02020123i
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:CITY'OVCUPERTINO '' - — . • .
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'CONTRACTOR INFORMATION:
:'sun.DrNG DIV' PERMIT..
BUILDING ADDRESS: ' - -
f; �;;,t;,i -, 1-�
PERMIT NO.'
20.355',VIA,VOLANTE.'. ,, „'
JUST WATERrHEA.TERSI.INC•
„."'' ;..,,.•02020123
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'OWNER'S NAME::•"^•.,__ �x-._.�.__....,..-.._:.
._. ..._...-_.... .... ......... ._..._._.__APPLICATION
SUB DATE... .-......_.. ....._ _
CHEUNG'.GREGORY=Y-KING AND 'SO
H .176'4''" -NATIONAL AVE"
02/28/2002
PHONE: -
SANITARY NO. CONTROL NO.
(510)293-9901
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ARCHITECT/ENGINEGR:
BUILDING PERMIT INTO
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BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
3`t.withSection7")ofDivision3oftheBueinnsandProfessionsCode.endmylicense
1 hereby vfrom Thal I am licensed under provisions of Chapter, 9l commencing
REPLACE 50 GALLON GAS WATER HEATER
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is in fall force unJ cRcn.
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License Cioss Lic. M
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ARCHITECT'S DECLARATION
1 understand my plans shall Se used as public records • '.
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e o o
Licensed Po4cssin od
OWNER -BUILDER DECLARATION
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.1 hereby d6on that I am exempt from the Committal's License taw fm the
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following reason. (Section 7131 5. Business and Professions Cade: Any city or county
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wnicn rcgoirca a permit m cncomel. chat. improve, demolish, or repair any structutn
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, pm t t e. al 9 d ppLs.ant farmeti Format fl g J t cement
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�3�1��1VJ.Y
Valuation
gran T sedP rs antt9thsprm nxoflhcContrvcmr L rtsefa (Chapter9
Sea 11 IDn of the B,u,me MPmf< oaCude)
mcco un<ing Ih c.7 aan,l
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or that he fa <nempt therefrom aM tha,b'isfor. cite mlegetl neapnon Any .iolm,on
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office , by any vpplicam for a Permit subjects the vpplicani mS civil pcnahy ,
aft;nfmaathan fivehundreddollars ($5oo).S024pN"ArL
;ENERGpccupancyType
PLUMBIN
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01 aso flit p peer > ploy with 8 th...'1 a scion
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"` "' '507 =" F INAL' P S�Q65Pecnons
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will do the wu k d the structure s not intended sar offered f I (Sec -704W
Biomass and Profess area Call The CmtitmZomTLicinFc Law dues not apply In an
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wner'thematic.propsay Who builds or improves then. and who does such work himself I
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y
'offered
n nployces. provide) ohucM1 improvements are not intended or'
or through his owum .c
for sale If h Ihe,u Id n8 p i Id - Ih o Ye f
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completion, the owncribuilder willh the den ofproving thth did notbuild o
p f t rpmse of sale )
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O I of property, exclusively vothattan, tit licamccl contractors t
p el (Sec ]m B and P (c Code:) Th Contractor'.
COnStMCt the project
License ow dines not apply man owner Lir 5 who num hoproves m
whocontracts for such p j ccs with a comiracmgs) licensead,purcusum to.do
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Cm' S1. ❑1reason,
derB&PCfor this
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pt
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WORKER'S COMPENSATION DECLARATION
I hereby Off,. under penahy of perjury. one of the following declarations:
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01 hive .ind 'will'ormhoin a Cehimcam of Consam to self -insure for Worker's
Compenimion, aa- provided lin by Section 3700 of the tabor Code, for the
'performance of the,work for which this permit is issued.
01 have arod'will titanium; W Ae Compensation 1 c req 'red by Section
3700 f Ih 'L Mir Code. for the perfuncrource of the k for which this Permit is
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issued My Workers Compensation Insurance cancer and Pnl cY be
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rte ,{' CERTIFICATION OFE%EMMON FROM,NORKERSj;
'I COMP8NSAl10N INSURANCE
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A,(T hs seclton need rot belcnmplueJ if the jarmit isfor onehiadred dollar,
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(3IW) nr less.) ', • , ..
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t on I c n fY Ihaiin Ih performaim f,hl o k f which N pcTisW..ad 1
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sham not emplay',ny p rson to y -m noel w m to bdtmle svb7m m the Wodm'
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Cto part in laws of California: Dare
Applicant._
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NOTICE TO APPLICAY I if. after making this CeniEcme of Exemption. you should,
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become subject to the Worker's Compensation provisions of the Wlwr Code, you must
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fonbwith'cmmply with such provisions ahis permit shall be deemed next ked,
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•.' ••"'""t"'CONSTkUCi'ION LENDING AGENCY -
1barony eRnn that there is a conamucdon lending agency for the performance
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'of the wolfs for which,his permit is issued (Sec 1097 Civ. C.7 -'
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-Lcndcis Namc'_.-n.-.. :., .. _ ...,t .. :.... r. _.:. ..:.-..J.
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Lcndem'6 Address ,,
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I ccnify than have mad this application tradition that the above infonnauan is -
cavi. 1 agree to comply with all city and county ordinances and state laws relating
m building conshomian, and hemby ambodn teprescinaJves of this city to enterupon'
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,the above-mentioned property for inspection purposes. ..
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(We)alime io save, indemnify acid keep hamdessthe Ciiyor C.Rmeoagainst
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liabilities, judgments, costs and expenms which may in any way accrue against said
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City in consequence of the granting of this permit..
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'APPLICANT UNDERSTANDSAND WI, COMPLY WITH' ALL NON -POINT'
Issued by: !
SOURCRREGULATIONS.
.Date
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Re -roofs
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- sig ,_ l'AppucaaUCnnowty,...,...' , Datc;v;.:':'
HAZARDOUS MATERIALS DISCLOSURE
' Will Nc applicant or future b6ildtngoc up-ttm or, handle bunhous material
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Type of .hoof-
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... •as ticfi ed by the Cupertino Municipal Cade Chapter 9 12, d the Health and Safety
Cole Seclo 255321u) 7 J ,..
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All roofs,shall,be.inspecteci pnor'to any material being installed.,.--...
W 11 the applicant or future building occupant use equipment odevices which
- -roofing " .
If a roof is installed without first obtaining an inspection, I agree to remove
Quality Manngeent
it com ta as defined by the Bay Amen A Q m
m t h r,ardo mman
eDist let? "„ - . r ,
all new materials for inspection. Applicant understands and will comply with
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all non-poirtsource regulations :. ..... ......:....r._ ,
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1 have and the haaallousmetoridls aciamom ccs under Chapter 6.950f the
- edifomiv Heahh&Safety CoJe.Seciiuns25505.25533 mr,25534. I undersandlhat„
'- ifthe building does not currently have a tenant, that it is my responsibility to notify the
ove.pam of the iequirentenls whlth must be met nmr to issuance Or a Cenifcoa of
- °"upancy' "
Signature of Applicant Date
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All roof coverings to be Class "B" or better
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madaed oma
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OFFICE