05090081 CITY OF CUPERTINO - '
BUILDING DIVISION PERMIT =-CONTRACTOR,}INFORMATION-.' 1
BUILDING A DDRESS. JUST WATER HEATERS INC PLRMITNO05090081
9n7n4 ArAT)TA C T
OWNER'S NAME: PERMIT ISSUE DATE
YIE-FONG DAN 3400 INVESTMENT BLVD 09/13/2005
JNE: -- - - - - SANITARY NO. CONTROL NO
(510) 293-9901
ARCHITECTYENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Lip LICENSED CONTRACTOR'S DECLARATION Job Descri t100T
F I herby affirm that I em licensed Bu undo povivons of CT , Y(m tic n ig p, E
i`s, with Section]0110 of Division 3ofthe Buvnue and Professions Code,andm license is a
^<a to full fora and effctt �..»ry n
;q= License Class '_ Lt.. REPLACE WATER HEATER
D•^ _ _ _ Contractor 50 GAL GAS
ARCHITECTS DECLARATION
2 I understand my plans shall be used AS public records
JyU
o
Licensed Professional
OWNER-BUILDER DECLARATION BUILD h
a0 1 hreaso affirm Nat 1 1. cxcmpt from Ne Ganhaaloos License Law far the '`&AVtlslgli ff
ip o whiiwin&reason NMI 1 711J 1.5,Business and oc,davo l coda:Any coy or mumy
s°m which oymms a lemn m cnnuwe,alms,t applicant for su demolish,m a a rig any ewcom
thathe tucensed c.auantto the lW ions o far such pomiuo Ric ,Lawlutcmcm
proo(commencing isliansithSCeant7")ofDivinrts3ofthentncmrinkcnselaw(ChapmrY Sq. Ft. FloorArea Valuatio$927
F"FC thathe 6 engwith Smvon70nd0Drvmonr ofaceged..and Prof ea iekCale)of
Net he u exempt tMrtfrom and Ne buts for the alleged cump0on Any violation of
Section]031.5 by airy applicant for a pesmil subjects the applicant to a civil penalty of APN Number Occupancy Type
A ream than Rw hundred dollars($500). 32656012 . 00
p y YP
I,uowner of die property,or my employees with wages u their role compenaton,
will do the work,and the atmeuo is not intended or offered for SAO(Sew 7044,Business
And Po ns fceva Car:The Canuacmr's License Law does Iml apply m an owner of Required Inspections
Naperry who builds or impraws thereon,and who does such work htmselfm though his
own employers,Provided that such improwments art naun¢nded moRered Image.if.
howewq ae building or improvement is sold within one Year of completion,the owner.
budder will have the burden of proving that he did rot build or improw for purpose of
sale]
IJ 1,as Owner of the property,am exclusively contracting with licensed convectors to
construct the pmject(Sec.7644,Business and Pmfwmans Cade.)The ConmcmYa Li
tense Law does not apply in in owner of property who Wilds or improvns thcmon,and
who contracts for such propcu with a contractor(a)licensed pursuant o the ContnnnYs
License Law.
❑lam exempt under Sew ,B&P C for this reason
Owner Dale
WORKER'S COMPENSATION DECLARATION
1 hereby aRftn under penally of pegury one or Ibe following declarttona'
I baw and will maintain a Ccruftam Of Consent m self-mince for Watkins COmpcn-
ation,ss provided for by Seaton 3700 of the labor Cade for the peffafmanm of the
work for which this permit noticed.
❑I have and will maintain Worker's Compensation Insurma,u mquned by section
37W of the Labor Code,for the performance of the work for which this permit is Issued
My Worlm's Compensation bmunnce comics and Policy number art:
Carter- Policy No
CERTIFICATE OF MEMPr10N FROM WORKERS'
COMPENSATION INSURANCE
(Thu recto.need not W completed dIW permit is fmone hundred dollars(SIM)
or lcaa)
1 CCrufy our to the Performance of the work for which this Permit is issued.I shall not
employ any person in any manner so AS CO become subjauo IM Workent Comlemalhon
Laws of California.Data
Applicant
NOTICE TO APPLICANT If,after making thin Ccnificate Of Exemption,you should
become subject m INC Wmkm'a COmPCnsamn PMISIOM of the tabor Coda,you must
Q forthwith comply with such pmvhvnns of thm Noun shall be deemed mwtked.
z CONSTRUCTION LENDING AGENCY
( CONSTRUCTION IWrebyaffirm that then iasued(See 309andmg agcnry for the Performance or /IOg/Il��` II
C' the work for wnmh this pennhl is issued($CC JOY],Ov.C.)
W Q Iatitle(s Nos^^
=z Lcndcr's Addm••
U Q I certify oat 1 have read this application and Cuts oat the above fnfohmuton is
U. P corocL 1 spa to comply with all city and county ooinances and au¢laws rtlaung a
0
Hy WJdingej and herbyaiprese
n City m the
aboe-menuoned propflY for inspection nuryoses
We)Agree to indemnify Ma ynee City O rrtMO g �labtltu( udgmnts.wsundee.whc main Any way acemeagainst Said Ciy
U Z in consequence of the gnnitng of this Permit
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by Date
SOURCE REGULATIONS. _
Signature of Appha Data
Re-roofs
Q
HAZA RDO US MATERIALS DISCLOSURE Type of Roof
Will tic a CuKm or future Municipal Co acupapt St..9.1 m handle h Health and Safety
l
u IC.Sac a 25 Cupertino Mumepal Codc.Chapter 9.13.and the Health and Safety
Code,Sachem Yes E)o All roofs shall be inspected prior to any roofing material being installed.
Ycs No
Will the applicant or future Wilding«a ant use a If a roof is installed without first obtaining an inspection,I agree to remove
Pp g p a Air Qua Ot dcmcas which g
w harardous air contammanu u dchnad by tm Bay Area Mr Quality Managcmcnl all new materials for inspection. '
JWnal�
❑Yes 0 N
1 have mad ac WvaWnusmverials mgmmmenn under Chaper695 of the CaltUr-
MaHealth&SafctyCak,Savons25505,25533 ani l undarrund lhutfNC budding
does not currently haw a tenant,that n is my reapomtmlity m notify IW O¢upant Of the
requirements which must be real Poor m usaame,of a certften,or Occupancy. Signature Of Applicant Date
Owner of authorr<dagent Date All roof coverings to be Class "B"or better '
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
: CITY OF Fax (408) 777-3333
CUPE(�TINO
Building Department.
JOB ADDRESS: PERMIT#
20704 Acadia Ct. b�3 y °Z:� k
OWNER'S NAME: Dan Yie Fong PHONE# 408-725-2962
GENERAL CONTRACTOR: Just Water FAX # 510-783-6360
Heaters 1
I am not using any subcontractors: � - o" I�� ^�-� 9/12/05
Signature Date
Please check applicable subcontractors and complete the following information:
® SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation J
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing Just Water Heaters 591329
Roofing
Septic Tank
Sheet Metal
Sheet Rock
® I
Tile
9/12/05
10/28/03
LOS�' � ° °
City of Cupertino Building Permit Application
E-Mail
jobsite Address: 20704 Acadia Ct. Date: 9-12-05
Owner's Name:---Dan Yie Fong
Phone No.(408)725-2962
APN#: 326-56-012 Project Valuation: $ 927.00
Building Permit Info: Bldg___ Elect___ Plumb-_—X-_- Mech____
Job Description
9
Replace 50 al as water heater.
p 9
Contractor Information
Company: just Water Heaters Inc. Phone: (510)293-2012
• Contact Name: Dulce Fax: (510)783-6360
Address: 3400 Investment Blvd. E-mail: permitdepttbsbcglobal.net
City,State and Zip: Hayward,CA. 94545
State Contractor's License# 591329 Exp. Date: 3/31/06
Worker's Comp#: 1626288-05 Carrier: State Compensation Insurance Fund Exp. Date: 4/1/06
Credit Card Information
Credit Card #: 5474-6390-0047-8660
Name on Card: Just Water Heaters Inc. #3
Expiration Date: 06/08
Visa ❑ MasterCard
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