10010121 BUILDING PENT No:10010121
ITY OFTUPE,RTINO WATER HEATERS PERMIT
C CONTRACTOR:JUST
SCOTLAND DR INC DATE ISSUED:01122/2010
BUILDING ADDRESS: 1158 SCO
0 INVESTMENT BLVD 510 293-9901
340
PHONE NO:( )
Cn.IDEE CHRISTENSEN HAYWARD,CA 94545 ,
&R'S NAME PLUMB
• 89961969 p; BLDG� ELECT �...
OWNERS PHONE. 40 TION BUILDING PENT INF �....
ON.TRACTOR'S DECLARA RESIDENTIAL COMMERCIAL
LICENSED C MECH
Lic.#
e Class IpTIpN:REPLACE 40 GAL WATER HEATS
License Date JOB DESCR
Contractor provisions of Chapter 9
I hereby affirm that I am licensed under the
7000 of Division 3 of the Business&Professions
(commencing with Section'7000)
Code
and that my license is in full force and effect. o declarations:
der pe of perjury one of the following ifo W°rker's
I hereby affirm un p r Code,for the Valuation:$1212
will maintain a certificate of consent of the Labor Area:0
I have and Section 37 Sq.Ft Floor
Compensation,as provided for by
ich this pen-nit is issued. provided for by occupancy Type:
performance of the work for kers Compensation Insurance k for which this ber:36228008.00
I have and will maintain WO for the performance of the WOr APN Num
Section 3700 of the Labor Code, START
permit is issued. IF WORK IS NOT ST
APPLICANT CERTIFICATION IT EXPIRES ISSUANCE OR
lication and state that the above information te relating pDi RM Di RMIT .
I certify that I have read lis a all city and county ordinances an TgIN 180 DAYS OF P
com ly to enter CALLED INSPECTION•
correct.I agree to P authorize representatives of this city FROM LAST C
d hereby (We)agree to save
to building construction,and property for inspection purposes. ents,
ino against liabilities,judgment ,
180 DAY
upon the above menti armless the City of Cupertin consequence of the Date:
indemnify and keep accrue against said City cO
costs,and expenses which may all l the applicant understands d will Se p°n Issued by:
ly
c permit. Addition Y Cupertino municipal
granting of this p regulations per the
with all non-point source
9.18. Date RE-ROOFS:
;nature rior11,11,10" to any roofing
material being installed.If a roof is
11 roofs shall be inspected p inspection,I agree to remove all new materials or
A
DECLARATION installed without first obtaining an P
❑ OWNER-BUILDER D inspection. Date:
m the Contractor's License Law for one of ection.
affirm that I am exempt from Applicant.
I hereby compensation, Signature of App
the following two reasons: to ees with wages as their sole comp g „OR BETTER
or my employees Sec.7044,
I,as owner of the property, ALL ROOF COVERINGS TO BE CLASS �►
will do the Work,and the structure is not intended or offered for sale
exclusively contracting with licensed contractors to TERIALS DISCLOSURE
Business&Professions rty dam e
I,as owner of the p P HAZARDOUS MA ter 6.95 of the
project(Sec.7044,Business&Professions Code). rials requirements under Chapter 6,4. I will eainta
construct the P J three and 2
of perjury one of the following I have read the hazardous Code,Sections 25505,25533,
nder penalty P CaliforniaHealth&Safety nici al Code,Chapter 9.12 and 1h e Health&
I hereby affirm u Cupertino Mu P
declarations: r the compliance with the Cup should I store or handle hazardous
Certificate of Consent to self-insure for,for
the Section 25532(a) vices which emit hazardous air
I will
I have and will In a Safety Code, ui anent or de Management District
as rovided for by Section 3700 of the Labor Co Additionally,should I use eq P Qua
Manag ter 9.12 and the
Compensation, P permit is issued. the Bay Area Air Q �' Chap
this provided for by contaminants as defined by ertino Municipal Code,
performance of the Work for°keres Compensation Insurance,as P for which this maintain compliance with the Cup 25533,and 25534.
I have and will maintain W e1fonnance of the work Health&Safety Code,Sections 25505,
Section 3700 of the Labor Code,for the p is issued,I shall agent'
permit is issued. ermitDate*
._--------
I to the Worker's Owner or authorize
in the performance of the work fore Dane subject I certify thatmanner so as to b this certificate of exemption,I AGENCY not employ any Person in any after making I must
Compensation laws of California. If,aftrovisions of the Labor Code, CONSTRUCTION LENDING A E the performance of w
Compe Compensationp agency f
become subject to the Worker'oVprovisions or this permit shall be deemed revoked.
r hereby affirm that there is a construction tend
CndC) g y
forthwith comply with such p I h Y Sec.3
for which this permit is issued
Lender's Name
APPLICANT lE l a the above information is relating
that I have read this application and state
With all city ordinances and fhistc city to enter Lender's Address
I certify and county
correct.I agree to comply d hereby authorize representatives TION
construction,an ection purposes. e agree to save ARCHITECT'S DECLARA
to building for insp u oses.(W ) gr judgments,
upon the above mentioned p1OPem'. o f Cupertino against liabilitof the ublic records.
indemnify and keep harmless the City in consequence1 I understand my plans shall be used as p
expenses which may accrue against said City
costs,and exp the applicant understands and will comply
granting of this permit.Additionally,per the Cupertino Municipal Code,Section Licensed Professional
with all non-point source regulations
9.18. Date
Signature