03020005 CITY OF CUPERTINO '� .+. 41" ` c", = '
BUILDING DIVISION PERMIT CONTRACTORINFORMATION:' `
BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT NO.
10209 BONNY DR
OWNER'S NAME: 1764 NATIONAL AVE APPLICATION SUB DATE
JANET CHIANG 02/03/2003
ZONE: (510) 293-9901 SANITARY NO. CONTROL NO,
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 o
or
affirm
LICENSED andli CONTRACTOR'SDECLARATIONof CON Job Description
z I hereby affirm Nal 1 am of the
BJ under provision of Chapter 9(commencing P
with Section]IXp)of Division 3 nl the❑usincss and Professions Cods,,and my license is
�� infuNfo=andeffeek REPLACE WATER HEATER
License Class Lit,at
?°iA Dam To S F'nr (50 GALLON GAS)
ARCHITECTS DECLARATION W ®
C Om I understand my plans shall be used as public mcurds L
Oy
LLo
Licensed Professional FEB 1 0 2003
OatNEm BUILDER DECLARATION
F uF oo 1 hereby affirm Second
11. exempt from the Comms Co License Law co the
Y-00 followingrcasun.Permit
](131.5. t,alter. and improve,
demolish,
or:Any city or county
>�$� which requires a permit m construct,alter,improve,demnlith,nr repair any structure
Fi`S+ prior to its issuance•also acquires the applicant for such Permit o file a signed statement W!111;QWQ
££ss< that he is licensed Pursuanitnthe Provisions ofthe Cuntra tors Liver.Law Chapter 9 Sq. Ft. Floor Area
Ns'$ (commencing with Section NVB of Division 3 of the Business and Professioox Code)(it $883
— Nat he u exempt therefrom and the basis for the alleged exemption.Any violation of
Section]031.5 by any applicant for a perrid"ubjecu the applicant to a civil penalty of APN Number Occupancy Type
not mom then five hundred dollars($500). 35912032 . 00 -
❑ hasowncr of the progeny.or my employees with wegesastheir axle componutinn,
will do the work,and the structure is not intended oronemd forule(Sec.]044,Business g p����{ p� �}y
and Professions Code:no Contractor's License Law does not apply m an owner of 502 - FINAL ft%P'1SJ11V l'ie hnRGY
progeny who builds or imgmves thereon,and who does tech work himulf or through his
own employees,providedthat such improvements am not intended or offered her use.If. 506 — GAS TEST
however.Ne building or improvement is sold within one year of completion,the owner-
maker will have the burden of proving that he did not build or Improve for purpose of 507 — FINAL PLUMBING
sale.).
I,as owner of the property,am exclusively contracting with licemed contractors to
construct the project(Sec.7044•Business and Professions Code)The Conrectori Li.
cense Law does not apply to an owner of property who huildi or improves thereon,and
who contracts for such projects wit a contr cmr(s)11censed Farmers to Ne Comments's
License Law.
❑ l am exempt under Sec. ,B&P C for this reason
Owner Dom
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Cenificam ofConsma to self-insure for Workers Comped
sation,as provided for by Section 3]01)of dm Tabor Code,for the porfotmanee or the
W
ork for which this Permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as required by Section
3 On of the labor Code,for Ne Performance of Ne work for which this Permit is issued.
My Workers Compensation Institution earner and Policy number sm:
Cemicr, Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
flThaecdtm need not be Completed if the permit Is forma hundred dollars(SH10)
,it less.)
I cenify that in the performance of the work for which this permit is issued,l shall and
employ any permn in any manner sac as to become subjecun the Workers'Compensation
lawsof Celifomia.Dam
Applicant
NOTICE TO APPLICANT:If,after making this CeniOcate of Exemption,you should
become subject to the Worker's Compensation previsions of the La an Code,you must
OO forthwith comply with such provisions or this Permit shall be,deemed revoked. i /''/AaGntas-^y
.~N.dCONSTRUCTION LENDING AGENCY F
f'd I hereby aRnn Nat there is a construction lending agency for the performance of
Rai the work for which this Permit is issued(Sec.3097,Co.C.)
aQ Lenders Name
z lenders Address
V O 1 cenify that 1 have read Nis application and Aute that the shove information is
(~ correct 1 agree to comply with all city and county ordinances and store laws relating to
I]V building construction,and hereby mandirc mpreunurives of this city m enter upon the
D.1 shoot-mentioned property for inspection purposes.
(We)agree m share,indemnify and keep harmless the City of Cupcnino against
CL
p,t CAA liabilities,judgments,costs and expenses which may in any way seems,against said City
U
in consequence of the granting of his permit.
ti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONPOINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
HAZARDOUS
Signature of ApplicaDateHAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
Will the applicant or future building e.Chapter
erre or handle Health and
as define)io the Cupertino Municipal Code.Chapter Y.12,and the Health and Safety
cInia
dt,Section z553z(a)] All roofs shall be inspected prior to an roofing material being Installed.
❑Yta ❑Nn P P Y g g
Will the applicant or future building occupant am equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
it hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
nder?
❑Yes L)No
I have mad the hereabout materials myuimments under Chapter 6.95 of he Celifor,
Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
s not currently bac a tenant,Neer it is my respomihilay he notify tM occupant of the
uirements which must be met prior or issuance of a Cenificntc of occupancy. Signature Of Applicant Date
Owner orauthoaredagent Dam All roof coverings to be Class "B"or better