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03030078 CITY OF CUPERTINO /" �T"r�'�} j �rydng';. BUILDING DIVISION rERivnT rC01 ,1CAC ®1lTNFt© AION` RUa.DINGADDRESs - WATER 'HEATERS ONLY PERMIT NO.. OWNER'S NAME: _ 970 E. MAIN ST, SUITE 200 PERMIT 99 A , PETERS E. 800) 835-5946 - - SANITARYN CONTROL NO. ARCHITEC IENOINEER: - BUILDING PERMIT INFO BLDG ELECT PLUMB MECH =3 30o LICENSED CONTRACTOR'S DECLARATION 10crehy M.that 1 am licensed under provisions Of Chapmr 9(cnmmcndng Job Descriptio , m with Section 7030)of Division 3 of do Budneu and Profession COM,and my license is = L,Cc..hoom CUanaeBep. - Lle r REPLACE GAS WATER HEATER- NAe® I- Dem Comncmr AU ? ARCHITECI'S DECLA Ano G 222903 j . . ,. 5$ I Losiand my plans.hall ha e used public records 4 2 C q0O"*f g G Limmmd Pmfcalonsi OWNER-BUILDER DECLARATION -'�0 S i hereby.farm o n 1.m exempt ul1. from the Comravors LiA nse Law for 7M ILS/V1,A'A O o which re mason.(Sudan 7 onsto Bualner.and Refusions Code:Any ally 0r county $ which requires a e,still it re mown,alm4 improve,demolish,ittri repair any sateen A SO prior to its issuance, a requires the ovisio s o for such Contractor's rile se Law statement - a thatheIslicensed pursuant to the of Division o othe r License Lew(CharterCode)or Sq.Ft.Floor Area -1lOn x (commencing pt 7000) basis r,3 m the Buslneuand on.Anynvi CnM)of - Net io b m1.5 b my li antl tie aper it the dieted exemption.n,Any l Penalty Of not on thLSbyanndredofApplicant plSODmilanbjecuthe.ppllmnttoedvllpenslrya( 3ABN N019he[ 00 Occupancy T! pe not more than Tien hundred ddW(SSW). ❑I,a owner ofthe property,or my employees with warm an their sole compensation, iiy will do sale work.and thenuuaure is not Intended or offered for sale 704),Business - INAL I7P Qt�gry+'RGY pe and Prudential..Code:The Contractors Llmme Law does not apply to an Owner of pmnywho build,orimprovea l0meon,mdwho dom much work himselforthrough hr 506 GAS TESrr�T rnrnrtrtOO own employees,proviMd M7su)h improvements am not imerded orolfered for sale.If. ,507 - FINAL PLUMBING however,the Wilding or Improvement r cower- mid within one you ofmpledon.the on builder will blow the burden of proving that he did not Wild or improve for pulp=of ❑1,as owner of the property,am exclusively connuling with licensed contractor,7o convect me project(Sec.7014,Business and Professions Code:)The Consomme,Li. cons)law does not apply to an owner of property who WIIM Or improves thereon,and who contamul for uch prejeots with.eomosctor(G limnsed Panama to We Commotion - License law, ❑I am exempt uoft,San .B k P C for Nb!coon Owner Dam WORKER'S COMPENSATION DECLARATION I hereby am.under peoltY of perjury..of the following deeluWons: haw end will maintain.Candlemas of Comma to self-Insure fm Worker'sCompen- ration,a pmvided her by Section 37W of the Labor Code,for the performance of the work for which this permit is issued. have and will maintain Worker Compensation Insurance,as required by Section ' 70D of the labor Code,for the performance of the work for which this permit 4 issued. My Worker's Compensation Inman)carrierand Policy number me: C,.in Policy NO. �SYl3 -0 CERTIp CATE 6 EKEM MON FROM WORKERS' COMPENSATION INSURANCE mal,section need not W completed lithe permit Is foronchundreddollara(SIW) or less) . I cc y Thu in In..perfnrmace of the work for which Nis permit r issued.I shall not employ any person In any manner sr,a[c Wcome subject to the Wofkeui Compensnion Lawsof Calif nod, Data Applicant NOTICE TO APPLICANT:IL after making this Oct inc.m of Exemption,you should become subject to the Workers Compensation provisions of the labor Code,you must O forthwith comply with such provisions or this Permit shall he deemed mwka � CONSTRUCTION LENDING AGENCY ' - El hereby hy dothat them its consuing ucim.lmdgcnry for thepedurmmm of _ ;> the work for which this Permit Is issued(Sec.3097,Civ,C.) Q Lender, z Lenders Addmaa fJ Q fe I certify that 1 have ed this application and u that the above information is is, !"�. )resect.I.gree to comply with all city and county ordinances and sum laws mining to C) building building construction.and hereby authorimmprcunullves of this city[center upon the W above-mentioned preperly for Inspection purposes. P. .(We)agme to saw,indemnify and trop humleu the City of Cupertino against vr4 � :y(A liabilities,judgments,costs and expenses which may in any my same against said City In conaquence of me,gruGng of this Permit. APPLICANT UNDERSTAND ILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. / 3yJ Re-roofs SignatureofAPPlicanUConDem " HAZARDOUS Wilding MATERIALS LstoreDISCLOSURE Type of Roof Will theapplicantor forum Wal Coe,Chaptmom2, andle ad oanmamsial u acfucd by arc Cupertino Municipal COM,Chapter 9.12.and the Hctlth end Safely , de,SeNon25532(a)? / All roofs shall be inspected prior to any roofing material being installed. ❑Yoe 6� Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove 17 haardous air contaminants u dcnned by the Bay Area Air Quality Manegcmcnt all new materials for inspection. ' ulrict? - - Dyes aw*k Ibave mW the haandousmamrials requirements under Chapter6.95 or Ne Califon ni.Hcett&Sally Corm,Smtioo25505.25533 and 25534.IunMmmnd thalirft Willing does not currently hew pi 17 4 my mspo Ihlllty w noUl'y the rccupanl claim requirements vel l-usr 7u iuvenc aCcninmm of 0�pu/c, Signature ofApplicant DateOwner or nthorir<a eg ) -eDI[D m All roof coverings to be Class"B"or better