03050113 CITY OF CUPERTINO
BUILDING DIVISION PERMIT wC,UN'TRt1CTOR xx ,c,,, Amzor�
BUILDING ADDRESS: PERMIT NO.
I JUST WATER HEATERS INC 03050113
NA PERMIT ISSUE DATE
1764 NATIONAL AVE 05/23/2003
(510) 293-9901 SANITARY NO. CONTROL NO.
RCH=rENOINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
30j
LICENSED CONTRACTOR'S DECLARATION u JobDescrI tion I hereby affirm Nal I am licensed under provisions of Chapter 9(commencing hx
with Section 7070)of Division 3 of the Business and Professions Code.and my license AL M
n in full roan end affect.
2� License ClassLic.x REPLACE WATER HEATER'
Dam cECICLARATION
ARCHITECTS DE (50 GALLON GAS) MAY 3 0 2003
5 I understand my plan shall he used u public records
�oO Licensed Professional BUILDING
OWNER-BUILDER DECLARATION
9 I hereby Af@m that I am exempt From to ContracmYs License Law for the
i
OO following mason.(Section 7031.5.Business and Profession;Code:Any city or county
IRE which requires a permit to construct,Kim. demolit.Or¢pair any stratum
print In its issuance.arm requires dee applianl furrows Permit ro Blea signed statement Valuation
�< tommencansrd Section lolbcpmvkeimuofdin Central.iLlanmlaw(,Cock) Sq.Ft.Floor Area
E $ (come I.exempt
pt Section 7000).f and
basisun3 ft
Businenand on,AnPrOficayovi Cock)tar
dot w I.ex1.5 b timrefrom and the basis fit dee allegd exemption,Any violation or
Out 7down by Ary red dant for a permit subjects dts applicant m•civil pundly of ppN Number O cupancy Type
Trot mon tion Five hundred do1W(2500).
❑I,asowas of dm propeny,a my employcn with waguu that soleemnpenasdon, 366 7
will do the work.and the structure is not intended oroffered form*(SOC.7061,Business Required Inspections
uA Prnfessitem Code:Td Con owtues License law don e not apply to an mom,of q P
property whobuildsor Improves Neocene"who doessahworkhimself orthmugh his 502 - FINAL PLUMBING ENERGY
even empl.Y=,provldcd that such improwmemstm not intended arortered formic.If. 5O6 - GAS TEST
however,Ne building or improvement Is sold within one year of completion.the owner-
wilder will have the burden of proving mat he did not wild or Improve for purpose of 507 - FINAL PLUMBING
❑1,as Owner of the properly.am exclusively contracting wide licensed eonumnon to
consumer the project(Sec.7061.Business and Profusions Code:)The Contractor's Li.
counts law dors not apply m an owner of property who wilds or improves menton,and,
who contracts for such projects with a contracmr(m licensed rom uou in the Oonuaetoe's
License Law.
❑I am exempt under Sec. .B&P C for like rwon
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby afllrm Under penally of perjury one of tits following deelanthaux
I haw and will mainW n a Cenificats of Consent mself-inseam rte WOrker'sCmnPen-
lf ian,u provldeod fm by Secdon 3700 of tax Lawr Code.fm me performance of me
work for which this permit is issued.
❑T have and will maintain Worker's Compewtion Insurance,as required by Sector
3700 of One latter Code,for dee perfemtance of that wort for which this permit is luted.
My Workers Comp omemion lnsannc artier and Policy number are:
Carsier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE '
(Thus section need one becomplemd If the permit is form hundred dollen($101) '
or rose.)
I expiry that In the perfohmana of to work for which this permit Is issued,I shall not
employ any pesson In any munerso a in become subject to the Workers'Compensmoon
Laws orcalifomh.Data
Applicant
NOTICE TO APPLICANT:If,after making this CeniBcam of Exemption,YOU mould
become subject ro Ibc Worker's Compensation provisions of to Iabm Code,you mum
.,0 fonbwide comply wit such Provisions or tis permit shall w doemd revoked.
Z► CONSTRUCTION LENDING AGENCY
�-h I wrtby alTtrm lout diem is a conversation lending agency rte dm Icrformua of
E the work for whim this Permit B wad(Sec.3097.Co.C.I
W
0 Leder's Name it
z IadeYSAdw
U 1 cast dust I haw mad els application and some that dee aww infmmadon is
IL cornet.I agree ro Comply with all city and county ordiunas and seats law relating in
O wilding construction,and hereby monetize representatives of tis city m enter upon the
Liz aware-mendond property for inspection Pugro L
a (We)agree to taw,indemnify and kap M1omleu the City of Cupertino against
y liabilities,judgmenu,costs and expenses which may in any way areae Assiut said City
(,)7 In consequence of IM sterling of this permit.
r1• APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of AppllcanVCOData m US MATERIALS DISCLOSURE Type of Roof
WIII the a Cupertino
or(alum veal Co Oaupant nae2.and Health an matansl
as de0ned by the Cupertino Municipal Code.Chapter 9.12.and Ota Health and Safety
Code,Section 25532(x)7 All roofs shall be inspected prior to any roofing material being installed.
Oyu 1-1 No
ImIf a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices whicM1mil hamodous air contaminants u darned by Ne Bay Area Air Quality Management all new materials for inspection.
utlet?
❑Yu ❑No
W mI hawrte hasardoms materials requirements underchipa 6.95 ofNeCGlifor-
elkalN&SaferyCode.Sadao25505.25533 ad 25534.1 understand dol if dee wilding
oes ret currently haw ana 4'nL deal II ii my reapel.ibllllY m ahourly dis aPant of dC
quirements which mom be met prior m iissuance,of a Cerdfwae of Occupancy. Signature Of Applicant Date e
Owner a.teNesivsdx enl Date roof coverings to be Class"B"or better
el� 3
City of Cupertino Building Permit Application
E-Mail
Jobslte Address: 1391 Aster Ln. Date: 5- 23-03
Owner's Name:---Ludwig,John
Phone No.(408)257-4192
APN#: 366-17-102 Project Valuation: $ 930.00
Building Permit Info: Bldg---------- Elect----_-- Plumb------X----- Mech----------
Job Description
Replace 50 gallon gas water heater.
Contractor Information
Company: Just Water Heaters Inc. Phone: (510)293-2012
SContact Name: Dulce Fax: (510)293-2022
Address: 1 764 National Ave. E-mail: permits®Justwaterheaters.net
City,State and Zip: Hayward,CA. 94545
State Contractor's License# 591 329 Exp. Date: 3/31/04
Worker's Comp#: 1626288-03 Carrier: State Compensation Insurance Fund Exp. Date: 4/l/04
Credit Card Information
Credit Card #: 5474-6390-0026-5679
Name on Card: just Water Heaters Inc.
Expiration Date: 9/05
Visa MasterCard
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