in the performance of the work for which this permit is issued.I shall trot '
employ any person in any manner an as m become subject to the Workers'Compensation
Laws of California.Doc ,
Applicant
NOTICE TO APPLICANT;If.after making this CCMIEeale of Exemption,you should ..
became tubjal to the Worker's Compensation previsions of the Labor Cade,you must -
�'z, forthwith comply with such provisions or this permit shall be deemed ranked. _
Z O CONSTRUCTION LENDING AGENCY
F" Ibex by which thi We then it a 3 leading tot lMperformance or n _
lye > woric ch lits permit is Wiled(Sec.J097,Civ.C.)
Q Lender's Name
=z Lenderi Address
V 0 I certify that I have read this application and stoc that the show information Is
l[.Fcorrect,I agree to comply with all city and county ordinances and sum laws relating 10 -
V building eomwetlon,and hereby amhodn mpraenutiwa or this city to emu upon the
ir] above-mentioned Pmpeny(Of lmpcaon Purposes
(We)agree to ave,indemnify and kap harmless the City or Cupertino against
M Ilabllides.judgmenu,cuts,and expenses which may in any way acme against said City
V 7 In consequence of the granting of this permit.
�7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicaO Dem
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the a Cumem or future building occupant atom m antic Heardousd Safety ss defined by drc Cupertino Municipal Code,Chapter 9.12.and the Health and Sdety -
Code.Seclien25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yin ❑Nu
will the applicant or future building=open(use equipment art devices which If a roof is installed without first obtaining an inspection,I agree to remove
I hauednus air contamimnts to dcfired by the Bay Ares Air Quality Management all new materials for inspection.
Am?
❑Yes ON.
I have mad the haraNnusmaterlals requirements under Chaplerii o(the Celifor. -
Ale Health&Sarely Code,Secdu x25505,25533 and 25534.1 understand thatlrWe building -
JaWhom N
e not comently ban a Whet it is my mw spomihility nodl'y the Occupant of the
rest
ulmmenexx which must be met prior At issuance of a Certificate of Occupancy. Signature of Applicant Date
Owner Or authorized,gem Date All roof coverings to be Class"B"or better
CITY OF CUPERTINO o,3
WATER HEATER
CITY O
CUPERTINO PERMIT APPLICATION FORM
APN# Date: ��.. Z
136 2 3 b
Building Addresv
e
Owner's Name: Phone#.
Contractor: j ?Phone: o ._2y�- �j2
License#:
G S //t /
Contact: Phone: Cupertino Business License#:
Building Permit Info:
_r
Bid ❑ Elect' ❑ Plumb Mech ❑
Job Description: l �
Residential Commercial ❑
Cost Protect; / �7� ,
i Dm L-
Strapped On Platform Bonded
New'Location ' P Re lacement ❑
Qty. if
A licable Fee ID Fee Descri don Fee Group
• BPWHEATER Water'Heater/Vent
BUILDING
PPERMITFEE
Plum in
Permit Issuance PLUMBING
BENERGY , Ener BUILDING
BUSLIC Business License BUILDING