02080063 CIBUDarcovSONO
ILiiNPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10181 PARISH PL JUST WATER HEATERS INC 02080063
OWNER'S NAME: APPLICATION UB DATE
MARIE STEPHENS 1764 NATIONAL AVE 0813/2002
PHONE: SANITARY NO. CONTROL NO.
p (510) 293-9901
O O ARCHITECT/ENGINEER: a BUILDING PERMIT INFO
uBLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
� I hercb afforded I am of B sines finer t .and(commencing
Job Description
of_.o yet °`°vizi°nxm °" g REPLACE WATER HEATER
F,_Cm with Section 7000j of Division Jof the Business and Professions Code.and my license
a Y is in full fame end ellen.
O U
License Class Lic.p
Date� Contractor
ARCHITECT'S DECLARATION
g 1 understand my plans shall be used as public recoNs
Wes O Licensed PraPol
xsiona
OWNER-BUILDER DECLARATION
sett= I hereby aRrm that I am exempt from the Contractor's License law for thc
1—2< following rcamn.(Section 7031.5.Business and Professions Code:Any city or county $750
❑ wh ch requires a Permit to conamet.alter,improve.demolish. p' Y structure
3
poor to its issuance,also requires the applicant for such pemmc no file a signed sentiment -- -- ----- - --
th t M1e d I anted poo rte the P -i.taro of Ne Contracm(s L emu la (Chager 9 ,, q,,,, I�nn
(common in hht t a 71aK1;l the basis
3 oleo Brom nJ Prof nom'dation 3�l'lT8 V IUOC(1�(!)ea o a,1 44 1T rlti Valuation
or Net he is exempt themfsvm'aM the basis for the allege)dempAon.Any violation
- of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty {a� .
of not more than live hundred dollars 650111. rj02APNP,Ypj9{HcE PLUMBIN ENERGY Occupancy Type
❑Las ownc'ifthe prnpenyormy employees with wagesms their audit compe"satioq 506 GAS TEST
will'do thend'Prkfand the structure is not ed or License
for sale(ScCapply to an 507 — FINAL PLRJ&45ihW(1nspections''
'Business anJ'Profeasions Code:The is Contractor's intens Liccnu law does not apply to am '
owner M property Who builds or improves thereon,and who does such work himself
or througgh his own employees.provtded that such improvements sere not intended or _
affected f6,s31e:IL however die Wilding- ve t is sold within one err of
mimen of pro y i
mprova for the owner-builder will have the burden of proving that he did not Wild or
c
improve for puryose oLsale). I
..O L as owner of the pmPen7(nm reclusively committing with licensed contractor m
License the project(Sec.yto a.Business prod arty who
milds or The Co thereon.s I •,',
LiccnuLaw tsar norapplysuch.
an ejownermf a cony won Wildseeimproves Norton. AU.G..2..7..2002-
e „and Cmeneeo.mntmds for,such.pmjccts wiiM1 a comranogs).liccnscd Pursuant to du _......__ .. - .___.__._
01rinneserplunac Law. ., fj�,„ i.✓ • i
❑lam exempt under Scc. - :B&PCfonhis rmun ,
- = Owncr Date BUILDING
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Pcwlly of perjury one of Ne following declarations:
❑ 1 have and will maintain a Certificate of Consent to xd6imurc for Worker's
Compensation. as provided for by Section 37M of the Labor Code, for the
Performance of Nc work for which this permit is issued.
❑I have and will maintain Worker'x Compensation Insurance,as required by Section
3700 of the Labor Cdk,for the performance of the work for which this permit is
issued,My Worker's Compcnxation Insumnec carer and Policy number are:
Policy No' { l� sl ( �; ;�1 f23w 2�Yf:,fi!� cl:A
., { !CERTIFICATION OF EXEMPTION FROM WORKERS'{
COMPENSATION INSURANCE
` 'Qfiiaduciion'naed rat be iiimpined if the permit is for one hundred dnllun - � - � '
(31001 or less.)
-1«.,t tha in the m I.an,nie'nf the work for which Nis permit a issued.I
shall not employ any Arson in any manner a as m become subject m the Workers'
Compensation Lows of California.Use,
:Applicant. _-
NOTICE TOAPPLICANT:If.after making this Certificate of Exemption.you should
become subject m the Worker's Compensation provisions of the Labor Code,you must
0 O fonhwith comply with such ptnvikions or this permit shall W deemed revoked.
`I 1- 'CONSTRUCTION LENDING AGENCY 'y
�'> c I heieby affirm thin them is a construction lending agency for the performance 1
W 0 .il4c 1 certify thae work fee t
thispe t sued(Sec JfN],Cis.C)
Under'
is
U y I base read this application and state that the above information is • �_'
W E. cmoce[.I agree t comply with all city and county ordinances and state laws relating
0 S:1 to Wilding construction:and hereby authorize representatives of this city toenterup"n
rr, the aWye-owntlmned prnpeny for inspection pugaises. _
E.Q. (We)erg.to save.miterrody and keep hatmins the City of C.,din.,,nr n
(4 liabilities judgments,costs acid expenses which may in any way acerae against said
U:z City in consequence of the granting of this permit. '
APPLICANT UNDERSTANDS AND WILL COMITY WITH ALL NON-POINT Issued Dale
SOURCE REGULATIONS..' ssy<
Signature of ApplicanUCommetor . Date Re-roofs
- s -HAZARDOUS MATERIALS DISCLOSURE .'.
.. Will the applicant or furore building occupant store or handle hazardous rat rial Type of Roof
a def d by the Cupertino Municipal Code Chapter 9.12.and h
te Health and Safety s . A,. ( s
..
coals.Seton M5321a) i 'I. .r .. !', t ,7 I,t• 4 Ay'.I Jit C .l.J.•, _ .•.. ...
Cl Yes '❑No ;: 1, }, > t All roofs shall.be.inspected pnor.to anyroofing material..being.installed.
Will the applicant orfuture builJngoccupantuseeq P t or devicei which If a roof is iilsialled without first obtaining an inspecti6ti; I'agree to'remove
clon Kniandoes air conoinnoarts as defined by the Bay Arc A Quality Management
District' all new materials for,inspection._Applicant understands and will comply with.
O .YON. all non-point source regulaiions.
I have madlNe hatandous materials requirements under Chapter 6.95 of the
Califimid Health&Safety Code,Sections 25505,25537 and M531.I understand that
-if the Wilding does not currently have a tenant.Ihat it it my respinsibillry to nrnify th<' _
uccupam of the requirements which must he met prior to issuance of a Certificate of
Occupancy.
Signature of Applicant --_ ., . . _ - Date
Owner nr anmmdaeapgeni Dam - All roof coverings to be Class "B"or better
OFFICE