03010163 CITY OF CUPERTINO
BUILDING DIVISION PERMIT 000NTRACTORINFORMATION'"°
BUILDING ADDRESS: HOT WATER INC PEROTr NO.
7856 MC CLELLAN RD 03010163
OWNER'S NAME 2531 GRACELAND AVE APPLICATION SUB DATE
SUNITA SHITOHE 01/28/2003
IG"E 650) 298-8494 SANITARY NO. CONTROL NO,
ARCHITEC AINGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
�00 LICENSED CONTRACTOR'S DECLARATION
�u F 1 hereby affirm Nat 1 am licensed under Provisions of Chapter)(commencing Job Description
Z6 with Seat n7 gpof Division Sof the Business a4t'soressiolu ode.ane my Torose is
F<m a mu It do at. 1/O 'J REPLACE WATER HEATER
ZZg, Liccnu x Cm-I FIM py L®�
G=Fp i Conlraa 'v�'t9 Ir`v
ARCIII'17iC1"S UEC AR PION
I undcrsta d my plans shall be used as panic records
adia FEB 10 2003
F a a License)Professional
OWNER-BUILDER DECLARATION
1 naso affirm that 1 um exam Pl from the Cs sons C's :Any
law far the
fallowing reason.(unisection 11111.5. ..Business and 1'C,derons Cod,:Any city or matey BUILDING
1 All ®'NG
_Z-
which rets io a Isemit In t'ttnsl dre t Bar,imp C,d,mr it m repair any eauctul, H L
prier d its ceased p also r,qui rhe the arson em f or such permit m f I...Law
aw(statement
�Z< [bathe canted pursuant lath)pfDisioreof the eBusinar's License lawsCosheer9 Sq. Ft. I''IODT Area bS`$'Ql.(IIlI00
qZ�p
(commencing la,is1.1minhicieftn7IXad of Diviaian3 urs he Business ands,Any
of
6�� that he is esemPt Iherefmm and tha bssis for Ne allege)eaemptinn.Any violation of
Section 7031.5 by any applicant for a froth subjects the applicant at a civil penalty of
net mere than ftve hundred dollars TIM)OL 6 Occupancy Type
I,az owner of the progeny,or my employees with wages as their sale compensation,
will do Ne work.and Ne structure is not intended Or Offered for safe(Sec.7644,Business 502 —
an tl Professions Code:The Contractor's Luebase,law does nos apply to an owner of 506 — GAS TE y•Ulre nSPcc LOOS
FINAt
progeny who builds or improve dercon,and who Cass such work himself or through his
own employers,provided Nal such improvements are not intended or offered for sale.If, 507 — FINAL PLUMBING
however,me building or improvement is sold within one year of completion,the owner,
builder will have she burden of proving Out he did at build or improve for purpose of
sale.).
O 1,as owner of the progeny,am exclusively contracting with licensed contractors to
construct Ne project(Sec.7044.Business and Profusions Code:)The Contractor's Li.
cense law does not apply to an owner of progeny who luiles or improrcs doctor,and
who contracts for such projects with a conaacmr(s)licensed pursuant to the Contractor's
Lic,
a.Law.
Q l an evempl under Sec. ,B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby M. our,penalty or perjury..,if Ne following&,I...tions:
1 have and will maintain a Cenilicate of Consent o self-insure for Worker's Compete
737'0()
tin.,u ctio
provided for by Sen 3700 of the Labor Cade,for the Performance of the
rk far which this permit is issued.
I haw and will maintain Workers Compensation Insurance,as required by Section
f Nc La nr Code,for NcPoffirm Ott of Nc work me issuW.
y orke' ter sa8n e ieranC Pdi
ec G I Pudic
CERTIEIC EorExEmpiC&1T6m—woRKrRy
COMPENSATION INSURANCE
(Thissemio n nese not M completed if tM permit is forme,hundred dollars(Sla)
or less.)
1 terrify that in the performance Of the work for which this permit is issued,[shall not
employ any person in any manner so as to become Subject o the Workers'Compenam on
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:If,after making this Cc nificam or Exemption,you should
become subject m,the Worker's Compensation provisions of the Labor Code,you must
O 0 forthwith comply with such provisions or this permit shall he deemed revoked.
z CONSTRUCTION LENDING AGENCY
[-+ � I hereby affirm that ther,is a construction lending agency for she pCrimmantt of
athe work for which this permit is issued(See 3097.Ci,C.)
W 5 lancer's Name
04 z Lenders Address
V 0 1 certify that 1 have read this application and sate that the Chose information is
W (~ correct.)agree to comply with all city and county ordinances and state laws relating to
OV building Construction,and hereby anthoria representatives oftho city m enter upon the
W above-mentioned Property for inspection purpous.
(We)agree m save,irecmnofy and keep harmless the City of Cupertino against
hliabilities,judgments,costs and expenses which may in anyway acerae agamsl said City
U 7 iAnPPLsc uc °UNUERSTANDStAND WILL COMPLY WITH ALL NO -P Nr Issued by: Date
�i S U :GULATIONS.
Re-roofs
(gnat APPlm If ZARDOUS MATERIALS DISCLOSURE ate Type of Roof
Will dcapplicantorfuI building becupantiame or handle hamrdous material
as ticEneJ by Ibe Copeman M viral COde.Chapter 9.12,and oho I lcallh and Safety
We. [Dyes 2s532ta)1 All roofs shall be inspected prior to an roofing material bei. Installed.
[D yes Na P P Y g g
Will the applicant or future building Occupant use equipment or devices which If roof is installed without first obtaining an inspection, I agree to remove
all harallous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
oixtrmr, C� s'o
❑Yes
1 have mad the hazardous materials mquirema.a under Chapter 6,95 of the Califon
nia Heald&Safety Code,Secdons]5585,25533 and 25514.1 undersand that if Can building
does rmmiy haec a Boom.that it is my mspomibility to notify I occupied of me
rcyui cos whim mustbemct pdnnnissuancc nfa Ccnif¢a of ,g9rm�,/y.,/I Signature of Applicant Date
w.er marnaa ag,.t t D All roof coverings to be Class "B"or better