00070188 (2) CITY OFN
BUILDING
UIPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMITNO.
OWNER s.10605 JOHANSEN DRIVE JUST WATER HEATERS I LI'ID"II`1411�` iBB
VIIONE; SANI'IAIIYN
ALLAN YUEN 1764 NATIONAL AVE 7/31fNWO,
CW ce O ARClil'I'EC DENGINIiER: _ BUILDING PERMIT INFO
Eurr - 510 293—y901 NIDD BI.14cl PLUMB Mica
h:U
Job Description
LICENSED CON'nsed mud
, DECLARATION
oz0 1 nereny ullirm that 1 am IireovmJ under Pmvi.iuns of Chapmr 9(ronunenense P
L,yf—J with force
of Uivizion3ofthe BusinnsanJ l'ndessions C,de. fid my
license
Y p. is in full force and efL ) l
3 c I.iccnnc Clnv, � Ls, #_
�,`_]—✓1
)mc S DELL or
13�)a iTHCf'SDCCublicr'ION REPLACE 40 GALLON WATER HEATER
m� I unJemmaJ my tans shall M used a.Public m<oN_L
zed
o O Luino ed Prof...ional '
S Ci z OWNER BUILDER DECLARNI ION s -
LL v. 1 hereby affirm that 1 am exempt from the Contractor's License Low for the
C Z< billowing rcmon.(Section 7031 Business and Profession.Code:Any city or countyor, -
F C which requires a permit or cunNrnut,alien Improve dumnlish,to repair any structure
iib "i..r at its i%.mace.alnu¢9uin the appli cant l issucb pe nnit ,,file aligned vmconvol
that he is licensed panuam to the provisions or the Contmem(v License Lass(Chapter 9 Sy. Ft. Floor Area Valuation
(commencing with Seetion 700)or Division 3 of the Busincss and professions Chi
,it mat he is exemint o,ererrmn and the I,oix further allcgcd exemption Any violation
of Sectio,7031,5 by any applicant for a"unit'chr'Wav,he nppllc:uu a,a civn Inroh'
of not more than five hundred dollars(s500). APN Number, occupal� e
❑1,as owner of the pmp,rr,or any employees with wase,as their sole mmpenamion.
will do the work,and the srmcmre is not Intended or offered fm sole(Sec.7144.
Business and Pmfcs.ions Codv:The Gmwmnr'v License Law down int vpply u,an gg cored Inspections
owner of pny Who build,or impnwcs Thereon.and wbo dre,such work himself 37537055. N
tit through
ro"his own enpler provided that such improvements an not intended or
olfcred foo vale.It,however.the building or Impnnenent is acid withm one year of
noisome,r..menwnm.yaiirwillha.emenmdemm�nwlnsthatheaidmmbaildnr 502 — FINAL PLUMBING ENERGY
prove puvwror '
C1,as owner(if the property,am exclusively entnmnmg with licensed cmmmnen to 506 — GAS TEST
con....el the pmjce,(Sas 7144.Rus2e..amt Prefe,simtis C,dco'rhe Cn,mmnnn', 507 — F I NRL PLUMBING
Live nw Law don not apply u,an owner of pnspeuy who builds or improves theocrat.
and who contracts lin such projects with a conourchurs)licensed panw,nt to the
Comrannls License Law.
El I ata cxcrlpl under Sec. .Il&P C rnr this rcuwm
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby aflirn under penalty of perjury one of tba following inclinations:
k7 I have and will maintain a Cenificam of Cement to misinsum for Worker:
Com"n,ntion, as pnword for by Section 37011 of the Labor Code. for the _
"rrornnm,t,of,he work for which this'Iriot'u isucd. _
11111have and will maintain Worker's Compensation Insurance as required by Section
1 of the Labor Cade,for the chronwnce of the work for,which this permit is /
L" d 1 WurkcrppnrrConpem��:wnn lnsmanwe currier mid%Policy...nnbe,are:
Carrie �NT 11,:1CATF l'OEEaEM111'TI(), — ROOV
COhll'ENSAT[ON INSURANCE
(This stni)n need not her nnnpleued if the permit is for one hundred dollars _
(Slip)or los.) .
I ccui fv that in the perfin undrice of the work fin which this pttnrh i,Issued,I
.hall nm employ any person in any manner w as u,M1eco n.subject bitter Work,,,'
Compensation Laws of California.Ilan
App icam
NOI'ne subject
APDL e AN Work II,army making this provisions
n sof fi Icabor Cor,you should
Obeeomc.vunjcain the Worker's Compensation pmcisi msll the Lunar Calmsed. must
lonhwith coonply with such pmvisionwr, this"snit.shall be Deemed mvokeJ.
z
.�. CONSTRUCTION LENDING AGENCY
1 irklond,,for wuponhich amt Nam Ins issued(See
Icnding agency rnr,hc pcdom,ance _
the work for which this permit is issued(Sec.J(N)],Ci,C.)
Lcndefs Name
z
.z Lcnde's Address ,
V 0 1 crIify that I have read this application and on.Nm Nc an,,,,int...motion is
4. t.. warem.I agree to comply with all city and county ordirr and state laws relating
C) U R,(wilding construction,add herchyaaloni,c mptosantiiws of this city a,corer upon
�y Wthe ubuv enerfl( ed popery or inspection papaws,
pis (We)agree to save,inJenndy and keep harmless the City of Cupertino against.
(✓ (A liabilities,judgments,casts and expenses which may in any way aceue against said
V z City in con,equence of the granting of this"nm t. I•� �� OD
SOURICF.WUNDRSTANDS AND WILL COMPLY WRH ALL NON POINT Issued by: Dille
Signature crApplicam/Contracmr - Date Re-roofs
❑Yat cN LSDluse in URC
IIAIARDOUS MAIERIA
w'mn,t ehCoped nnnuronaulCode,eupamsmrc2,and le Heard,andS fetd Type of Roof -
as defined by the Cu"ninn Municipal Code,Chapter 9.12,and the Ilealoh and Safety
Cede,Section 3553PIe1T
All roofs shall be inspected prior to any rooting material being installed.
Will the aPWicmtt or hone building occupant use e4ahunentm Acv nes which 11'a roof is installed without first obtaining an inspection, 1 agree to remove
emit harartm,air comm inhard,as defined 1y the Bay Area Air Quality hfanescmcnt
fin^ I all new materials for-inspection. Applicant understands and will comply with
CYes 0 N all non-point source regulations.
1 haw Tend the hesardouv materials requirements under Chapter 6.95 of the
California Health A,Safety Code.Sections 35505.25533 and 25534.1 understand that
if the bui Icing does not co eraly have a barrio.ohm it is my rcapm ibility or notify the
ecopent of me rcyulrcnm i filch must be tact"tion In ivxummc r n Co Ittcum M'
Occupy ��jj..,, /1
a t — - 1__L�\�— Signature of Applicant Date
All roof coverings to be Class "B"or better
Date
OFFICE