01030007 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADURISS: - PERMIT NO,
19964 WHEATON DR JUST WATER HEATERS INC 01030007
OWNER'S It AI'1'LICAI'ION SUI]ONE Ii
THOMPSON .JONATHAN AND FELICIA 1764' NATIONAL AVE 03/01 /2001
Pl IONIC: SANITARY NO. CONTROL NO.
(510) 293-9901
0 AHCHITIiCf/ENGINIiEH:
BUILDING PICRMIT INFO
�u— BLDG ELECT PLUMB MIiCH
y J LICENMiD CON'1'RAC IOR'S DECLARATION
z l hereby aa and I lana hm-M tenor,poosI m of C11,11,9(ea,mt Im,ms Job Description
nim
Fa.,tw with Section 7000)x1 Division Sof the Bminessvnd Rnfcsial.Gale,and my license
pxsis mfull force and effect. REPLACE 50 GALLON GAS WATER HEATER
nseho...
s C 2 LiceCLic.N
aq5 O i O Dole Cnnlmctor
n+3 a'e ARC]111 HILT S DECLARATION
t= g 1 understand in,plans shall be used es public record,
5 ae
p O I,iecnce,l Prn(essinnul
c c that
I.,a 1carom,iH DECLARATION
IKu 1 hereby ufhmn on I Int exempt tram the Cnnvns Coo Limuse for the
t 2 Q
fellow re rcasam ritual In 703 1...Business andimprove,
ver eerie..Code:Any city m scuts
Eo which,egobesvpm,ou,camtmcl,after.impmae,dem olish,ata-i,anyercumum
a.3 ']. r t I' I pylic h 1 rise .'g d.t t nem
Ihatl licensed'unwind n the n vise un ofthe Business and
1 on pter9 Sy. Ft. Floor Area Valuation
Ittthat hi mg wnh Section rm,and
Division o thea❑asides mp ProRsny vi Gdd
or that he erupt Ihcmftnm and thr nasis for the alleged exemption.Any violation 1687
at See eI.tISby a nydurdduatforapamnit smjlcd Ibc vpplicam mIcivil prtndty
Of run mom oma,Bee 1ta„arm dallnr.(550m). APN Number Occupancy Type
01.re ow ser orthe property.or my employee,with wages as their snle compensation. 00
will do the work,and the structure is not intended or offered for sale(Sec.7D4,
Btu,irri Intl Profe,,;mn,Code:'I he C factor.Liernw Law dnex mal apply ,,im Required Inspections
sof Propury Who build,or Improves thereon,and who does such work himself -
caro,
his own employers.provided that such improvements am not intended of 502 — FINAL PLUMBING ENERGY
affected for pule.If,howevcq the building or impmvemcnt is sold within one year of
°,n,plwion,thr swam buildcr will have the be,dcn afproving to t he did as build m 506 — GAS TEST
,pro.0im, a,rafxtar.). 507 — FINAL PLUMBING
01.a%owner of the pri f exclusively contracting with licensed commuters to
instruct the project(Sec.16W.Ousinr,.and Profession,Cade:)The Contractor's
Lactim..1,w does not apply to;in ow net of property who her Ids or Itnpruva dutrum.
and who contracts fur such pn,jcics with a u ntructons)licensed pursuant to the
if ais License law.
01 ass 1 e.annpl under Src. .B k P C for this reason /
Owner Panic
W(1RK13R'S COMPENSATION DECIAHAB'IsIN
0 I hereby anion tinder penalty of prjmy one of the following declaration.: Q/
0 1 have send will n aiamia a Certificate of Content I, wlLlncarc for Wader's
Compensation, as provided for by Section 37110 of the 1aM,r Cada fin the
perfor ii if the work for which this pe,,air is issued
01 Noc and will Inflation W'orker's Compenmtion Insurance,as acquired by Section
3700 of the Labor Cade,for the Icrform nce of the work for which this permit is
sued.My Wnrkcis Compensation Insurance earner and Policy number arc:
Cartier', Lilley No.:
CER'DPICATION OF E%EMI"I'ION FROM WORKHRS'
COMPENSATION INSURANCE
frhls section nacd not he om lural If the ry'nnit is for one hundmd dollars
($100)nr I”)
1 certify that in the performance of the work for which this permit i.issued.I
,hall run said,airy ler,na in amy manner wI is ,,hecome.rtIhjfct in tar Wnrke,s'
Compcam;i lon Laws if Calif moria.Date
Applicant
NOTICF,'lo APPLICANT:If,atter making this Cenilleme of Exianmtion,you should
become subject mthe Workds Cnmlrenwtiomp wixiorw of the Labor Code.youmust
Q tinthwidI nnnply with wan faro......,,ser mi, ,air shall be daetncd revoked.
Z
f"
CONS them iCfIONLENDING AGENCY
' I Leahy anima that there is s eau d!(S
icn lending agency for the perfonnance
W of the work Gn which Ihix Iwrntit is nsmal(Scc.301 Civ.C.)
S Q Land ,brute
z lands,crl Address
V rO 1 crall y aha I have mad thi,uppfiraaon and¢am that the above affirmation is
E. �+. turfed.I,gree m,anoply with Ill city land canary anlinance,send xenc Iry relating
OU u,wilding construction.and hereby umhoHre epm,rntutives of ih6 city ,I enter upon
iy the shows...emfoaed property far inspection pimpi
rFi d (We)agree h,save.mdeamifYand keep harmless the Ciyof Cupertino figmiet
U) habdhies, unSmad......le:md rxpen.e,which may in any way latus againw,aid
U z City in con..........I the grunting of flu,perm,.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONd'01N' Issued by: Date
SOURCE REGULATIONS. y'
Signlummol Appliciva/Cmara,... Item Re-roofs
I HAZARDOUS MNIERIAI S DISCLOSURE
Will thcapplicant orfuture Wilding occupant state orhandle Naturalist,material Type of Roof
a,defined by the Cu,samo Municipal Code.Chapter 9.12,and the Health and Safety _
Cn]I,Section 25532001
O Yes 0N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
rail bwardous air ramramimnm..as all by the Buy Area Air Quality Management
Dixrierl all new materials for inspection. Applicant understands and will comply with
OYe, 0N all non-point source regulations.
1 h:eve read the harardnus materials requirencris under Chapter 6J5 of the
Callfn...a Health MS,ddy Coda Sections 2.1505,25533 and 25534.1 unll it that
if the building does nm cursntly have a mato,,that it i.c ry c,pnnodality m unlit,the -
rant of the requirement m
which must be et prim In issuance of a CrrtlfiCme of
nupccepanry.
Signature of Applicant Date
Ownmar authorized Igen, Dale All roof coverings to be Class "B" or better
OFFICE