02080081 'CITY.OF,CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
•. BUILDINGADDRESS: PERMIT NO.
21'952 LINDY LN JUST WATER HEATERS INC 020800��8,1
Ifff"'EMEHMET''U AND CANDAN 1764 NATIONAL AVE , APPLICA8(g4$T JA/yL002
PHONE Ise r'rf}S rel aH -I )IE.! t ( '•a-ss s SANITARY�NO/. CONTROL NO.
41
(510) 293-990: ( '
O O ARCHITEC rENGINEER: q _ - s BUILDING PERMIT INFO
"BLDG ELECT PLUMB NIECE
I'--t L"=3 r�
H= LICENSED CONTRACTOR'S DECLARATION ] ]� g
Z ani,'9.:'Ina;inyarfirmmatlamrtenamamaerpra�iamnaofennpter9(tammentmg• REPLACE WATER H7pAbD cription
PZC= with Section 7IX10)ofDivision3.ftheBusinessandProfessionsCode,endmylicense E T
Pag is in lull f.me and effect.
m z�.\Lltenu Claas LIC.N
n itL O Date' Connector
„ ARCHITECT'S DECLARATION
T0 g I undersand my plans shall be used as public records t -
i an an❑O Licensed Pro&ssionel .... - - : •i _ ,
o OWNER-BUILDER DECLARATION -- - - - •-- _
mI h rtby oBirm
that 1 am a mpt from the Conuacmr'a License Law for the
?< fall g n.(Section]0315 Business and P feuions Cade Any city or county $850
O tab h req 'rt a sm
pcit t c nswct start,improve,demolish or repair any structure
�$ Pnos E uanceelso regmedt sit orfarucnpemduoicenw ne(aamem- .. - - - -
J6t ha tA.lt¢nacl Puntwmtu she pmvrxt of the Contractors Uccnu law(Chaper 9: 'a. Valuation
as comment with Stttio ]0011 fDivisi n3of the Busness and Professions Codd 'r 3 3 2_HlaYy .tY {,• 44 S
- or Choi he ii exempt iherefiofn and the basis for the alliged eiemptim.Any violation C' d a s_ ''t 11:: y t ,A:),a. s.
-of Section]031:5 by ehy upplichm for a pemdt sobjttn the epplicam m e civil penulry. tai ..aa.,
ofnaim.rcthmnfivehundrtddollers(5500). SO2AP-NpSU'1V4L PLUMBIN ENERGY Occupancy Type
°Los ow ar.fdm,m,oy,ormy employees with wages as Retrole mm,xammort. 506 - GAS TEST
'-will'do'll e'work;and the strvcmre is not intended or nRercd for sale(set.]mase,' 507 — FINAL P �tb��TispeClionS
' r Business and Pmfession.s Code:The Contractor's License Lew does nm apply't un s
owner of property Who builds or improves thereon,and who does such work himself
o er through h n however,
rye pro building
that such improvements t e n intendedyFar or
- offerclfor's le ILh wee thebuildinB. mpro, 1 s' Id wth one year of
iampletlan the ovine b ddkr di have the burden f poising th t h dud not build or -
tmP
°1 her of the p(Sec.7 um exduavdy controcung with licensed contractors ats t. _ _ s_s -_...
doinwn the does
no(sec.7toa Business and Professions Code:)The improves
thereon,
License Law don not apply m mj owner of proptoy who).fids.r improves thereon,
cmusa e,LicctseLow. hprolecu with a.contraztoKp.Erenud.pursuamao Na' _. ._ .._____.--- _SER-2-0—K02.-.._._...-__.,,- .._...T.--.- ..........._-----_._.- ------
C 1 mo axe License law. '
- - Onlam exempt undir,Sec. ' Date _, ,B&PCfunhis rtman.
y Qwner" . W:ORKEWS COMPENSATION DECLARATION �u'�®a��
1 hereby notion under penalty of perjury one of the following declamations:
`If� O 1 have'and,will maintain u'Camficme of Consent to self-insure for Worker's
Campenmtinm,-a!-inovidedfor by Section 37M of-1ha Labor Code, for the
_ 'performance.(the work for which this pamal is ismad. ,,,-.,_ _ ., •^ -'
d. °Ihave ed 'll maintain Worker'sComproustramin Insurance,as reqnincil by Section ..
370p if the Labor C d< fur the performance of the work for which this tumor a
y I1.A 6 aiMy P r�,curs,C inp e ii a[o,.l sui ccatri er andPilcy number are _
C
Y I4' -. It Y}`s:'r Policy ' t { -� ' ] 1 ,., ....
C
if '+ ICERTIFICA'rioN OF EXEMPTION Nn.
TION FROM,WORKERSj {..•l.t� �- 5.y. + ylf, .l- f]- l>raf�s L,�Aa it;� .
COMPENSATION INSURANCE;.`
f.
i
tri it xenon need not be'com kmd if the rmii is for ane hundred dol Ion 'I l't "I -
(SI00)orlese.l
- ;s I ten f thmr n the rformance of the w rk for wh h this "-��`-*• - "- - -
y ,p< pcmtn a issued 1
Card not employ any pesion m any manner u as w become subjttt io the Woikcn
Compensmian Laws of Celimonio.Date,
.Applimni
NOTICE TO APPLICANT If, @r making this Can ftc to of Exemption you should
becomesbjeiuu theWorkers Camper i provisions of the LaborCode,you must
t f
Q 0foM th compiy;w th mach provisions or Nu pannit shall h deemed revoked' 1 w
F '
:. fix. _ 3 a 1 _
F W �,. CONSTRUCTION LENDING AGENCY - •- "- _
ai I hereby efimt th t theresconstruction lending agency f d performance r1
of tb< k forwhich'hisPermit isued(Sec 309] C.C I
-Lender's'N n' .... _ .._ _ _..._ .
V 0 I certify that 1 have read this application and state that the above information is
Taxi H �cnrrecir l.ng.t.comply with.II city and county ordinances and state laws relating
robuilding aonamction,and hereby summarize representmives of this cityto enter upon -
;y-(,a the china-mtot,`neJ property for inspersionry
purposes�a-Ow+ (Wel agree tosave:indemnify and keep harmless rhe City of Cupertino against,
::- U (4 liabilities.judgments,costs and expenses which.may,in any way acerae against said
C.a City m consequence at the granting of this permit ,
-_ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALI:NON-POINT
' Issued i
Y SOURCEREGULATIONS. y - - 'Date
fignmumJApplicantlCammctar ; -�! Date.I , Re-roofs
`; - HA7ARDOUS hiATER1Al5 DISCLOSURE
W II Nc vpplicas ft Wiwing accupmt arum or barilla hauNaua materiel ..Type of Roof -
a d fined by the Cupentno Mun opal Cade Chapter 9.12,and Ne Health and Safety •-
Cod $moon 25532(.)?.*-' i -'.•• ; e- -6'q♦♦t I s x•) p x• i- ! sl
°Ye kt ON.
.- -_ - _-All roofs shall be.inspected.prior to any roofing material_being.installed._
Will theapPlicantof future building occupant use attainment or deices which If a roof is installed'without first obtaining an inspection,-'l agree to remove
emit hazardou it coommmants as defined by the Bay Ana Air Quality Management
District all new materials for.inspection. Applicant understands and will comply with
ON. allon-
npoint source regulations: 1- I
'Sit ,I have read the hazadous materials requirements under Chapter 6.95 of the Y "I
Ctrl fnrain Health&Safety Cad -s chums 25505 25533 and 25534,I understand that
If pthe building does not curredy have a tenant,that it is my raspornibiloyto notify the
nrupam of
din
rdnermem which antiob metpd,to mmuce
of.Cenifm c of
it
t.tf
t Oocu o c
Date g PP All roof coverings to be Class B"o
r Signature of A bean[ Date.
better
- .
owner pr nuihnnud i '
. OFFICE ... -_ _._...._._._.. .-. ... ._ _... .. . . . .. .