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02120024 (2) CITY OFCUPERTINO BUILDING DIVISION PERMIT 4%0NTRAGTOR INFORMATION..'.. jju1QlY-9k"FsElRENDA CT WATER HEATERS ONLY PERMITN(02120024 GW4v'GNAWARRAL 970 E . MAIN ST, SUITE 200 APPLICATITH�'a1�vFNlgf 2 002 Alk IONS: (415) 566-2209 SANITARY NO. 77 CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 00 LICENSED CONTRACTOR'S DECLARATIONp �u I hereby affirm that l am licensed under provisions of Chapter 9(commencing REPLACE WATER 'A''R�0tion with Section 1fgM))of Division 3 air the Business and Profess ms Cndc,send my license is in fall enJd / Z, OZ- Dadnse Sly 'L- Contractor ?D'e4..�—� ARCIIITECTSDECLAR � y+� I understand my plans shall N used as public records ap�i1D LLot2 Licensed Professional j Oat I am exempt from DECLARATION O K 00 I maxo ,sect that I i, exempt from the Contractor's is License Law for Ibe $700 m.p O which re maven.(Section W13 s r Business and ova.de oar Cmlc:Any city air county n e.$ which requires a e,also re amnrthe alter,improve,h Permit t or repair any structustatement �Yl+ thior,he its iimancc,elimat1.requires theapplicantI for such Permit mfense Leal harterm qq,S,SO that mis ecing it puuuaouothe provisions of the Coutmnessan Prof Law(C Code) �j9h1.3dub2A109 Valuation (commencing herefromon $ad the Division rth al Business prion.Any vi Code?or 3 Nel he is exempt therefrom end Ne Maio for the alleged exemption.Any violation of Section 7031.5 by any applicant fore Permit subjects the applicant to a civil penalty of b UXPT-rNJWRgFLecupaney Type not more Nan floc hundred delta.(S500). 506 - GAS TEST 1,u owner of Ne pmpeny,or my employees with w gm a emir mic eempeuation, will do the work,and the suuctum is not inrendW oroffert4 for sale(Sec.?044,Busimu and Professions Code:The Comncmr's Licerme law data not apply in m an onar of equ2re nspections propertywho indicator improves thereon,and who doessuch work himself or through his Own employees,provided that such impmvemenu art not intended or offered for sale.If, however.the building or improvement i&suld within one year of emoplathm.the owner- builder will have the burden of proving Nat he did not mild or improve for purpose of - sale.). 2 1,as Owner of the properly,am exclusively contracting with licensed contractors to convect the project(Sec.NW,Business and Professions Code:)The Contrxtor's Li- comm law does not apply to an owner of property who builds or improves Neremn,and who contracts for mors projects wiNecontracmr(s)licensed pa..anuo Nc Contractor's License Law. I em exempt under Sec. ,B&P C far this recon Owner Data Ifs`Bl / WORKER'S COMPENSATION DECLARATION Jb., I hereby mind under penalty of perjury one of the following declarations: I have and will maintain a Cenificen nfCmucat to self-insure for WnrkerY ComNn- sation.u provided for by Section 3700 of the labor Code,for the poromunce of the wort for which this permit is issued. j have and will maintain Workers Compensation Insumacc,as required by Section 100 of Ne labor Code,for the performance of Ne work for which this Permit is issued. My Worker's Com nuNon lnsunna artier and policy number are: brticr. ate- Polity No.: CE IFICATE OF EXEMPTION FROM O (�� COMPENSATION INSURANCE (This section need not WeemplmcJ if the Permit is foronc hundred dollars(SIM) Iasi.) 1 certify Nal in the performance of the work for which this permit is issued.I shall not employ any person in any manner us ae to become subject to the WorkersCompensation Laws of California.Dale Applicant NOTICE TO APPLICANT:IL after making this Cci iOcan of Exemption,you should become subject to the Worker's Compensation previsions of the Labor Code,you mut OO forthwith comply with such previsions or this permit shall N deemed mvoked. z CONSTRUCTION LENDING AGENCY [-i 4 Thereby affirm that there is a construction lending agency lot the perlbrmam:e of ('1s > the work for which this permit is issued(Sec.3091,Co,C.) W Q Lender's Name z I.ondcrs Address V Q 1 certify that I have read his application and soon that the mow,information is W F Cocci.I agree n comply with all city and county ordinances and&hire laws relating to �U building convection,and hereby anhoox representatives of this city to enter upon the W above mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless tM City of Cupertino against y liabilities judgments,costs and expenses which may in any way accrue against mid City V z in consequence of Ne Brartin,of this permit. If( r`^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL`NO -PAINT Issued by: Date SOURCE REGULATIONS, f � w/ // tV if^�� 5 AP Re-roofs Signature of Appfcant/cmitructor Dale HAZARDOUS M TERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant store or handle harardnus material as defined by the Cupertino Municipal Code.Chapter 9.12,and be Health and Safety Cole,Section 25532(&)? All roofs shall be inspected prior to any roofing material being installed. QYCa Dales Will the applicam or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hvardnus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? [I Yes DJW/ 1 have read the humorous materials requirements un&r Chafer 6.95 of the Califor- nia I Ica1N&Sa@Iy Cad,Sections 25515.25533 and 25534.1 understand thin ifthe building does not currently have a¢nand,that it is my rcaponsihility mandfy the Me of c reyvirem Ibemdprinr iaaancnnracenifeannrat cat Signature of Applicant Date Owner air aamnri, agcm Dale I All roof coverings to be Class "B"or better