03010127 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTORIINFORMATION:
BUILDING ADURESS: JUST WATER HEATERS INC PERMITNO.
10131 PHAR LAP DR 03010127
OWNER'S NAME: 1764 NATIONAL AVE APPLICATION SUB DATE
RAO THIAGARAJAN
IF
--- - 01/23/2003
Nm 510 2 9 3-9 9 01 SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER; BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
00LICENSED CONTRACT'OR'S DECLARATION Job Description
uz F 1 herchy infirm Thal 1 um licensed under provisions of Chapter 9(commencing P
<� with Scninn]INMp of Division lnf NC Business and Pmfcseinns Cndc,and myliccnac is
mmuforecandeffect. REPLACE WATER HEATER
DyF a s Item¢Claza Lir.i (4 0 GALLa
Date Lic.4i for ARCHITECTS DECLARATION tI understand my planssell M usedas public records
FLLOLicensed Professional —� t-
prior
OWNER-BUILDER DE CLARATIONE:0 I herchy affirm Thal 11. acmpa from IM Cosies o :Anye Law for thew-00 following rcazun.(Scctinn]IIJLS,Business and Pmfcssimns Cate:Any city or countywhich requires a permit to conswm.start,improve,demolish,ar repair any structure�F$ m itsissume ,also requires tho applicant for such Permit rile asignrd......
££xx that he is licensed puavam tu lM provisions of the contactor.License f.w(Chapter 9 Sq. Ft. Floor Area Valuation
e(F$ (commencing with Section 70p)or Division 3 or the Business and Professions Cmle)ar 6
that he is exempt therefrom and the hazis for the $726 alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five Madera dollars($500). 32639059 . 00
0 I,as owner of the property,or my employees with wages as their sate compensation,
will do the work,and the structure is not intended oroffered formale(See.7044,Business �pp�yl�es�[p,�p �[�pp�.,
and Professions QMe:The Conlaaur's License Law docs not apply to ea owner or 502 — FINAL PLI lJ1v1;371V15 et:1 ff.�GY
properly who builds or improves thereon,and who does such work himself ur through his
own employees,provided that such improvements are not intended or offered forsale.It. 506 — GAS TEST
howevrr,me building or improvement is sold within one year of completion,the Owner
builder will have the burden of proving that he did not Mild or improve for purpose or 507 - FINAL PLUMBING
.Jr.).
0 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.761,1,Business and Professions Code:)The Canmcaor.Lb
cense Law does not apply to an owner of property who Milds or improves Neaman,and
who contracts for such projects with a contraaor(s)licensed pursuant to the Contractor's
License Law.
0 1 am exempt under Sec. B&P C for this reason
Owner Daae
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one or the following decimations:
I have and will maintain a Cenificae,of Consent to self-inaure for Worker'.Comped.
I as provided for by Section 37M of the Labor Code,for the performance of the
W
for which this permit is issued.
1 have and will maintain Workers Compensation Insurance,az required by Section
)of Ne Labor Cole,for the performance ofNe work for which this Permit Is issued.
Worker's Compensation Insurance crosier and Policy number are:
rtier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not M completed iftM Permit is formic hundred dollars($1(X))
Ices.)
I¢of fy aha in she perrnrmmee of Ne work for which this permit is heard,1 shall nut
employ any person in any manner so as to become subjeruo the Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject to the Workers Compensation provisions of the IJMr Code,you must
OO forthwith comply with such provisions or Nis Permit shall be deemed scvnked.
z
[-+NyCONSTRUCTION LENDING AGENCY
rThehereby arythat thereis a ()
agency lot the Performance of
IX the work for which this permit is issued(Sec.3097,Civ.C.) `
aLender's Name
z Lender's Address
V 1 candy that 1 have read this application and smte that the above of or amort is
IL F.t correct.l agree to comply with all city and county ordinances and state laws relating In
QU building construction,and hereby atuhorim repmsenutivcs of this city it,enmruPon the
117 ahovnenlinncd property for inspection purposes.
(We)agree to save,indemnify and keep handless the City of Cupertino against
V) liabilinfejudgmenta.costs and expenses which may in any way accmc against mid City
U z APPLICANTnsequenceUNDERSTANDS Aof the gowning offND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOURCE REGULATIONS.
Re-roofs
Signature ofAlitelmonlCononcLuar Data
HAZARDOUS MATERIALS tDISCLOSURE...orhandl Type of Roof
Will the applicant or forum building e,Chapter
stoic or handle ocaNaus material
u def rmJ by IM Cupertino Municipal Code,Chapter 9.12,and the Ilcelth and Safety
Cade.Section 25532ur. All roofs shall be inspected prior to any roofing material being installed.Oyes ON.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
smia'I
O Yes ON.
1 have read the h rmodous materials requirements under Chapter 6.95 of the Califor-
nia I Ic.IN&Sufcly Calc,Sccunns 255115,25533 and 5534,I undcmmnd thaiif thc building
does not currently have a tenant,that it is my responsibility to notify Inc occupunl of the
at,
which must he met priorm issuance Ufa Certificate of Occupancy. Signature of Applicant Dale
Owner(it autholredagent Date All roof coverings to be Class "B"or better