00100188 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUII1,1NG ADDRESS: PERMIT NO.
11. 150 SANTA TERESA DR JUST WATER HEATERS TIC o f ' 1
OW'NER'S NASI[: APPLICATION SUB DATE ,
SMITH WARREN F AND S10/27/2000
IONE: SANITARY NO. CONTROLNO.
QWZ ARCHI'rE ENGINEER: BUILDINGVERMH INFO
O O BLDG ELECT PLUMB MECH
I—I GI CI
�N= LICENSED CONfRAGrOR'S DECLARATION - Job Description
OZ y✓�u 1 hereby nffinn mall urn licensed under provis ion,of Chapter 9([t mmencing
I llh Sort con 70(X)luf Div nn3ot he Bu,inessr IV l'cxvumv Code and my license
t^ is in full force and elYem.s
a,",a,s 6 License Class Lis.M
5 LL N Dale Contractor
nlccunllcr's DECLARATION
40 GALLON GAS WATER HEATER.
g O I and cnead Illy plan,,dual he uvcd as public record.
�Y
w a M o Licenvcd Professional 0. OWNER-BUILDIR DI:CLARAl'ION
IYi1 I hereby affirm that 1 a exempt Baal the Cnmmctnr'p License Law for the
o.
rzw following maw (Section 703 L5 Business and Nov,sion,Code:Any it,.1 county _
whch co,rices a ermitt INI after, p demodish. p y_wcture
Prior to its 'I: 41 sthea I' ' tl ...I I 'u fie aligned la Ion, _
'hit lie is licensedpursuant t file provisions oftn Contractor%License 1 (Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Section AXIp)of D noon 3 of the Business and Profess opt Code)
or that he is exempt mernfront and the basis for the alleged exemption.Any violation
N Section 90315 by ary"I'liaatl fm it permit suhject%the Iy,Pfcam ha a civil penally
of col nom man Five hundred dollars($5()(y APN Number OCcupapyj pe
D 1.as owncr of me properly,or my ealployees with wage,as their sole compensation. .
will do IIIc work,and the structure is not imcndell or aficmd for sale See.7144.
Business;aid Profc..ion,Code:'The Comemar's License Law dtws not apply ht anwired Ins ections
r of prnpeny Who build,or improves thereon.and who does w6work himself X561 7024. l Jlq p
mthrough his own employee,providad that such inWmvenents me am intended or
nlremd aur Bale.If,nnwevur,the building nr ilnprovamum i,sold within one ycm of
iaeaplalnm.meowme,lanicke will nnvede burdenof prnv.ug Joe ho JiJ ooi hold in 50L — FINAL PLUMBING ENERGY
mprove lin panto e Wilde.).
DLL,ower ane
he Properly.toll cxelo
lsivcly cvacting will licensed commm
ract , 541E — GAS TEST
cans,...the Orojccl(sec.7044.Ravines,and Proc,A is Cade:)'no,C'nmruaair 4 507 — FINAL PLUMBING
License Law dues not apply to an owner of progeny who builds or improve,thereon.
and who ennlrm'P For such projects who a comerw ols)licensed pursuant to the
Canlmemr',Licenµe Luw.
D l.,it exempt under Sec. ,It&PC for this n.00
fawner Dale
WORKER COMPUNSATION DECLANA'rION
1 hereby rival under Penalty of perNn one of the liflowing declamlions:
JI have and will m;tlntaln u Cenilicwc of Cement In Nvit-more for Worker', Qiy
Ca b culaIion, as Provided for by Scotian 37011 of the labor Code, For Ilse
performance of the work for which this P,cul is issued. s
D 1 have and will anainlam Worker',CoopenwJoo Insurance.as required by Section
3700 of the Labor Crde,for the perforumere of the work for which uric Pcouil h
sued.My Waders Connpen ation Insurance carrier and Policy nunther am:
Currier: ;'Baily No.:
CCR I'H ICNI'R'N OJT EST:MPTION FROM WORKERS'
COMPENSATION INSURANCE
ITB I,section need nal be.... end if the Ixx ok is lar line handled dollars ,
(81(X)or Ius,J
1 unify that in the performance of the work for which this Permit i,issued.I
shall not fallibly any"I'm iu any Ioanner No a,m becmne subject to the Worker
Compen,them Law,or Cnliloraw.Dole
Applicant
NOTICE TO APPLICAND.If,after making this Certificate of Exemption.you.should
become n,.hjc,l to the Woder',C.....pematiun p okion,of the Labor Code,you nem
Q Q tonhwim comply walla such provision or this penret shall he del m rl revoked.
Fty CONS Ire.,a[ON LENDING AGENCY _
a ' hcleor slash Ihis Incur 1,a cmnm(See lending ttgcncy for the p:dirtnmove
of the work for which this Permit IN issued(-Sec.J(E)].Clv.C.)
O Lander',Name
5
.z LenJcr'n AAdress _ •
U Q I certify(hit I have rend ibis application and.state that the above Inlornetion is
k. E., court I.,me to comply with all city Ind county ordinances and state lax,relating
Q C.7 to building comwction,and hereby authorize repmwmative,of this city to enter upon
y the above anculluncd,,,.army t'or inspection PurPtscs '
t.. b
(We)agree t,,woe,indemonly;ud keep mnnde,s It,City of Cupem ao ugaiml
Z liabilities,judgments,en,l,and expemes which any in any way accrue agaimt avid
U 7 City in comqueno,of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Signature rrnpPlmanoean,raemr Dale Re-roofs
HAZARDOUS MATIiRLLLS DISCLOSURE
Will the apphriam or more Molding mcnpmu smrc lir htudle nwurdoe,mwenal Type of Roof
as defied by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
CWc,Section 25532mU
D Ye, 0N All roofs shall be inspected prior to any roofing material being installed.
Will the aPplicam or future building cicupam use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
it hmmdnm ser onntuminmty a,deined by the Bay Area Air Oualuy Management
mien all new materials for inspection. Applicant understands and will comply with
Dye, 0N all non-point source regulations.
1 nave mad the haeardoue materials m,fimmcel,under Chapter 6.95 or the
California IIea11h&Safety Code,Sections 255115,25513 and 25534 1 wWer,ored that
if the building does not currently little a Tenant.(hit it w auy rnspanoduhty it,nmily the
cupent of the m,morrenb which must IN,met prior Ir iswanee W a Cenificae of
0,v.,.ne, Signature of Applicant Date
Owner or truth orimd agent Date All roof coverings to be Class"D" or better
OFFICE