02100168 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT %�CONTRACTOR4NFORMATION:
_ 4
Bulqup14k !9RHRZM PART AV JUST WATER HEATERS INC Pr:RMrr Np2100168
owSANDEEP PANDYA 1764 NATIONAL AVE APPLICATIp05�UH214TJ 2002
op]ON[:.: 51-OT-293 -9901 SANITARY NO. CONTROL NO.
ARCHIITCr/ENGINEER: BUILDING PHRMI r INFO
BLDG ELECT PLUMB MECH
C7
00 LICENSED CONTRACTOR'S DECLARATION
zF I hereby affirm that 1 am licensed under pmvisions of Chapter 9(non.mnamcin� non
Fiw with Seaton70plpK Division Sof the Bosinesa and ProfessionsCale.and my license is REPLACE WATER 'fe`t'e
nrnuloom and effecl. (40 GALLON)
0 i Cwcnae Class Lic.x
F h r w Date Comme,
ARCFfl UBCLARAItON ���
rc< I understand my plans shall be used as public rnmNs ���®
n3au
^LL0� Licensed Pmmxsional
OWNER-BUILDER DECLARATION NOV
am as I hereby afprm Nat 1 am exempt from the Comracmr's License Law far the ry p C q0 res
m apo following reason.scelion 7031.5,Business and Professions Gsk:Any city or county J C
n X S( which mquims a permit ,,cousno.O.alter.improve,demolish,nr repmr,any structure $6 lj
=_y prion its issuance,alxn requires the applicant for such Permit to file a signed smtemem
a that he is lice owdpursuant to the provtstomsAthe CoutmcOOrsucenseLaw Chapter 9 Sq. Ft. Floor Area �'L�f� lualion
mFo (commencing with Section 7000)of Division)of the Business and Professions Code)I 36926041 . 00
y $
that he is exempt therefrom and me basis far the alleged acmplinn.Any violation of
Section 7031.5 by any applicant for a permit suhjecu the applicant to a civil penalty of APN Number ane Occu Type
net mare than live hundred dollars ESWB' 502 - FINAL PLUMBING ENERGY Occupancy yP
0 I,as owner of the property,or my employees with wages or their sole compensation,
will do the work,and the strvctore is not intended or offered for sale(Sec.7 N.Business 506 '3A7% a�Jsapry
and Professions Code:The Cont aclar's License Law fires not apply m an owner of 507 - F I NAL g`�IIfCS CCIiOnS
property who builds or improves thereon,and who does such work himself or tbmugh his
own employees,provided that such improvements arc not intended or offered for sale.If,
rename.the building or improvement is sold within one year ofcompletion,mcowner-
builder will have the burden of proving Nat he did not Wild or improve for puslmse of
sale.).
0 I,as owner of the OtOpeny,am exclusively comm Ong with Income contractors to 4
construct me project(Sec.7144,Business and Professions Cwle:)TOO Contractor's Li.
mnse law does not apply ,,an caner of p open,who Wilds or improves 0whem,and.
who contracts far such projects with a armranm(s)licensed Pursuant o the Contractor's
License U-
0 l am exempt under Sec. ,B&P C for this mason
Owner Dat
WORKER'S COMPENSAI]ON DECLARATION
1 hereby affirm under Penalty of perjury one of the following declarations:
01 haveand will maintain aCsmf rd,of Cnnsenuosel4iawmforworkerm
'sCopen-
sation,as provided for by Section 3701 Of the Labor Code,for the performantt of the
work for which this permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,as required by Section
37110 of the Labor Code,for she performanm of me work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number art:
Carrier. Put icy Na:
CERTIFICATE 01'EK FLM PITON FROM WORKERS'
COMPENSATION INSURANCE
(@is a,mion need not he completed dive peanut is for one hundred dollars($100)
or lcsa)
I mnily Boom me perhomance Of the work for which this permit is Issued,I shill not
employ any Peron in any recons us as m become subject Ip the Workers'Compensation
laws of California,Dam
Applicant
NOTICETO APPLICANT:IL after making this Cenificxte of Exemption,you should
become subject to the Worker's Compensation prov sions of the Labor Code,you mon
OO forthwith comply with such previsions Or mus permitshall W deemed revuked.
z CONSTRUCTION LENDING AGENCY
P
I herebywhich this
chattherei iasued(Sec.30G.nding igencylobe performance of (�
the w fere which this permit is issued(Sec.OMP.Civ.C.)
Lfl Q Lender's Name
Z lender's Address
U 0 1 molly that I have read this application and sons,that the shove information is
E, F cnm el.L agree m comply with all city and county ordinances and state laws relating Io
0 U building construction,and hereby authorim MEOMsemmlves of this city to enter upon the
aMrvementioned property for iaspecoon purposes,
(We)agree m save,indemnify and keep harmless the City of Cupertino against
(~ h
liabilities,judgments,en.as and expenses which mayin any way acerae against said City
U Z in consequence of the granting of this permit.
r. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: �6iDate
SOURCE REGULATIONS.
Re-roofs
Signmurc of ApplioI IAZARDO Dam
IIALARDOU S MATERIALS DISCLOSURE Type Of Roof
Will fire applicant me
building occupantnomor and handle M1 Health
anmaterial
as dcfirmd by Be Cupertino Municipal GMC,GM1dPrer 9.12,and me ficalm and Safety
coae.sectom 25v2(arr All roofs shall be inspected prior to any roofing material being installed.
O Yes ON.
Will the applicant ser future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit haaardous air contaminants as defined by 1W Bay Arca Air Quality Management all new materials for inspection.
Disniol
❑Yes ON.
1 hve read Oc havardnus mamfialswquircmcnls under Chapter fi 95 of the Cantor
niaflcalth&SafetyCodc,Sm'uom 25415.25511and255H 1undcnonndthmifilr Wilding
dace not cuoendy haw a tenant.Nat it is my responsibility to notify the occupant of the
tcquirementswhich muslbe mel Prio In ismance^fa CenificaR ofOmuWnay. Signature of Applicant Date
owner or aumnroedagent Date All roof coverings to be Class "B" or better