04090267CITY OF CUPERTINO
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BUILDING DIVISION PERMIT#CONTRA�,OR�NF'ORM4TwION
-
BUILDINGADDRESS:
JUST WATER HEATERS INC
PERMITN04090267
OWNER'S NAME:
PERMn'LSUEDATE
ONE:
SANITARY C OL NO.
ARCHITECT/ENGINEER:.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O
LICENSED CON'IRACfOR'S DECLARATION
Job Desc
1 hereby affirm that 1 am IianwA under provisions of Chapter 9 (commencing
HNALED
wit Section 70M) of Division 3 of the Bmimer end Prafessiom Code, and my license is
in full force and effect.
Liemse Class Lie.«
REPLACE WATER HEATER
pate Commeter
(10 0 GAL GAS) NOV 2 2004
ARCHECrS DECORATION ORATION
1 understand my plans shill he used as public records
Licensed Profbssionil
OWNER-BUILDER DECLARATION
B U I L® I
I hereby .(lino that 1 exempt from to Crnuacmo Uecnse law for the
]1131.5, Business and Proressons Celle: Any city at county
fallowing reason. 1.
s
which i ms a permit to mrtswct. alter, impmw, demolish, or rtptif any suuaunt
Permit t
its
priormitsissuaac, also mgoirts tbu applicant for such Permit m License Law (Chapter (come is licensed pursuant m MC
of the
Sq. Ft. Floor Area
Valua�01028
eBusinessnProlaw(Cheplor9
of Division3 of eceged Business Professions CMG) or
(commencing of Division
t Mit exwit mfm]and
that me u exempt therefrom and the mesa for to alleged exemption. Any violation of
'
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty or
-
APN Number
Occupancy Type
not mom tan fin hundred dollars (S50p,
P y YP
❑1,.owner Otte propcny, or my employas wit wegu .Ulovsalecompensstien.
32615119.00
will tlotcwons Cosec (Sec.]oan Business
Required Inspections
mtl Code: The ConhermYS Law aces not apply lf an owner err
oComersnotinwiensmoRcrtosnota
entywhioh
ndwho imulfor through his
cnywhrbuildsiid
Own moRered
Own employers, t doistch i paraw enume not intended
impmwmentsam not ear
however, Nebuilding or improvementissold within one ofo the Ow. r-
Wilding or i improvement
ildofcompletion,toowncr-
builder will have Ulo burden of proving that he did ram buii0 or improve for purpose of
❑ I,. owner of the property, am uclusively contracting with licensed conlrmmrt m
convect the project (Sec. 7044. Business and Professions Code:) The Convector's Li-
cense Law does not apply m an owner of prepeny who builds or improves thereon. and
who conflicts for such projects with a conusemgq licensed pursuant o the Contractor's
License Law.
0 I am exempt under See ,B &P C for Cis ruson
Owner Date
WORKERS COMPENSATION DECLARATION
1 hereby aRrm under peiW ty of perjury ode of the following declarations:
I have and will maintain a Ccrulte ,of Consent to self-insum for Worker's Compen-
.firm, as provided for by Section 37M of the labor Code, fm the perfo on. of su
wort for which this Permit is issued.
❑ 1 have and will maintain Worker's Compewtion hvmrsna, as required by Section
37W of to Labor Code, for the p rlmorm. of the work for which this permit is issued.
My Worker's Compensation Insurance artier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE.
1
Mix section need notbc comPlclod ifthe permit is fmonemundrMdollam(SIM)
'
or less.)
1 certify that in the Performance of the work for which this permit is issued, I shall no(
employ any person In my mmnef.. ut beeDme.biter to IIM WrrkeR Compensation
Laws of California. Dow
Applicant
NOTICE TO APPLICANB If. afor making this Certifies. of Exemption, you should
bucrme h Comp to to Worker h Pro Conformation s Or this previsions othe Labor CMe, you must
feMwitcomply with such provisions or tic permit shill Inc decreed rtwkcs.
-
CONSTRUCTION LENDING AGENCY
1 Mmby affirm Nat then is a construction lending agency for to Performance of
to work for which this permit is issued (Sec. 3]9], Civ. C.)
IcndcYs Name
Lenders Address
I certify that I have lead this application and sutc that ec shove mfrrmation is
correct. I agree t comply with all city and county oblinances and sure laws relating to
building convection, and hereby authorize representatives of this city to color upon the
show dmentioasproperty for impesiou purposes
(Wc) agree to saw. indemnify and keep bmm4ss the City of Cupertino against
xjudgmc which
oapenn which may in any way aceruc against.id City
m thocastand
incom of the granting permit.
Sthis
APPLICANT
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date '
SOURCE REGULATIONS.
Re -roofs
Signature of ApplicanUCon Palo
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will Nth a or fMuni Wilding fee or e
. de. Cuixtm Municipal ke, Chapter Health anmaterial
by to Cupertino Municipal Code, Chapter 9.13. and the Health and Safety
and t
Sea
CMG. 23332(x)?
Oyes ❑bur
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant Of future building =open[ use equipment or device which
If a roof is installed without first obtaining an inspection, I agree to remove
it W.1dous it conumimmut as der.ncd by the Bay Arc. Air Quality M ... gemcm
all new materials for inspection.
District?
❑Yes ON.
I have mad the hazard ormacriabrei.immcnu under Chapm6.95oftheCslirm-
nieHalt & Safc(yCode, Savo. 25505.25533 and 25534.1 understand thoifthe holding
does not currently haw a tenant, that H is my nomm ibilay b notify the occupant of the
mquimmenu which must be at prior to issmncc of. CeldOcste Of Occupancy,
Signature Of Applicant Date
All roof coverings to be Class "B" or better
Owner crmthmi.cl .Tare Do,.
A
9
p�C >?0z /
t_Ity yr t-upertino tsuiming vermit Application
E -Mail
Jobsite Address: 10256 Alpine Dr
Owner's Name: - -- Copley, William
Phone No.(408)725 -8420
APN #: 326 -15 -119
Building Permit Info: Bldg_______
Date: 9 -27 -04
Project Valuation: 5 2,028.00
ect--- - -_ - -- Plumb X_____
Job Description
Replace 100 gal gas water heater.
Contractor Information
Company: Just Water Heaters Inc. Phone: (510)293 -2012
Contact Name: Dulce Fax: (510)783 -6360
Address: 1764 National Ave. E -mail: permits @justwaterheaters.net
City, State and Zip: Hayward, CA. 94545
State Contractor's License # 591329 Exp. Date: 3/31/06
i
Worker's Comp #: 1626288 -04 Carrier: State Compensation Insurance Fund Exp. Date: 4/1/05
Credit Card Informatinn
Credit Card #: 5474 - 6390 - 0026 -5679 o /
Name on Card: Just Water Heaters Inc.
Expiration Date: 9/05 d Z
Visa MasterCard
Kz
Comments
ICITY aOF
CUPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777 -3228
Fax(408)777 -3333
Buildin g Department
JOB ADDRESS:
10256 Alpine Dr.
PERMIT # o q a z ��
°
OWNER'S NAME: Copley, William
PHONE # 408 - 725 -8420
GENERAL CONTRACTOR: Just Water Heaters
FAX # 510- 783 -6360
I am not using any subcontractors: 0-01'w- 9/27/04
Signature Date
Please check applicable subcontractors and complete the following information:
Owner/ Contractor Signature
9/27/04
Date
10/28/03
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
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
Tile
Owner/ Contractor Signature
9/27/04
Date
10/28/03