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03090226 . CYfY Of CUPEW11NO xi�, yt BUILDING DIVISION PERMIT CFONiTR'A�TORINFQRMATIQN 5 BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT"°.03090226 OWNER'S NAME: 1764 NATIONAL AVE PERMITISUE DATE (510) 293-9901 SANTTARYNO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELER PLUMB MICH oo LICENSED CONTRACTOR'S DECLARATION O O O O I u F I Wreby affirm bat 1 am limned under provisions of Chapter 9(commencing Job Description :c' withScaion7IXN))ofDivision3olNCBusincxeendPmfcssiunsCnJc,endmyliccnuis ��00 qq L enseClaanderre"' REPLACE WATER HEATER FI,YALEO �? License Class LM.p w Date- Contractor (5 0 GALLON GAS) ARCHITECTS DECLARATION FEB 1 8 2004 w U I utWcrsuused my plans shall utl as records cnrtls .cep 1- Licensed Professional ai,iI OWNER-BUILDER DECLARATION �y`/pV�BUILDING�� P 1 hereby affirm that 1 am exempt from Ne Contractor's License Law for the . 00 following reason.(Si 713 I.S.Business and Professions Code:Any city or county 2 m which requires a permit m Consumer,alter,impro.c,dcmnikh.or repair any structure =„ priorm its issuance,also requires the applicant forsuch permit to file a signed ammmcnt ago hot be is licensed pursuant lnLim previsions ofbcContmctor,uccmeLaw(Chapter 9 Sq. Ft. Floor Area Valuatio$850 2t-$ (commencing with Section 7")of Division 3 of the Business and Professions Code)or _ Nm he is exempt NceRom and the basis for the alleged exemption.Any violation of Section 703 1.5 by any applicant for a permit subjects the applicant to a civil penalty of 3®BIN�`rOfilge700 Occupancy not more than five hundred dollars(M). P Y Type El I,m owner of the propcoy,or my cmpluyccs with wages as Nair sale compensation. will do Ne work,and the slructurt is not intended or offered for sale(Sec.7041,Business and Professions Cade:The Contractor's License Law does nut apply to an owner of Required Inspections property who Out&ser imnrows tomon,and who does such work himself or brought his 502 — FINAL PLUMBING ENERGY own employees,provided that such improvements are not intended or offered for sale.If. 506 — GAS TEST however,the building or improvement is sold within one year of completion.the owner builder will bass be burden of proving that he did not Wild or improve for purpose of 507 - FINAL PLUMBING sale.). ❑1.as owrom of doe property,am exclusively contracting with licensed contrmmrs to construct he project(Sec.7064.Business and Professions Code:)The Contractor's U. toe Low docs not apply to an owner of property who builds or improves themun,and, who contracts for such projects wit a eonaractur(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sec. ,B&P C for this moon Own" Data WORKER'S COMPENSATION DECLARATION I hereby,alarm under penalty of perjury ane of the following declarations: . I have and will mainmm a Cenificam of consent N self-insum for workers Compcm sation,u pmvided for by Section 37M of be Labor Coda,for the performance of gar work for which this permit is issued. ❑1 ban and will maintain Workers Compensation Insurance.a national by Section 37W of be labor Cada for the performance of be work for which Nis permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Carrier. Policy N., _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not hecomplcmd if the permit is for one hundred dollars(51(10) or less.) 1 CCniry that In the performance of the work for which this permit Is broad,I Shall not employ any person in any manner so as to become subject to the WorkersCompensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,otter making this Cismas or of Exemption.you Should become subject tome Workers Coons or this provisions of Ne Labor Code,you moat �t`q✓�`-�/ z forthwith comply with such provisions or Nis permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY W` l I hereby affirm bar there is a cunstroction lending agency for be perfurmanec n! L' to work fur which his permit is issued SCC.3097,Civ,C) 33 0Londcr's Name L Lander's Address D ;J Q I ttoil,mat 1 hale read Nis applicmian end sort mat the above informaalun is y correct.1 agree to comply wit all city and county ordinances and Stam laws relating to V building construction,and hereby amhOTiM rcprascntarives of this City to Cater Upon the above-mcndnncd property for impaction whichpairings. may ti Oa (We)agree to save,indemnify and keep harmless be City of Cupeninn againat liabilZ incoitieajudgmcnuecosuang expenses;which bey in any way accrve againstsaid City ..3z in consequence of due Braining of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: - Date SOURCE REGULATIONS. Re-roofs Signatureof ApplmxH ZARDOUS MATERIALS DISCLOSURE Ciamingtor Date Type of Roof Will be applicant or future building occupant store or handle haruduus material U.;defined by Ne Cupertino Municipal Code.Chapter 9.12,and be Halt and Safety Calc,Scaion 25532(.)? Ig ❑Yes ONO All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or dcviccs which If a roof is installed without first obtaining an inspection, I agree to remove t barardous air Contaminants as denncd by the Bay Arca Alt Quality Management rict, all new materials for inspection. QYcx E)Nu 1 have mad the haaardous materials rcquimmrtuunder Cloy mr 6.95 of the Califon niaHwlth&SkelyCode,SM60M 255115,25533 and 25534.1 undcrsmnd that ddhe Wilding docs not currently haw a tenant bot it is my responsibility to nobly the occupant of me m4uiumenu which mug he met prior to issuance of a Condficge of Occupancy. Signature Of Applicant Date Owner or auNarirsJ agent D,m All roof coverings to be Class"B" or better n / City of Cupertino Building Permit Application E-Mail Jobsite Address: 7569 Barnhart PI. Date: 9-26-03 Owner's Name:---Hsu, Mike Phone No.(408)257-7937 APN#: 366-16-077 Project Valuation: S 850.00 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 • Contact Name: Dulce Fax: (510)293-2022 Address: 1764 National Ave. E-mail: permits@justwaterheaters.net City,State and Zip: Hayward, CA. 94545 State Contractor's license# 591 329 Exp. Date: 3131/04 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. z3 3 �� Expiration Date: 9/056- 6 Visa MasterCard Comments •