01110033 (2) CUPERTINO
CITYBUILDING DIVISION' IT CONTRACTOR INFORMATION:
PERM
BUILDING ADDRESS: PERMIT NO.
10580 CASTINE AV JUST WATER HEATERS INC 77 yB 01110033
DAOL ASKOUNIS PAUL L AND FRANCESC 1764 NATIONAL AVE APPLICATION
p PHONE: (510) 293-9901 SANITARY NO. CONTROL NO.
R
C C z0 ARCHITECf/ENGI,NEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MF.CH
L7 LL=]
8 y 2 LICENSED CONTRACT'OR'S DECLARATION Job Description
ii,_p , Ihercbyaltinnthalamli«n¢dundcrprovisionsofChaptcr9(comtilencing REPLACE WATER HEATERP
,wish Scotian JfYdO)of Division J of be Business and Professions Q>de.and my license
in ran fnree and erre«. (5 0 GAL GAS)
6 '
is
Class tie.n
'O'n Date- Contractor
I C G ' ARCHITECTS DECLARATION
{, I understand my plans shall be used as public records
I
as,o O Licensed Professional '
t OWNER-BUILDER DECLARATION
1 hereby affirm tbar 1 am exempt from the Caroni I License Law for the
< following mason.(Section 7031.5,Business end Professions Code:Any city or county '
Y t--O .which requires a permit to conumst.niter,improve,demulish,or repair any structure -- _
u°67 3 m rPnor t.t inumance,alba"tilOwthe.,lamorl fo such pc 't m file a sigted statement _. _.. - _ _ _ _-----
Val
.--
- mat paa,l«mwprs ImlheProvvronanrmec tiatnreL<enulsw(eM1aptn9 �a i Sq:•Ft FloorArea.,I• I Valuation
aon g _msat, 170n0)of Di 3f theBuxtnexpp aad Prpfesann,coo f,.,�;� R_ _ 3 \.t :.✓t'..tF ) :(�.
or that he rs exempt memfrdm and the bass for me allage8 eiemytibn.Any violation o s' '
-of S«tion 703 LS by any applicant fm o permit sobjcrn me applicom to a civil pewiry-
mrnmmnrcmanEvenamrcaannarslsstw>.
APN Number 4L..>::Tcn Occupancy Type
❑I.aso oar of the PmponY•arOn,ma,Icyce,wilh wages a,lheh,Plecompenm0oa. 502 - FINAL PLUMBI G 'ENERGY
will"do"the work;and the structure is"not intended m offered for.]a(Seso'7D14,' 506 - GAS TESR,
'Busim,is and'Profession,Code:The Comian RacmCs License Law does not apply to equired InspectlOns°o' "-
owner of pmpeny Wnti builds or improves mcrenn,and who does such work himself 507 - FINAL PLUMBING .
or mynagh his own employees provided that such improvements are not intended or. _ _.__.---.. _ __ _ .__._ _.___
offend fo'r sole ICnawe.e�,the ba Iain --- ...:.. .. .-_.
- - i 6 or improvcmeni is sols with n one car of
omelet un rhe Donor bu Ider will have the burden of proving that ne did not build or •^C-
improve for Durµisc of sale.).
,asownerofthe pmpony,am exclusively ronuamiogwith licensed Contractor
oaaorsm "_--- --- - ---
- irl IJ„I ..
_ -= onswa the Pros«,(Sec.70Mf,Busiowner of and Frty who
ills or The improves
trc neon, f "e.°.`s ”" _
License Law does not apply to an owner of a cowry who halide s improves mcrenn,
,.aod,who.ivntisetse Lot.ch prolems.wim a contract«(s)licensed p
01 a.torn License Src „ o _ ...
-i71om pt nd Sec ' " " ,B dPCNorth
'src con ,i'': ti s:I',,,LO•'
Owner ' 1 Date
- WORKERS COMPENSATION DECLARATION
1 hereby affirm under pc ally of Perio"y,oric ofthe following declarations:
❑ I have and will'mainim.aCcnifica l'of Consent•ia self-insun,for Worker's
Compensation, us..provided-for by Section 3700 of the Labor Cade,-for the '
perfo nee of Ih k f h h,h's pe t ed
,01h d will t Wokc C ' pc t In a,ne"moodby,5'tion
3700 of the Labor Code,for the pefforommer,of the work for which this pe- n is
ismW MyW k s Cmwsemsafiom lmtcourncamierind Policy bar arc: .. _
Carver Irx §lt:il 14 1 :J PolicyNo ._. .__ _
li CERTIFICATION OF EXEMPTION FROM WORKERS "' j'jii ..c:K_ l. [• If,II.\:
..
..:,..._....._C,OMPENSATION INSURANCE-''"
^gy''''p% nneed m becomleied if the ----- ---
(Sl Wlor less) p Permit is for one hundred dollars 'r,
1clotfythat in the Pe ina of, work for which this ct ts'. d,'1 -'".`."'•^•'•'^'.•. •^-
Countempty anyPersonn Ymanna s t 'becb a subject theworkers' I - ,.Cti iIOP'h":^grin
PP of Clif rote Date _.' .
Comps sat on Is x '
A I t
NOTICE TO APPLICANT If, ftc,main,thit Cn'f am ofE pu n you should
been uby it th Wok tsC pc ton pro ' ns of lb<Lebo Code y66 must
zfonho th comply with such pros s ons or Ws perm t shall be de coed invoked.
.. Cq r6 is i i'f
CONSTRUCTION LENDING AGENCY
a ; "Thereby effran that me construct lendingagenry Forth perfo ante 1{ ,i ,U
W..a .fill. ork for hich this permit s 'cd(Sec 3097 Gs C) ""-
0. in ..Lender hlm ..... ..,.._.,y. .... ., .. p
.`I. Z Iknde Addle
Ufc
G I nfY in.,Jh selead mi sept t and tt that be above f Ynis
O U t t I gree s comply th all.city.and county m ante and stn laws rel ting
Wilding t s on a d h rthy i th rim ep tot of m city to enter poo
F ,he eW t on d o f inspection purposes.
him
i. � prPpe z x
Is,)agree t save hand a alis k«p hannl ss ale City of Cupenino ag'nettZI
z liabilities,itjudgments. me den wh ch y any way against;nst said
Usk Cityincosq nee ofine Nan,ng f tVHJ< t "
pPPL1CAYf UNDEkDNS. SA,JD NY:, C. ,IPL'(N'FTN AI,L hON:PoL\^Fit' _ _
SOURCE REGULATIONS - Issued by: Date -
uaN of Appl anUC t n r t t. + D t Re-rOOf$ - -. -
Sg
HAZgRDOUS MATERIALS DISCLOSURE
Writhe eppl'ant«futurt bund og oce pa t tort. handl haraN ,con al
--Type Of Roof.
CMdefined bYm C }1 I1 \ } m H Imo dSafety .: --'..-_:-.
penin.M contest Cade Ch pt 9 12 d � - ,
cmla ov[zss7z(e). t oN 4 < tiq� '("ff 5zx f t)i': rL"{P. i. ' y {'if`',,°,..�a :t,'.
._.All roofs shall.be inspected.prior,to,a ' roofing.matenal.being metalled._
�no' Wsitheapplmamo fuwrcbultlmg« pan��scequPmemnrdeviaawnich If a roof is ifistallediwithout first obtaining an inspection;I'agree:[o remove
t hvaN a r comm ria t d f M b m B A qct III Mane
nt
calir❑H`ealt&soR Codu.Secauons25505 r25533nnd255 s1 �Ra all new materials for inspection. Applicant understands and will comply with -
D ria
i rte ><f ONo ,, t iI _- _ - --
all non-point source regulations.
P the
if the boldg does nm counci vc1- jot mat ism - - mat _ -. -, -._. .. .._ .__
ytespons blly t, .ofy,the -- .. . . .. ._ .. ..
moon t f me q rcme t which must be met p r to c.sumle f a C nifc rte of C. "
.
,•,v - - _-. ".-._. .. _ Signature of Applicant _ _ . __- _--. Date
_
Owner?fa sionacdngent All roof coverings to be Class "Bii or better '
-OFFICE- -- - . .. .... _ .