02030222 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS; PERMIT NO.
11148 SUTHERLAND AV JUST WATER HEATERS INC 02030222
OWNER'S NAME: APPLICATION SUB DATE
FONG JAMES AND MARIAN M 1764 NATIONAL AVE 03/29/2002
ONE: SANITARY NO. CONTROL NO.
�'. (510) 293-9901
OO ARCHITECT/ENGINEER: BUILDING PERMIT INFO
coF BLDG ELECT PLUMB MECH
y" " ' LICENSED CONTRACTOR'S DECLARATION Job Description
w 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
'MC with Section 7000).(Division 3 of the Businessand Professions Code,and my license REPLACE WATER HEATER.
in full force end Offal.
l&rc < Luxurse Clic. Liu g (4 0 GALLON, GAS)
I3 tU1Dam C.......
• Q ARCHITECT'S DECLARATION
1 understand my plans sholl he used as public records
t
Licensed Professional
'gg 1i OWNER-BUILDER DECLARATION ^'
w I hereby effirtn on 11. aurin from the Connector's Co License law for the
• following rias...(Semon]031.3.Business and improve.
d Professions Code:Any city or county
O which requires a permit to conn..,aper,improve,demolish,or repair any structure " `
a,_ prio tot merne,also requua dm eppliam(m such pemdno file.agtmd smumevt "Z••. _._.
thathe t)tt sed Increase,to the provisions of the Com.stews License law(Chapter 9 OOC e - b„ nation
(comment gwith Section 70(chof Division3ofth,Btatin"a red Professions Code) ( (' it �, ',I 1
or that he is exempt iheiefmm and the basis for the alleged elempuou,Any violation
of Section 7031.51, rmy appimantI.,.Permit subjects the applicantro.avil penairy
of not more than five hundred dollars($500). - U e "i"jt > Occupancy •JP e
°h as owner of thepmputy,or my employees with wages ss their sole compensation, _ /
will do the work,and the structure is not intended or offered for tele(Sec.7614, Hat,
Business and Professions Code:The Contractor's License Law does not apply to an 506 - GAS TE Slfe s e ns "
owner of pmpar y Who builds or improver thereon,and who does such work himself
or througghh his own employees,provided thio such improvements are not intended at 507 - FINAL PLUMB I
offeied7oi sale.If,tidwever,the building or impibvemem ii5old within otic Year of
completion,the comer-builder will have the burden of proving that he did not build or
improve for purpose of tele.).
111;as .. _ .._ .. ._ _. . _ ._ _. _ _
owner of the properly,am exclusively contracting with licensedcontractorsContract to '"'- ^-- '_. ... _. _ .... . ..._. .. _. .. ..
- _ Lhecontmet the project(Sec. to a ownBuser o prod Professions Code:)The improves
the,o n,
License law dos nal apply care man owner th progeny who builds s improva thereon,
:. .,end.who conwcts..farsuch.projects.with.cnntrector(q.littnud.punuam 1.the. _
_ Conwa.a Pt,.lettse Lew.
_ ❑1 em exemttdSec: El"Sk P C for this reason � - ;'.i:'. ` .,
Owner Dile
_ - -WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declensions:
I have'and will maintain a'Certificau,of Conant to cadrinsure for Worker's
Compensation, as Provided for by Section 37M of the Labor Cade, for On
perf rumancdaf the work for which this permit is iseued:
°1 have and will maintain Worker's Compensation Insurance,u required,by Section
3700 of the Labor Cade,to,.,
he perfoemvnce of the work for which this pariidit is
lamer,My Wormes Compansadon lnmrance carrier and Policy number arc:
ComerY i., f s s hl ,ijix No:• 1;is YY IF a is('v t.
CERTIFICATION,OF EXEMPTIONFROM;WORKERS' - �J:a' '�.'ii i ' fP _ 1'`t�4S. IIFN
COMPENSATIONINSURANCE' ,"""
Ind.section rail use Ise completed if the Permit is for one hundred dollen
($
100)tic
I certify that in eraineffornersta
ma of the work for which thissubject
permit ts issued;l r
shall not employ Any person in any manner so a to become aublect t the Workers'
Compenmiion Laws of CWfomu:Dale -
' .APPlaeni`-: is .. .. . _ ... .-_ .. _.
N(come subject70 APPLICANT.IC after Commaking this ovisio s ofof Exemption,you should .,
bechavibopy'Ne such provisions
Compensation Permiti shall
of CMO,you mita
O � fonhw th compty wilti such provisions or this Permit hell be decmed revoked.
IY' s i` CONSTRUCTION LMDING AGENCY "
I hereby whom that there ass issued es. IOM ng agenry far the perfomtentt .. '
of the work for which thispermit rs Issued(Sec,3097,%4.C)
Lendc' -Addreu '
V I camify that 1 have read this application and state that the above informatmn is
ga [r coiled I agree t lnplrwith ell city end comply ordinances and stem-laws mindng a
O C.) to budding construction,aria hereby authorize mprawnmtives oftWtiry to enter upon
y (� the move-mentioned property for inspection purposes..• %
C6 (Wep'egree m save,indemnify and keep heimlem the City of Cupertino against
W liabilities,judgment.casts aM expense which may in any way gimme against mid
City in of the granting of this Period.
. _ APPLI"NT UNDERSTAND$'AND WILL COMPLY WITH ALL NONfPO1NT'l' JsSLLedU
_ SOURCEREGUI.ATldNS.' '^" Y Date
Signamrc�f ApplicaoUContrenor' /" "• Date Re-roofs
` ' 'HAZARDOUS MATERIALS
ns deMM �, DiMoseor URE' I ad
NSII the a Corson.Muni beading e,Chaps stere or red the Health an S airy - Type Of Roof _
by the Cupemiw Municipal Code Chapter 9 I7 end the Health.red Safety " 'l 1 } I v-•,, ., s
Cade X.)Section 2553 k LY ��., I ,i s - •- =•
Oyin "' 4"o All.a roofs shall be inspected pnor_to any roofing.materlal being installed._ _.-. .
twill theapplicoribuilding o
f;&,am ccupant use equipment or devices which If a roof is installed without first obtaininginspection, Iagree to'remove
rnii hreardous air contaminants a deRnW by the Bay Amo AG Quality Management an P
! mno all new materials for inspection. Applicant understand_s and will comply with
1(f, °Yci ON. I I 1 all non-point source regulations..
1 uwae mad'the hvardou¢materiels ngmrements under Chapter 6.95 of the
Celifomia Health&Safety Code,Sections 35505,75533 end 25534.1 understand that
if e does tenant, o i responsibility
the
Occupant oftherrcquirrtmcnts which must be,me,prim 1.Issunnce ofa cWhIca'of'
-
'= ° ap.pry' Signature of Applicant Date
' G ow.erar amh.nud agar. Dae All roof coverings to be Class "B" or better
rip
r
„ , OFFICE