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05080026 CITY OF CUPERTINO � BUILDING DIVISION PERMIT CONTRACT,ORhINFORMATION "i -:� . . .,, BUILDING ADDRESS: JU . ST WATER HEATERS INC PERMITHo.05080026 22054 BAXLEY CT OWNER'S NAME: PERMIT ISSUE DATE ATILARA MERTOL 3400 INVESTMENT BLVD 08/03/2005 ONE: I SANITARY NO. CONTROL NO. (510) 293-9901 ARCHITECrIENGINEER: I BUILDING PERMIT INFO BLDG ELECTPLUMB MECH 10 C LICENSED CONTRACTOR'S DECLARATION = O O O til❑ 1 lenity afrom Nat I am licensed under provisions of Chapter 9(commencing Job Description' fiU with Section 70111)of Division 3 of to Business arW propulsions Code,and my license is �f- 1 O ® 4U! in full force and effect. REPLACE WATER HEATER B �Il tV }i License Class LK.Is 50 GAL GAS a F,q Dale Cormier., £ ARCHITECTS DECLARATION a< I understand my plans shall h used w public records d •J 200[ nose J s LL Licensed Professional f,1, cg o 3 Oat I am exempt B nn Oc CoATION IfLfL.,1ll\' �jj DIN tltf A<x 1 hereby Affirm Nal 1 em exempt(rum th Contrecmh License Law for IW LaJyS llpra9V/1J�e WI�t p o following reason.(Section 7031.5,Business and Professions Code:Any city ser county VVV m E� which Maim.a Permit to construct,eller,improve,dermumb.m Mimi,any swemre _Z< pnor hrits issuance.alsonquires the applicant fur such MrmitmflcasigncJ su¢ment £ thatheisliccnwdpumanLmthepmvisiouoftheContractorsLiccnselaw(Chapm,9 Sq. Ft. Floor Area Valuat 71100 yrs (cmmmencingwith Section7")MDivkion3ofthe Businessand Pmfessiom C< )or i 3 that he is exempt threfrom and the basis for the alleged eaemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of ffNNNpprr��ber Occupancy Type not mom than five hundred dollars(5500). 3 5 6 0 6 U L 9 . 00 0 1,as owner of the property,or my employees with wages As their sole compensation, will do the work and th aructuM is not intended ormRcmd forsale(Sec.7064,Business And Pmfusims Code:The Courommr's License Law docs not apply to an owtle,of Required Inspections property who Wildsmrimprona thereon.and whodoes suchworkhimself orthrough his awn employees,provided Nat such Improvements are not intended oroRerW(or sok.If, however.the building or improvement is sold within one year of compledon.the owner. , builder will have the burden of proving that h did not build or improve fm purpose of sale.). ❑1,as owner of the propeny,am exclusively contracting with licensed contractors to consumer the project(Sec.7014.Busirecs and Profusions Code:)The Contactors Li- cense law does not apply to an owner of property who Wilds or improve themon,and who contacts for such projects with a contracror(s)licensed pursuant to the Contractors License Law. O lam exempt under Sec. ,B&P C for this mason Owner Dat 7037WWORKER'S COMPENSATION DECLARATION 1 hereby Arpin under penalty of perjury One of the following declaration: 1 have and will maintain a Coruk.m of Cmnsenl to self-inti.for Worker's Compen- ' on,ss provided for by Section 3700 of the Labor Code,for Ne performance of the rk for which this permit is issued. I have and will maintain Worker's Cormaggadon Insurance,u required by section of Ne labor Code,for IW pcofarmance of the work for which this permit is issued. WmMe.Cmmpensation Insurance carfcr and Policy nmber are: rtier: Policy No.: CERTIFICATE OF EXEMMON FROM WORKERS' COMPENSATION INSURANCE [This xcdon oud not he completed lith fermi,is for one hundred dollars($100) or less.) 1 cenify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner sou An banns.mbjecuo the Worked Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Eacmption.you should become Subject in the Worker's COMIKMSA ton previsions of the Labor Code,you must 0 z forthwith comply with such provisions or this permit shall W dcsmed revoked. Z O 71CONSTRUCTION LENDING AGENCY F .. Ihenb affirm that Nene is a construction lending c o` Y a S ap my for Nc Performance ser V C work for which this permit is issued see,309'!,Civ.CJ Le m f31 z Linda's Na . �,z lender's Address —� U O I century the 1 have read this application and Suitt that the above information is it, f-' corm.I agrce to comply with all city and county on inances and sum laws relading to OLJ building construction,and hereby authorise mucamemives of this city to enter upon the Ualive-mentioned property for inspection purposes y (We)agree to save,indemnify and keep harmltas the City of Cup otim,agmina F[n liabilities,judgments.coo and expense which may in any way see=against said City U in consequence of the grants ng of this permit. ^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signature or ApplicaDale HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant mfuture building Occupant store or uodJcc, by the Cupertino handleh aalmammal fSedtiMunicipal Code.Chapter 9.11,an0Bih Health and Safety ' ❑Yo ON. All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hazardous air contaminants as dcfmcd by dm Bay Area Air Quality Management all new materials for inspection. arin9 ❑Tcs 0 N 1 ban mad the hamardous materials mquirements underChpmr6.95 Oldie Califor- nia Health&Safety Cade.Seeuons15505.25533 and 15534.1 umlmslaNd Ih ttif Irk Wilding dos not currently have a Mount,that it is my responsibility m omily the eccupanl of the reyaiMmcnts which mug h met prior to issuance of a cerdfitate or Occapamry. Signature of Applicant Date Owner orapthonaedagent Dart All roof coverings to be Class"B"or better Cv Community Development �� 10300 Torre Avenue V' Cupertino CA 95014 Telephone(408)777-3228 � CITY OF Fax(408)777-3333 UPEkTINO Building Depart me t JOB ADDRESS: PERMIT # 1 / 22054 BaxleyCt.. 0-(-D � [-l] OWNER'S NAME: Mertol, Atilara PHONE # 408-255-8380 GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360 I am not using any subcontractors: ) -d fo1 7/01/05 Signature Date Please check applicable subcontractors and complete the following information: 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 �L�Qce 4-i 7/01/05 Owner/Contractor Signature Date 10/28/03 City of Cupertino Building Permit Application E-Mail jobsite Address: 22054 Baxley Ct. Date: 7-01-05 Owner's Name:---Mertol,Atilara Phone No.(408)255-8380 APN#: 356-06-029 Project Valuation: $ 1100.00 Building Permit Info: Bldg_-------_ Elect----------- Plumb----—7t----- Mech Job Description Replace 50 gal gas water heater. Contractor Information Company: just Water Heaters Inc. Phone: (510)293-2012 Contact Name: Dulce Fax: (510)783-6360 Address: 3400 Investment Blvd. E-mail: permitdept@sbcglobal.net City, State and Zip: Hayward, CA. 94545 State Contractor's License# 591 329 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 q Name on Card: just Water Heaters Inc. / Expiration Date: 06/08 Visa MasterCard Comments