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05120076�z 0 a>_ dA oz UO_ g�0 t—t W raj v fa CITY OF CUPERTINO BUILDING DIVISION PERMITG`UbiTRACTUR;T�MA'CIQ�1V•",; BUILDING ADDRESS: Q100 CRESCENT ED AFFORDABLE WATER HEATERS """�ND' 05120076 OWNER'S NAME: PERMIT ISSUE DATE IGAHE DJAFAR AND GOLESTAN 24707 SAN FERN 2005 NE: SANITARY NO. CONTROL NO. (661)259-7131 ARCHITECT/ENGINEER: - BUILDING PERMIT INFO EO PLO MEOCH Job Big] a LICENSEDCONTRd DECLARATION Job Descri IO ® under9 (commencing affirm (hativid 1 am Ikensed undo provisions 1 herion w xoCTade. Section 7IXD)ofDivitlon Sof tint Businessand Pmfculona Code. and mylicense u 7 . f m fend mrce a eqe t. Lkenab Clan Lk. a G27.�G 8 WATER HEATER J q q/ Dam COnDEC PC ^nnA 1 +� ARCHRECsS DECLARATION / p e _ V rJng]ra I understand my plans shall be used as public records (j s, Licensed Professional OWNER -BUILDER DECLARATION I hereby afOrm that 1 em exempt from the Curbstone, License Law for the l�pjVq��'y following reason. (Section 7031.5, Business and Professions Code: My city or county Up+Jlre which requires a mos it m constrocL alter, Improve, demolish. or repair any abrasion,G$400 Prior In Its iuuanec. also requires lite applicant for such Permit m file asigned statement that he is licensed pursuant o the provisions of the Conmamr's Lkeme Law (Chapter 9 Sq. Ft. Floor Area Valuation u Busiocand Professions Code) or (commencing with Section 7000) of Divbion 3 of Nu Nat haes, exempt the almm and the bub for the alleged exemption. Any violation of r Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of not more than fivehundred dollars (5500). , ❑ I. as owner of the property, O my empdoyeu with wages as their able compensadon, Required Inspections will do the work, end the structure is not Intended oto@rsd for aau(Sax. 70th, Business ,ad Padmat.ns Cade: The Contra ar's License Law does ret apply m an Owner of 9 P property who builds or Improved, thermn. and who dms,tech work himself or tiuough his Own employers. provided Ihatsaeh Improvements are malnended oOEmed for sal. If. however. the building or improvement is sold within ane year ormmptetion, me Owner. Wilder will have the burdan of proving that be did not build or Improve for purpose of sale,). ❑ 1, as Owner of the property. am exclusively contracting with Incensed mnuaa7Os to roue= the project (Sec. 7044, Buineu and Pro(essiou Cade:) The Contractor's U. cane Law does not apply In an Owner of property who build& or Improves themon. and who caneacu for such projects with a camracmrts) licensed pursuant to the Conmw.To/s License Law. ❑ 1 am exempt under Sec. . B Ss P C for this ration Owner Data W ORKER9 COMPENSATION DECLARATION 1 barely allunder penalty of pedury, ane of the following declarations: 1 haw and will maintain aCcrdfinteof Consenito sel6lnaum for Workefa Compen• nation, u provided for by Station 3700 of the labor Code, fear the performance of the work for which this permil Is iuued. ❑ 1 have and will maintain Worker's Co npewdon Insurance, as required by Section 3700 of the lahor Code, for the petforma en of the work for which this permit is bound. ' My Workefa malmasation Insurance carrier and Policy number are: Cartier. �'�"�✓^� Policy NO.: 6 CERTIFICATEOFFXEMFDON FROM WOR .RK R COMPENSATION INSURANCE 07M, section need not be completed ifthe permit Is far onehumbereldollars (SIM) or ksa) 1 certify that in the performance Of the work for which this permit Is issued, I Ghali not employ any person in any matter an as to became subject to the Worked Compensative Laws of California. Data Applicant NOTICE TO APPLICANT. If. aper making this Certificate, of Exemption. you should become subject in the Worker's Compensation provisions of the labor Code, you mum (Onwith comply with such Provisions Or this permit Mall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hesehY alfirm that there is a construction lending agency fm the performance of the work for which this permit Is Issued (Sm. 3097. Civ. C.) Lender's Nam, Lendefa Addrus 1 certify that I Mw reed Ws application and sum that the show information is costed. I &Sree in comply with all city and county ordinances and mute laws relating to Wilding construction, and hereby suthnrixe mpresenutivcs of this city m enter upon the abovnmenlioned property for Inspection purPoes. (We) agree to saw, indemnify and keep harmless the City of Cupertino against liabilities. judgments. nom and expenses which may in any way amuse against aid City In eov emonsC Of the Starting of this permit. APPLICAnNNT UNDERSTANDS AND WILL COMPLY WITH y.1. NON -POINT SiSna�REGIe,r N� -r Issued by: Date Re -roofs Type of Roof /2//y/0 signa. ofAppIlesWCmanwmr Dam HAZARDOUS MATERIALS DISCLOSURE Will the applicant Or future building occupant more rehandle banned. material M defned by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safely Olc. SOYoonn 255320)7 All roofs shall be inspected to any roofing material being installed. prior If a roof is installed without first obtaining an inspection, I agree to remove Will do applicant or furore building Occupant use equipment at devices which it huvardous air contaminants M d by the Bay Amo Air Quality Management all new materials for inspection. bWOT ❑Yes Nu I haw rod the hm uasdous mrialsrequhements under Chapmr6.95 of t e Califon. ole Hulth AS rcty Cade,Sccdau253(15,25533uo125534.Iundesmndthaifde halding docs am curmn11 haw a Is it is my ms uihilitymtm.ly the Occupant of de rcyulrtman t m jriafmima r i se.raeapan Signature of Applicant Date _ > 2�iy� All roof coverings to be Class "B" or better es Owner r auNorixed agent teDam 11/23/2005 08:49 66122599556 AFFORDABLE WATER HET CITY OF CUPERTINO WATER HEATER PERMIT APPLICATION FORM PAGE 02/03 O,S/ate � APN # ?aae� A/ Water Beater / Vent plumbing Permit Issuance BUILDING PLUMBING BBNERGY BUSLdC Building Address: �• I b1 Ob Cre.�c_e.nr Owner's Name: ? ,u Phone #: Lt og- a53 Contractor: Phone: 1<la 1 License #: worJo6le a 20rtrs ,51-713 1 (va67 3 Contact: Phone: (P61 Cupertino Business License #: Coif L -i 1T I e,(:i P- i ASA -0540 .4(0KO Building Permit Info: Bldg ❑ Meet Plumb Mech Job Description: RePIGC.e anon WA'ref b1eA'ier (Sq me. IoCar�vn Residential Ed Commercial Cost of Project: W o 0 Strapped On Platform D Bonded ❑ 02", New Location Leplacement Qty. if rn Rae TIeemt-&inn , BMSA` ER pPBRNffME Water Beater / Vent plumbing Permit Issuance BUILDING PLUMBING BBNERGY BUSLdC Ener Business License BUILDING BUII-DING