02120039 CITY OF CUPERTINO -+� xi-
BUILDING DIVISION PERMIT GUNTRACTOR INFORMATION:
BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT NO.
22035 CREEKSIDE CT 02120039
OWNER'S NAME: 1764 NATIONAL AVE APPLICATION SUB DATE
Mk MARTINSON WILLIAM J AND PAME 12/10/2002
IIONE: (510) 293-9901 SANITARY NO. CONTROL N0.
ARCUITECDF.NGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
a a a a
�00 LICENSED CONTRACTOR'S DECLARATION lb Description
L9 I barelylfire athat I sm de
licensed under pmv simu of Chapter 9(mmo
menciag
with Section 71XXH of Division 3.f dm Business and Professions Code.and my license is
F�F in full force and effect. REPLACE WATER HEATER
OZ LL License Claes Lic.M
F=F'ag Date Convenor (40 GALLON GAS) FINALE®
ARCHDECES DECLARATION
og w� I understand my plans shall bo used a public records
LLa Licensed JAN, 0 3 2003
OWNER-BUILDER DECLARATION
HUI hereby affirm that I am exempt from the Contractors License law for the
ad following named.(Section 7031.5,Business and Professions Code:Any city or county BUILDING
a�$ which m litres a permit to construct,alter,improve,demolish,or repair any someone
Fiy prior m its issuance,also requires the applicant for such permit to file a signed statement
< that he is licentand pursuant to the provisions of the Contractors Liam Law(Chapter 9 Sq.Ft.Floor Area Valuation
�$ (commencing with Section 700)of Dimino 3 of the end Business Premiums Code in $303
that he u eampt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by mty applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy T
.at more than BK hundred deRers($5fo). 32639040 . 00 P Y YPe
❑ I.asowner of the pmpeny..r my employee with wagaasthe'v sok mmpemauon.
will do the work,and theswnum is not intended orofered for ale(Sce.7044,Business ,�gg�,�, l�
and Profession.Code:The Contractor'.License Law does not apply to an owner of 502 - FINAL YL" N�eARGY
property wh.build.M impmsuhim
ws thereon.and whodoesch work alforfl rough his
own employees.provided that such improwments are not intended orn0ered formula.If. 506 - GAS TEST
however,thn building or improvement u sold within one year of completion,the owner.
Wilder will have the human of proving that he did not Wild or Marmon,for purpose of 507 - FINAL PLUMBING
ale.).
❑I,as..or of the property,am exclusively mnhacting with licensed contractors to
construct the project(Sec.Ti Business and profession Code:)The Contracmrs Li- .
cense law don not apply to an owner of property who huilda or improves thereon,and.
who enntracu for such projeca with a comractorud licensed pursuant to the Counselors
License Law.
❑Ism exempt under Sec. .B&P C for Nis mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby stand under penalty of perjury one of the following declarations:
I haw and will maintain a Certificate ofComent to alf-imure for Worker'sCompen-
alion,a provided for by Section 3710 of the Labor Cable,for the performance of the
work for which this permit i.issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3701.(the labor Code,for the Performaae of the work for which this permit is issued.
My Workers Compensation Insurance artier and policy number are:
Carrier: Policy Na:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thisscetit0 need not heeompicted If the permit is Tomos hundred dolurs(51(0)
or less.)
1 certify that in the perform.of the work for which this Permit is issued.I shall not
employ any person in any manner so an in become subject to the Warkeri Compematim
Laws.f Callf.mla.Data
Applicant
NOTICE TO APPLICAT:If.after making this Cenifcate of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Cask,you mum
OO forthwith comply withach provisicmor this permitthat]N deemed revoked.
tiCONSTRUCTION LENDING AGENCY
[-r I hereby affirm that them is a construction lending agency for the Performance of
fi,s7the weak for which this permit is issued(S037
(-Sec.3 .Civ,C.)
QLenders Name —
Z LcndcrAddma
V 1 1 certify Net I have read Misty and county
and sate thm and state
information to
0 correct lag=to comply with all city and county otatims of and sole laws reining e
V Wildingconstruction,and horeby authorivcmprtanmiwa of Nu city berates upon the
W above me e)sag agned ree
to ertymoo(m inspectionniakeep hs
V) (We)agmc to ave,indemnify and keep harmless the City of Caperton,against
U Z judgments,the coming of this
may in any way seems against aid City
V z AeoLICA T UNDERSTArountingNDS
of Nis Per mit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicaDate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof v
Will Ne applicant or(Muni buildinggoccupant arta or handle hasardom material
as al See by the 31 1?nn Municipal Coda,Chapter 9.12,and the Ilcalth and Safety
Gsdc.Section 25332(x)? All roofs shall be inspected prior to an roofing material being Installed.
❑Yee ❑N. P P Y g g
Will the applicant
'Man,
future building aeupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haaardous air contaminants a dcfned by the Buy Arca Air Quality Management all new materials for inspection.
District?
Oyes ❑No
1 have mad the havardnmmalerials requiremenuunder Chapkrb.95 offt Califor.
nia I Ratio&Safety Gale,SciWm25505,15533 ad 25514.1 undersand that ifdc building
does not currently hew B tenant,that it is my m roomihility a notify tM occupied of the
requirements which mum be met prior at issuance,of a Ciamfma,ofOccupancy. Signature of Applicant Date
OwMuor maldnimd agent Date All roof coverings to be Class "B"or better