01030009 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10341 PHAR LAP DR JUST WATER HEATERS NC 01030009
OW'NER'S NAME: APPLICATION SUR DATE
BROWN GEORGE B JR AND ALICE A 1764 NATIONAL AVE 03/01/2001
PHONE: SANITARY NO, CONTROL NO.
(510)293-9901
BUILDING PERMID INF11
re0"TO ANCHITIiCI/ENGINIiER: BLDG ELECT PLUMB NIECH
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LICENSED ih t ID coMnRd under g,)Cions of CION Job Description
O 1 hereby aRinn that l nm licensed under pnrvisinn.v lir coaster v ummnmncing
ONTO with fall for elcabal Division 3 of de Rrviness:md Prote.esions Cale,and my license
�yg� Necaurora°niteadct. REPLACE 50 GALLON GAS WATER HEATER
< License clan Lica
y�3 LL y Data Carlmaor
F a O vo ARCHI'ITiCT'S DECLARATION
J I undenland my platy—hall he^uaJ as public records
d ac
y dO O Licemed professional
ca K OWNER-HUILDER DECLARATION
ce= I hereby elErm that I a cmpl t'mm the C rmic'm's Licence Law for the
I-Z a following mason.(genion 703L3,busness and professhms Code:Any city in county -
'F O which requires aprinalt t t h e ini deariolustro,nepair my ormone
orevpenot 'Iso y thel suchpe ill 11signed statement
a3°—O 'hat he is licensed iscrousent to the p . l'the ContractorsI (Chapter9 Sq. FL Floor Areu Valuation_ -
tcom 6 with 70018 ID' it t or B ess 11 demon,Code) $8�2
or that he is evempt Iheref ion and the basis for the alleged exemption.Any violation O
of Section 7031.5 by any applicant tar a peril amjects the applicant to a civil penalty
of not tmtm Iran live haustral dollars(5510). APN Number Occupancy Type
❑ n
I.av ancrod the inept or mycmpinyces with wages as their vole compensation. 32639044. 00
will do the work,end the structure is nut intended lir offered for sale(Sec.7044.
Bashes+and Profession+Cale:The Contractor's License l.aw sae.+out apply to an Required Inspections
r of progeny Who builds ar imp rovea'here i,and who does such work himself
or through his own employees.provided that such improvcmanu are it...Inmoded m 502 — FINAL PLUMBING ENERGY
offered for sale If,however,the building or inrprova-ent is sold within one year of
mIt cliun.maowncrbuildcr will We buMcnofpct lag for he did ten bund ter 506 — GAS TEST
improve fnrpttgom of tele.). 507 — FINAL PLUMBING
❑1,acovernrol'the PoSwo,on esclu11mly croma ling with lirenad conmacurts to
s'ma the p jce,(Sec.70)14,Reardns and Pre elision+Crde:)The Contractor's -
Iecenw Law dxs nal,such man ownor of property who build,or inpmvun thereon,
e /
and who contracts
lira such pow r of u sena who h Ilds or
pursuant err the
Con nfacun's License I.aw.
❑I ten esemp'under gm. H&P C fill'his rwnon
Owner Dale
•WORKER SCOMPE'NSA'TION DECLARA'I']ON
I hereby rollout under penalty of perjury enc of the following declurulio-v / �(
❑ 1 have and will maintain a CMircae of Consent to self-insure for Worker'+
C'on'persoiur, as provided for by Scnlou 37011 of the Labor Code, for the
rerforaee of the work for which this permit is issued. O
❑i have and will traincein Workers Camgrensa'inn Insurance,tar required by Semior /
37110 of the Iadrt Code,five the perfonmince of the work lis,which thio permit is
sued.My Workers Compensation Insurance carrier and Policy number are:
Cartier. Policy Nov.:
CCR'I'IIICA'I'ION UP CKEMIll ION FROM WORKERS'
COMPHNSAIION INSURANCE
(This eccli^i need mol he eomplead it the peoul,i,burro hurdrnl dollars
051 BB or Ics,.)
I certify that in the peri tiounae of the work for which Irk permit Is issued,I
shall not employ any person in any manner ma as to became subject to the Workers
Cmnycnsaion Lais—fCarfomia,Doe
Applicant
NOTICE TO APPLICAT:IL alter making this Certificate of Eaenption,you should
hce,)na whieat Ill ILe workers C'nmpeanloupmvlscmn of ore L^ba CIRle,you Tri."
Q O nlimnevilhamrply with such provisionsorthlsicnnit shall bedeaned revoked. +
.~�. CONS'(RUC'TION LENDING AGE Cy
I hereby aRir that hem is a construction lending agency for the performance
oI Are work ba which this permit is issued(Sce,3 W 7.Clv.C.)
L Q Lender,Name
5 Z LcndeC,Address
U Q 1 cenlry that I have read oris application and state that the ommi,information is
I-. rr•, correct.1 agree to comply with till city and county ordimmee,and state laws retain,
Q U uihuilding construction.and hrum,au'hori,emposentative,nl''his dry to enter upon
the aMwe-n¢ntioned propeny,for inspection parrarin.
F C,,r (We), ocemsa,I,'mdrounry,md keep hamro,xrhe Cilyof Cupenino against
r (n liabilities,judgments,civ>rc and circuses which in,In any way accrue against+aid
U ti Cory in consequence of the granting of this perit.
APPLICAN C UNDERSTANDS AND WILT,COMPLY WI of ALL NON-POINT' Issued by: Date
SOURCE REGULATIONS. y'
Sign'dam of Appllcan'/Contoamrt Date Re-roofs
HAL%RIUOUS MATERIALS DISCLOSURE
Will thcappbcanor future building overtrain store or handle haradaas material Type of Roof
as defined by the Cupcnlno Municipal Code Chapter,9.12,mrd Im Hral,h and Satay
Cole.Section 255321o)!
❑Yc, 0N All roofs shall be inspected prior to any roofing material being installed.
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
,i,harridan,air conuuninums Ip dermad by he Bay Are,Air Quality Manage cal
Des'dcil all new materials for inspection. Applicant understands and will comply with
DYes 0N^ all non-point source regulations.
1 have read the hornrdous materials requirements under Chapter 6.95 of the
Cahlmmw Health&Safory Cale.Sections 25505,29533 and 25534.1 undcarnd that
if the building dee,not ormally have a lenanl.'hm it is limy m1prmsibill'y m-,)till tau
cecuract or the requires cas which moot be mel prior to issuance of a C aeadicae of
Decorate, Signature of Applicant Date
Owner or truth mdmal agcal Dae All roof coverings to be Class `B•' or better
OFFICE