01050020 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRIiSS: I'EKMI'I'NO
''`33```33687 VOSS AV WATER HEATERS" Ohll_Y 01050020
OWNER'S NAME: APPLICATION SUIT DATE
V. P. SHENOY 500 .AIRPORT BLV 05/02/2001
. PHONE - SANITARY No CONTROL NO.
(415)34.9-3747-
OO O O ARCHITECT/1iNGINEER: BUILDING PERMIT'INFO
z 0— BLDO I!LEC'1PLUMB MI C11
FZ� 1=1 Cl 1=7 1=l
Fes" LICENSED CONTRACTOR'S DECI,ARA1[ON Job Description
Oo y E I hcreM1 ff inn then 1 an,licensed under ns of Cha ¢r 9
Z_O yin Pmvisw p (annmcncing -
FinC� wi,b Section BIBB)of Division3ol'the 6mine,.and Polee,mrao Code.:mdmy llctnm
axs.a isiomlloru,: Jurat. REPLACE 50 .GAL WATER HEATER. -
C C C a `tame Cla.,x Lie.N
Owl,a lF Dae Commel r
ARCHITECT SDICLARAT ION
1 undersmnJ my clans,hall be used a.public me de
< RY-•
i S6 O O hlamcd Poole.,ionul
OWNER-BUILDER DECLARATION
1 herchy affirm mat I:nn exempt Irma she ConlontiW,License Law for the
F Z> kol oxing rcu,un.(Section 70315,11 ine,x and Professions Code:Any city or county
cwhich requires a permit to voirtrout, II p dcamolull.or repairany aroctue '
poo I I y :tl rl1 , h p t t filloo,ii,nedoammern
s— Ivan Ineawdp ,t dhe provisions 1 he Ciaturnetr Laverse L. (Chapta9 Sq. Ft. Floor Area Valuation
(commencing with Section 7100)of Division 3 of,he Bu: w I I a:: n,Code) $700
nr ma,he is exempt darmhronl module hwL,Inr Inc alleged uxcmp,ion.Any violation
of S,,fi 70315 by anyorplicunt for aI cmit mbicus,he applicant Ioa civil penally
of not more than fine hundred dollars(SSW). APN Number Occupancy Type
0 1,a,tworapof tire pof,ey,or my employee,-ith suples Its their solo,compensation. 3427.5048. v')0
will Jo,he work,and the structure is no,Intended or offered for sale(See.7044.
Bu.ine..a,.d 11 IcWonx Cnde:The Cronhenna's Li,tmt Law does Dol apply In an Required Inspections
r of property Who bolds or impve.,bceor.and wM,does such work himself 502 — FINAL PLUMBING ENERGY
m thro
rough his own cmdu r,,,.pmvmed deaf such Innprnvemenm are no,imceded o,
murex Torsade,11Lw
Hoever.die bonding m impmvemem L.sold within one rear nr 506 —' GAS TEST
ompletion,the ownerbuilder will av
hent the burden of proving that he did not Said or 507 — FINAL PLUMBING
improve fornmry,.c of Hale.).
01.as owner of the property um exclusircly contracting with licensed comruciers to
instruct the pp oc,(See.70)44,Bu,lmas and Proco,sionx C(4u:)The Cormuchn's F'N���
License Law dor,not apply o,an owner olrtnperty who build,m improve,thereon.
00
and who contract.4o such Projects with a vontroemnx)licensed pursuant n,the
Cnn,merors,piamh See MAY 0 9 2002
0l tin tors Li ense Law. .B n r e far this ea.,�n
Owner Date
W(IRKER'S COMPENSAI[ON DECLARATION
• Iherchyalliin,under penaltyofperjury one ofthe fulowingdeclarations: BUILDING
0 1 have and will man.in a Ccniticse of Consent to.elt-insure for Worker's
Cmmpen,tron, it, Provided Inr by Semion 3700 of the labor Code, for ,he
performance of,be work for which this permit is issued.
❑I have and will maiomin Worker's Compensation Insurance,m related by Section
3710 of the tabor Cada for,he performance of the walk far which this pnnit I.
sued.My Worker,Compensebn Insurance currier and Policy number arc:
Cier: Policy No.:
Cartier:—
Cl-on IICV'ION 01 EXEMPTION PROM WORKERS'
COMPENSATION INSURANCE
('Phis senior need no,be on,plmrd If,he tenni,is for one hundred dollars
(SUIT)nr fuss)
I cunify mut in the perfonmmee ol'tire wink fnr which this permit i,issued,I
,hall no,employ any perxan in any nomme,so as ,,1we am subject,a,he Wooers
Compensation law,of Culil'umio.)late
Applicun,
NarICF:TO AI'VLICAM:Barrel making this Certificate of Exemption.you should
become .hjem I. W..kcr'a Comruuamme
,ion pv,i , f,he laboest
r Code,you n
0 4mbwifh coo,ply with such pnwlxionx m ra,pcm,it shall be JttmeJ revoked!.
CONST RUCPION LENDI NO AG IiNCY
I herchy Of ion fnm mere is n contraction lending agency fonts performance
of the work fnr wNcb,hi,Note,is issued(Sec.31147,Co,.CJ
SQ Lender's Nam
5 z Lmder'.Adds,.`
V Icrody,hat l lao—al this api icmion and xvm fhmme Irmo,information is
4. F. emrcef.I agree to crnnply with:d1 city and county ordinances and state lows mining
G (� :11a
o btri,dingummumin I,and herchy mire,mwahmot,,,r,hi,i ley ,,enferu,ma
the abovcmcmional pmpuny for imremioa parposcs.
P. (We)agree to sure.indemnify and kap harmless the City of Cupertino against
W liubidinwo.rydgme t..c„s,F and v,,ocs which may in any way accrue against said
V Z City In Con.cynence'a the gmming ofthis permit
APPLICANT UNDERSTANDS AND WILL COMPLY WIT I ALL NON-POINT' Issued by: Date
SOURCE REGULANONS.
Signature of APPlicandCummmor Dute Re-roofs
HAZARDOUS MA'I'HRIALS DrsCI.OSORIi '
Will roe a"Iica n or lattice banding eaapont entre dr bangle hammous rumedal Type of Roof
ax defined by the Cupertino Municipal Code.Chapter 9.12 and me I Iculfh and Safety
Code.Sec
Pus,155311u)! 0 No
All roofs shall be inspected prior to any roofing material being installed.
Will meapplleantoelane 1,enild goecewanto,avripeemtodevltt,which If a roof is installed without first obtaining an inspection, I agree to remove
emit nueadaus air continuants a,defined by the Bay Area Air Quality Managenen,
District? all new materials for inspection. Applicant Understands and will comply with
❑Yes 0No, all non-point source regulations.
1 halt read the hmallom ntmerinl,uyn maital,under Chnpmr 6.95'If tire
Coli Oman))alta ecSatc,y Cnde,Sections 15505,11111 and 15534.1 uncultured,hat
If the building dous not carnally have a tenant.that h i,my re,rymsibili,y,o notify the
acceptor of the requiranenb q which nmInt n¢t prim no isa arwC of a CenirCam of
acceptor
Signature of Applicant Date
0,ac—,monori,ed agent note - All roof coverings to be Class"B" or better
OFFICE