02070077 CITY OF CUPERTINO '- •- ••
BUILDING DIVISION PERMIT C0N7.cRACWRI,NF®Idi4EAEI0'N
BUILDE4G ADDRESS: PERMIT NO.
2167R OLIVE AV JUST WATER HEATERS INC 02040077
ONT'ER'S NAME: APPLICATION SUB DATE
FUKUMURO KUNI AND EIKO 1764 NATIONAL AVE 04/16/2002
PHONE: (510) 293-9901 SANITARY NO. CONTROL NO.
t� ARCHITECTIFNGINEER: BUILDING PERMIT INFO
kC�-" BLDG ELECT PLUMB MECH
ya_ U C_I L j L i
S v i LICENSED CONTRACTOR'S DECLARATION Job Description
7 I- 1 hcmby affirm Net 1 om ofihe d under Prov fc of C CWc. =comm Been g P ,.
I- isinf.1111 ]OW)ofDivision3oftheBusi«ss andProkuiouCode,andmylicenu REPLACE WATER HEATER.
is in full forte end affect.
u c u Lice m Class Lic,x
Due Can uacmr
u O G ARCHITECTS DECLARATION
S 1 undemeM my plans WII be used as public records
E o O Licemu d Professional
to OWNER-BUILDER DECLARATION
1 hareby a1firre Na,I am exempt from the Comma a-1 Lime Law for the
o following season.(Section]0313.Business and Professions Code:Any city or county $700
7 O 0
s which squirt a permit to consulter,alter,improve,demolish,or repair any structure
i3Pwdot.lus nunun,a, I»requres the-Pplictral for such pemuuo flee s,g«d stemmed,,` - t ._....... _____.-------------
__. _ih repun7ahapasmthe ConurxmisLicense
Law(Chapter S$ Valuation
(commencing Section o of Division 3OfmenlditkOK coda)
Z O �•' I i+ s or Nat he r eiinit Ne6efrom and the bass for the allega ciemptmn.Any violation -
-of S«don•!031.5 by any opplicant for o permit subjects theop,Ihmn,..civemil pby-
'of hnt m ric than fin hundred dollars(SSW). N r
50 - AL PLUMBIN ENBRGPccupancyType
❑Las owner of Ne property,ter my employees.ith.agcs u their sok compensation.
-BTlfgo the-ware;and Nc ode:Th is mordk's Licded crbrtLaw doe sale"(ped.to an 5 0 7 — FINAL PR9NftWGsp "I!,:.'ie
owner
or property
erty V%ns Calc The Convenor's.and W Lew s su not apply m w action's i0'
owmrfofh.his oYWhobuildsorrmprovu Merton,andwhmem, such workhimself
or Nrou 1 six own cmployahowever.s.dw b provided that such vement is sol art ria intended or,.__...__._......._____.__...._.__..._....__.__...
offered m s heat,however.Um building or improvement n sold within one year of -
ompinioo,the owner-builtler will have the burden of proving Chet M did not build w
impow for purpou of uleJ.
Ol:tr ownerPojec property,u,Businessacommc,tn¢na oce:)Tcommcmrsto •,'"ILD!:,•.i '!.:f'F :,f"�
construct the Project Sac.]064,Business and Professions Code:)The Conwaor's
5-' Littme Law d«s cot apply ro en ow«r of popenY who Wilds or imProw Merton.
..aha.wba.emtsclada
: ' Contranors Liceram
❑I cmp,under
Dwo r APR 2 9 2002
Dam
< -WORKER p COMPENSATION DEChARATION
_ +'"""IMmbyaRrmvndgpennitY;ofperjuryorcofthefollowingdeclam,ions:" BUILDING
❑ I Mve'vd .ill'mainuin'i'Ccriificam of'Cmueni io'aclf-insure far Worker's
Compensation.u provided-for by Secthm-37W of-tM"LaborCode,-for the
PeHomta oa of Nrk
e'smfor which this permit is issued.,
❑1 Mss Ertl 'll marmm Wn
ork s Compervauon li:sunx, required by Section
300of,he tabor Code for the perform f she work for h ch this pcmu,is
sued My Workers Compe recti Insurance carrierandPolicy number 4e cit _"_- "_"- „-„•", _-
2'..tPolicyN
t CERTT FI�CATION OF.EXFD1PIlON'FROM WORKERS L., s� a � tr fl� tit a,.l.'1�, ff.J }: �/:I. uJ r•.
COMPENSATION N'SyAANCE t -
'"'' rlhrs rzcuon Dad rid W comPkied if Ne .it for one hundred dollars •l)'-
ISIW)«los.)
't o "wokf 'N . .. ..-_ _._.._.__
-.Com euon Laws ofC if aDamnner soot hero -. •� ��..._._....___,_____,_._.__.,-....._ ____..__.......__._.
r.,y l car fy d!t n Ne perforins cc kh Nis pc he issued,l
}Nall ati employ ny person n any ma 3 ,me sub)cs a he Workers
Om
"
Applet , - .. _._._ .__ ...... -_ .._.. _.__ __
NOTICE
YTOAPPLICANTIf Be kingy'his Crtf,e m.ofE,_emptor youshould
Aecortesubjecno the Walk,,',Compemsmo proi sitmj bfd IAhre Cods,y u t
fonbilN comp* t «h Provisions.,his pc ,shell bed d revoked Z
5 .
CONSTRUCTION LNDING AGENCY N,I,
O
IhiOCctolndjgcyfr
oferebynili tNerets.cnnswnor"ce
r )'.w6,kfo whichMrslkim[lisisued(Secn309]CIvC)
_
.-
I<rAcre Address .. _.._-_...-
) y III sNry that l have mad al p city
ad d u to Nu N ban mimmation is
rohen 1 avec t comply N allhereby
,y sod cote ty orNna«s and r«lava cr upon
� f 5 to Wddn¢mnswct do v011 pen,fo inspection Pcpmuntnirvu o(dus aty,,o tnurupon
�rW theaWye-mcmione6 pva:fmborify and
barred..
the city
r_,. minor
y:,L! IWjud,poetosavemand ,Nfyntl whihirmless an way!cruc!jno iearnrt
W Ciry idce.mqd note.costs aha eapensa.Xm may..in any rny`accrvc apumI ui0
U.Z' Ciry n coququance df Ne pont P pf Nii yemn,.
`" APpLIC�]T 6ND4RSTACDS q5D S3T LCOMPLY�s RH ALL\O�:POLSio�e r
SGL RCE REGUL.AtID]s. i' ,4 r Issued by: Date
Siglmmrt'of APPlicmVConvactor[;,':'_+,';_'•;-s ata r;.r;,.;!„ i•�'�Da{c r-, :, ! Re-roofs
' r � , HA7ARDDUS MATERIALS DISCLOSURE! h `
�”" WII Ne applidsns a f mie Wdd n¢« pan,st rt o hukl ha�uNous genal ..Type of ROOF -
u E f l d by the Cupertino Mumi6pal Code.Chapter 9.12a and the Health and Safety
Code Sections]5532(.y?Vf x-a 4r ➢ t_ .i f- ,,{ it.. �V .-I-tf tj "�,�f c = :. .,if
e: 'o DYa L ❑N y 1 f yx4pL q.
, - All roofs shall,be inspected prior to.anyroofing matenal.being installed._
Will the applicant a rumrt bulldin¢Occupant ute equipment devices which If a roof is installed without first obtaining an'inspection;'I'agree to remove
emit hssado s ter contaminants u defimad b)Ne Bay Area A Quality Man gcmcm ,
District l. : - all,new materials for inspection..-Applicant understands and will comply with
❑Yes ❑hq _ ....... ...... .,
all non-point source regulations;,. r' `-
1 M:;�rtad'the hmAousmaieriils requirements under Chapter 6.95 of the
Cahfom,a Health$Safety Coal Secuom 25505'25533 and 75534,I understand that .. ..._.. .__.__ ... ..._ _.._._. . .__. . _ ._. _ . _.....-___...__......_.._ _
recd int of the requirements w M.e a ten a mets ii is mY issuance
oilhgmmot!fyphe
t Nc.Wildin d«a nowu
s � * met prior to issum¢of i Cehificate'bf
OcNpaneYI .r which must be
r . Signature of Applicant _--.Date------
All roof coverings to be Class"B"or better
OFFICE... .