02080109 (2) TINO
CI BUILDI G DIVISIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10360 PHAR LAP DR HOT WATER INC 02080109
OWNER'S NAME: APPLICATION SUB DATE
JAMES & ELAINE KLAPROTH 2531 GRACELAND AVE 08/20/2002
PHONE: SANITARY NO. CONTROL NO.
(650) 298-8494
❑-OZ ARCHITECI'/ENGINEER: T BUILDING PERMIT INFO
kL� F BLDG ELECT PLUMB MECH
a i
Z N= LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that 1 am Iicer,c under Ii-saiom of Chapter 9(commencing
Fy_a9 with section 7000)of Division 3 of the Business and Professions Care,and my license REPLACE WATER HEATER
assa x y 5 is in full force and` 33t. see.a 7�3G/�I n
K 6 Liccnu '�—
a4r Coal'vcn�Yy�
a+3 W I-ii ARCHITECT'S DECLARATION
C g g 1 understand my plans shall be usN u public records
in
�N
i o p Licensed Prefessional
OWNER.BUILDER DECLARATION
un'--•,, 1 hereby air.Nm
at 1 acomp from the Convenor's License law for Ne ,
C? following reason.(Section 703I.S.Business and Professions Code:Any city or county $500
Y S p
which 9 a permit to c n hast Iter improve,demolishrepair- y structure
ce 1—a3� pnwt u m.also req N applicant for such Permit to fl signed statement
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Nat he sl -icd pun no the pro funs of the Comercia! Lien La (Chap 9Valuation
(co c,gnh Section 7")of Division 3n fine BusinessandP .femcod) ;_{};'�;;,'+32�3E30��?r,�lF;{'yt.�';rr��•„
or Nm he'is exempt therefrom and the basis for the alleged eseminhir Any violation
of Section 7031.5 by any applicant for a posit subjects the applicant to a civil penalty
of not more than live handled dollars(SSW) 502AP_Ny1q&L, PLUMBIN ENERGY Occupancy Type
°l,as nwner ofihe propny,of my employees with wages as Nelr sole compensation, S06 GAS TEST Ti
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'will do the we&:and the svudur,Is not intended offered for sale(Sec.7W' S O7 — FINAL PIJtHEJIHI�HIQJIspe1S[iOns '
Busineva m and Professions Cade:The Contractor's License Law does not apply an
owner of property Who holds or improves thereon,and who does such work himself
or Nmugh has own employees.provided Nat such improvements sol ere not intended or
offered for sale.If.howeveq the Wilding t rs sola within oit< - r
g or impmvemen Sear o .
a
bmpleti the owner-Wilder will have the budcn of proving Nm he did nm Wild or
imfarprove for puryose of sale.). '
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.co L tr owner at theproPe property.am exclusively contracing wird--licensed contractors
onimeors to
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construct the project(Sec. os and Professions,Code:)The tm 's
LimmaL doet apply to an owner of property who htiIds or imp ves thereon.
and.whoc t f T Bach projects wird a onvastodN licensed pm to theAUG- 3 0 -2002-
CommitCc slaw
❑I ole csempi ®. _._,....,.........._..._..-_
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under Se< _T B&P C for chis reassess ' 'I' •
Dwher C t MPreassess
"WORKER'S COMPENSATION DECLARATION
I hereby hili,,under penally of Perjuryone of the following declarations:
=h ° I have and will maintain a Cen Tient of Consent to self-insure for Worker's
Compnmtion, as provided for by Section 3700 of the LagW, Cade, for the
prformance of the work for which this Permit is issued.
will maintain Worker's Compensation Inumna,as required by Section
37011 of the Labor Cade,for the performance of the work.for which his permit is
issued,MyW kers Co rip ton Insurance center and Policy number arc:
...f h.�Polily Na. ('�% g�p� r1
"CERTIFCATI�EKEMPI'ION FR DM WORKERS a r .)g5 . .'•1 II'xi t t.: . 6.i+•
" COMPENSATION INSURANCE"- '"�
mox'section need not b<completed if the Permit is for one hundred dollars
(S IM)of Iex,I ,
I certify that in then in anym:enn the work for which this ct to c issues,1 •t I. t. ,
shall not employ any Person in any manner m as m assume subject to3he Workers
aam
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PParaLaws a[Glifornlu.Dote
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NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should s "
become sdject to Ne W'orker's Compensation prnvisinns of the Lobar Gare,you must
Q (nnhwith comply with such provisions or this permit shall be Jeenmd revened. _
FLeiCONSTRUCTION LENDING AGENCY
ai 1 hemSy affirm that N constructionleading agency for the Performance
a.Q ofthe work for fish thisp, t ed(Sm:3W7.0 C) - _ __.. ... . ... .. ... ._........ .
LenJnsNm ..'_... .. ._ .. _ ._...._ ... . _.
Z Lander's Address
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1 my that ihave read this
ity f and state that binformationis
k. E„ torted I agree to comply with all city and counts,endurances and stale laws enter
upon
_ >; V the almingcomtmed ro,andhcmi nspeconeerepresentaivcs of thiscity to en¢rupon
the ubo(We)agree 1.propny Tor inspection p taintle
�.L (We)agree ro scosts road epee sk hi taintless in
way s Cupnin against
said t`
Ur-Z liabilities.judgments,costs aid expenses which may in any way accrue against said (ynrv,
U Z City in ANTUconsequenceR ihdgmntA D this Permit.
SOURCE REGULAIOTAND5'ANDWILLCOMPLYWITHALLNONPOINT Issuedb Date
- SOURCE REGULATIONS. ... � ys
Signature of Appiicam/Canvaaor ' Date Re-roofs
.HAZARDOUS MATERIALS DISCLOSURE
Willthepylic i ft building aceptin store at handl hazardous material Type Of ROOF '.. '.'. . .
as thermal by the Cupertino Municipal Cad Chapter St12,and the Health and Safety - . .-. J; ,.••„ 3..• 1 '; f I 'i
Coe Section 1553'_lal s - yA
°'"°a All.roofs shall be inspected prior.to any roofing.material.being.installed. _
HI applic i furore Fuld g pat equipment or s Mon If a roof is installed without first obtaining an inspection; I agree t6 r6move
cotcob rd rcontnano as defined by the Bay Area A Quality Management
D t t all new materials for inspection.
•Applicant understands and will comply•with all non-point source regulations. . ,
I have read the buardoui materials requirements under Chapter 6.95 of
California Health&Safety Cole,Sections 25505,25533 and 25534.1 understand that
if the building does not currently have a teem,that it is my responsibility to notify the
occupant of Ne requirements ch must be met prior to imuaiic of a Certificate of (���'VVVsss �iFV'✓✓
_. pocuponcy
cAll4-,/ fis ,!r :.�, - 1D ��_...- Signature o Applicant _. ..,., _ .. Date
weer ar aallone ,gen, Date All roof coverings to be Class"B" or better
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