02060050i
CI OF
BUILDI
c DIVISIONPERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
21433 SHANNON CT
JUST WATER HEATERS INC
PERMIT NO.
02060050
1KgXs.LNAMYOHN C AND JUDITH L
1764 NATIONAL AVE
APtcfi.T"diIT-2
PHONE:
(510)293-9901
SANITARY NO. CONTROL NO.
ARCHITECT)ENGINEER:
E
BUILDING PERMIT INFO
BLDG ELECT PLUMB MF.CH
i LICENSED CONTRACTOR'S DECLARATION
pgTIpIIOn
Ihercb)'aRrm that lom licensed under provisions of Chapmr9(commencing
HU
REPLACE WATER H)✓A'1•E
with Serum. 7(1W) of Division 3 of the Business and Professions Cyte and my license
is m mu farce and engirt.
(4 0 GALLON GAS)
ULiccnsc Clan Lica
Dam Contractor
Ia
ARCHITCCT'S DECLARATION
g I understand my plans shall M used as public records
0 Licensed Professional
OWNER-BUILDCR DECLARATION
,
so 1 hereby affirm that I am exempt fmm the Contractor's License Law for the
a following record. (Section '1031 S Business d Podessiond Cod Any city or county
O which requires a permit to compact.It r.improve. demolish, or repair any station,
-7 5
pnort t mane also reaches theapplicant for such perm File signed statement
— dau he is latticed f batt im porm,pions mite Cdamd,mC, [.auto,, I(Chapter9
(comatec with Section 7") fD so J of the Btyrouand P Professions Code)
a S FL Floor Area., ) r r -R
_I q'
, Valuation
g
or that he is exempt therclrom and the basis for the alleged clic uPlion. Any violinist
).•s
s y
3620u'04 .0 0`
any applicant far a permit subjttn the mpplinm to a tril penalty
-of Section rooman n five
,of not marc me lmnerea dollars (ssW).
APN Number
Occupancy Type
01, as owner of the propeny,ormyemployee' wan W.",a,their sole compensmion.
502 — FINAL PLUMBIN
ENERGY
will do the wmk.*zmc1 the structure is not intended or ancmd far Is (site. )044,"
'BeirmIx Professions Code: The Contractor's License Law does to
506 — GAS' -TES' a ut red Inspections - •'
acid not apply m;
owner of,impeny Who builds or improves thereon, and who does such work himself
507 — FINAL PLUMBING
or Nmugh his own employtts. provided that such improvements are not intended or
onefcd'for sal e: If, however: the buildiri '- t is sold within one of
ger improvement Yeld
"-'--'-----" u--"'-"'--"-" _
completion, the owner
P hale.) will have he burden of proving that he did not build or
improve for puma>e of soled.
. _...-- ._—.. . ___
131...
mowncrafsheim ntd-
1 pe y, um na antracton
... _.._.._. ..._ _._ _ .. ___ _._ ... . ..... ..... ...... .. _.—
_o; {:',•';' ,
the oejen (Sac. Business ns Co c:) The
Professions
Business and Profusionsildsr) The Contractor's
FI
License Law
- License Law tact not apply man owner of who builds de improves thereon,
to an
T aG O
a contractors)
.Comas o contracts far. such projects -with with a comoctor(s) Iicensed.Pursuvtt m.thc.
_. _... __. __ . __. _ .___... ___.__.... ®.__...._..
E
Cnnvamrs License Low.
_ ❑lam aempt under Sec.' '," "LB&PCfor this re
1
,
� ��� �.�."� '. jf''''P '
Ownir' " "' Date
2ao2
WORKER'S COMPENSATION DECLARATION
I hereby affirm under 1.Penalty of perjury one of the following declarations:-
D'p'G
BUILDING
❑ 1 have find will maintain 'a Ccrohmme of Consent to self -insure for Worker's
,( Compensation, as, provided for by Section 37M of the Labor Code, for the
- pirfomiince of the work for which this pe.it is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
_ 37W of the Lahor Codc; for the performance of the work for which this terms is
- issued. M Worker's Com nsauon Insurance carrier and Policy number are: `
._ .. ....
y'..PulicY No.:' t"' "'
.. ,. ,
a t.� f_ p,;�.la ItIh '`s,i.� •' f'i
CERTIFICATION, OF EXEMPTION FROM WORKERS I'
COMPENSATION INSURANCE't - .....
, .. . t �:
.__._. __ �._..__.. .. __. ___........ r
. i. - ...
ma asecuon'need not he complete) if,he permit's for ane hundred dollars
t '' v f r ' " 1' 4 1%n J
(SI W) or Ices.)
A -I n fj'th t o the o f f the o k f h ch th s perm h mo J' 1
--
all nix emIalay any per r ii'm any manner so as to become suhject to the. Workers
Compo . ai Inws of Cel'( 'Date' `'
-APPI can( - ` ." •° "' " ..
. _ . _ ._ . ... __.._ __ _ _ _ _ __ _ _._ -_
NOTICE TOAPPLICANT. after of Exemption: yaou
mulst
� tion
rs Cron,ikingthPolimm, o
his perm s of the Labor Code, you must
co sly the Colons
ftinhwithi inch pr or
Linhwitti oomply With smith previsions or this permit shall be deemed revoked.
'
3CONSTRUCTION LEN DING AGENCY
I hereby'alhmi that there s B conxmmctton lending agency for the perfonnanee'
_ ._i
of the kfo whichth pc tit s ed(S C 309) C C)
] Londe sbh a -• .' _.
_ _ ..._ _.._ .. .._ .__.._ .._ _. .... _
Leede x Address
/
f 1 candy that 1 have read this application and state that he above information is
rorrca. 1 agree to comply with all city and county ordinances and state laws relating
to building con.umctio a and hereby authorize representatives of this city to enter upon
the above-mentioned property for inspection purposes.
L. (We)agree to save, indemnify and keep harmless the City of Cupertino against
n liabilities, judgments, costs and expenses which may in any way acerae against said
L City inconsequence of the granting of thin permit. "'
'
n
APPLICANT UNDERSTANDS'AND WILL COMPLY'W ITH ALL NON:POINT
`::'
Issued by. Dale
SOURCE REGULATIONS. ,
- .. Dam
Signora di
Re -roofs
,HAZALARDOUactor. MATERIALS DISCLOSURE.
Wllfth ee 12AWilde
pp g us upom store tar B dI huxamiciudoterial
Type of Roof .._
as defined by the Cupertino Municipal Cade Chapter 9.12. and the Health add Safety
-!h `,'•... ..1'
CodYOti 25532(a)a. i �N t tint tI,.
r I' it•, 1r t"
All roofs shall be inspected prior [o any roofing material being installed,
w'nm w hp a t r b ldingoccupantuse equipment or devices which
, ,
If a roof is installe'dtwithout first obtaining an inspection, I'agree to remove
e it briamded, aircomate t - defect by the Bay Area Air Quality Management
District?
all new materials for inspection. Applicant understands and will comply with
to °Yea ON. V.
_
all non-poibt source regulations.
ous materials impr me its wider Chapter 6.95 of rhe
I have mad the haeutdrt
California Healtf &'Safety Code. Sections 25505:25533 and 25534,1 understand that
iflheboil not totifica the
n ismyor
ofinedeas
egdrecuremlyhaveast be thahat
rccdparit o! rte rcquircman¢ which must be ton prior m issuance of a CeniGcatc of
' Oce p ey - .::..
of Applicant Dale .
_Signature
All roof coverings to be Class B or better '
Ow oamhonredage t Dae