01090036 CITY OF CUPERTINO
BUILDING DIVISION 'PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
18436 CHELSFORD DR. JUST WATER HEATERS INC 01090036
OWNER'S NAME: APPLICATION SUR DATE
1764 NATIONAL AVE 09/10/2001
PHONE: SANITARY NO. CONTROL NO.
i (510) 293-9901
C m ZARCHITECT/ENGINEER: BUILDING PERMIT INFO
P w o BLDG ELECT PLUMB MECH
5 i LICENSED CONTRACTOR'S DECLARATIONlob Description
1 hereby affirm that l am licensed under provisions of Chapter 9(coencing p
'_C8 _whnsectInn7000)of Division 3ofthe Business and Professmnsmmcode,andmyhecnse REPLACE WATER HEATER.
m fail Internal effect.
si�'a LiamosClass Lic,x (50 GALLON GAS)
O E U Data Coutrecar
a.a.a.n ARCHITECTS DECLARATION
g1 understand my plans shall he used as public records
A,
O O Licensed Profaslonal
x o I,�, OWNER-BUILDER DECLARATION
—m I hereby affirm mar I am ex hn"ham the Commuldn"License Law Ric Area
C Z a following reason.(Section 70315,Business and Professions Code:Any city or county
o wh'ch uo,aires Apmout to ema um,aper,improve,demolish,or repair any structure
ce c 3_ "Pr A I e m mase m ppliif hpemiu I I grad sat m. ..._. . .. .__.._._.._
m tna sl aka]p r nom prpvisio nn Contractor's L' Law(Chpt 9 , ,S Ft FIool Area r V ua[ion
(commencing wim$eai 7")of Division 3 nn businessdProfessions Cartel t,t,i"'�.,:!12„',9 EF -ri r dc'+rad. ? y�tt.FIN,
or that he is r:iempt therefsohn'Snd the basis for the alleged eiemptlon.Any violation {
—of Section 7031:5 byany applicant fora permit subjects the applicant to a civil penalty
IoroaA ram thnu.Eve hundred dollars S50(1>. umber (,'P,m'I,a Occupancy Type
❑1,as owner of me properly,or my employees with wages as their sole compensation,
.111 do the ails:had the sbumme is rad intended or off red for Ande(Sec-7044] - t
Ba nd'Professaas Code The Contmctor s License La does not apply to an 506 - GAS TES7Required Inspections-',
ow f property builds o improves(here n cad ho dose Lich work h self
or ir gh his wn ampl yeey provided that such em cis said
ore not intended or 507 FINAL PLUMBING
.oQ redT f sale.If.h e e the bu have
t rpm of phas is what w hhm ane Y
c
omplct on,purpose
owner builder will hav<the burden t f proving That he did not build or f' -
impro a farpulpa.a of ale 7. '
❑I as ow ne u a f the p report v,am a a clusicly c on mas,t ml' d t arst ... ' .. ..- ..._
con wa thep m 3 (ii 70l Business i d Prof Char ) Cbe...,
., E1 i L a 1.
Len L d not pply i fp pent' h bo ldimprove, u h A
O eel p 'p' Dole Pa...,t me. ..._. .._ .... �..._._..„ ,
. and whotat f h j a w th t t Is)I d.
❑I t der Se mss" a&PCforthia ream
„ r .4
WORKERS COMPENSATION DECLARATION O�
hereby Iuffirm a&,pen lty m6x,AryImuA.f the following at I tin s:
❑ 1 h d will nrman C nifc t f C .rnt''o elf rare for Worker's O/
Compensation, as provided f by Section 3700 of theLabor Code, for the
,.. „
Performance of dic wick,ficialialI this c7it is issued...,
❑1 have'entl will intinulto Writer'.Co pe I bA Insurance ha recoiled by Section
3700 f the'Labor Code for the Performance of the woik for'which this'hurn'Is
I. hinhid.'MyW k' sCompe4ion himmuce carrier AndPl y'number An
Ca le a. :'.:'t ses .-..Policy Not ;r% a.'. Iry ty� A s 4 ft,t}.d f t IJ„ x ] 8 ,
s {CERTIFICATION OF.E%EMPTIONFROMA'ORKERS " s.-<. l'U 4,.. 3, t G. _ . t."4j„Y::t 3 at}, t A '
t.-n COMPENSATION INSURANCEz E; ;�I .,. .t .._._.._.___...... ... .. ....__..........,._..__,._.., ,ti.._,..�.... _�..,. .._. . -----
t
' _ of - rihuf S.+r ;,a:c,i,p iit i
(Th s.eclion d t b mpin d f thepe t is f one hundred dollars
r �
i W1(b)or ess) i
certify thatin the performance ohhe urk fol wh ch th s pe, t s tswed I
.shall t k play III pe o any trance,x us to become bJ ct to the Workers
t Comp ti L 's f Ifo .Date'
.Applichnt.- ., .._._. __. . .
'NOTICETO APPLICANT It,after mak gth ,Cenificaa fE ehhphi......shauld' It'.^:,.'r'* "! �
Z forth th c mply sk e W rktt C lim,.1ti n pmv hall
be c anne Cody d. run i
become mb3ecti ih
d
,i^h uchpo s ns or thispe l h IIMJee d k y _ .. ...... ._. ._. .____... _.._. ._ ____. L.. ... ._ _ _. _.....
F'� s'aa i CONSTRUCTION LENDING AGENCY
a,' '. I h rmy afntathat diancianconstruclion lending g y for hm,�hpxmaiuca , .. i.
rw of the work'far which this Permit . .:ued se 3097'C"C)
Lenders Namei
ZIAcross."
-' Lenders Andre.
D"Z. uli ,,. .1.a6J❑
I I cartify that I have d this application d cons that the above Information is I '
w'F, co t 1 agree to comply with all city a d county ordinances and state laws relaang
� C.1
building construction. dhI Arthritic ncrovanninesf this cityt me upon, //-
y W ;the b.'s-onshounumd P p ny In, speer purposes.
C[y� UO _ es,political,
e a s drainft' ndk phamate. theCty f r pen o.game
Cg
liabilities,nec.ance a and expense which y n any y eccroe Against said,
V.z A yLICAncgUNDEfTe NDm AND
ihsp Inn '
SOURCANT,ULATIONANDS'AND WILL COMPLY WITH ALCNON-POINT
SOURCE REGULATIONS '- .-. -.,n, Issued by: Date
Signature of Appl¢ntlC Ian - 1 Date. Re roofs
MATERIALS DISCLOSURE
AppletonY Cupertino mIG g oc.pant siert w ha age'laasrdati cashoW Type of Roof..
HA A U
s WlBytheCpert Municipal
—,
as defined b the Cu eni Mum pal Coda Ch pl r 9 12 and the Health and Safety
C
ode CVs us311a) rlk our a', li i ft arfi / 1 tBl'aD N
I All roofs shall be Inspected prior to.any roofing-matenal-being.installed _.
W1l the appirmato future bolding eacortain us==gipmem of devices i which If a roof is ihstalled'without first obtaining an inspection,Ii agree:to Yernove
mark Namur..,arota is asdefined by theBy Area All Quality ARmin'throm
Di t R
ppLcant understands and will comply with
Cahfornm Health&.Safer Cade,Seellons 25505;25533 and 25534.1 understand Nat l
❑Yes -• No a neW mateIl S Or lnSpeCtlOn A
r ❑, rl , all nori-point source regulations ,;<.
�l 1 ha e head the h drI not mels regatameta.undo Chapla 693'of mei `
' 6 does AD(.uhre I Yci
atenam that it Y responsibilityto ',
notify
�Ii the
moth rp missuaneofeCnficote ofaap m fm9ur<mrnt which
Oc r
. ... . .... - ...
. Signature of Applicant Date _
Ow m ll c ea age t „t D. All roof coverings to be Class B or better
.:
__OFFICE-