00110003 CITY OF CUPERTINO - - - - -
BUILDING DIVISION PERMIT - CONTRACTOR INFORMATION:
RUILDINCIADDRESS. PERMIT NO.
11063 BEL AIRE CT JUST WATER 'HEATERS' IIC 00110003
OWNER'S NAME '
APPLICATION SUIT DATE
BALABINE IGOR 1764. NATIONAL AVE 11/01/200
'HONE. - SANITARY NO. C NTROI.NO.
qARCH]
, - 4.510) 293-9901.
Lu O O ARCHI fECT/ENGINF.h:R: - aU DING PERMIT INFO
BLDG RLE PLUMB MECH
y<y h L
C r OR'
Z 3 LICENSED CONTRAS DECLARATION
O Z 4N 1 hereby atOmt that 1 not licensed under provisirim ome
f Chapter (commencing Job Description
21F with Section 7100)of Dlvision Sof the Buslnesxnnd Profess in ns Code,and my license
in se 1r,S efree` REPLACE. 40 GALLON GAS - WATER HEATER"
z 6 IS in fall
Claus LIrM
3 a y Dam contractor
ARCIHTECI'S DECLARATION _
I anderemnd my plans shall be used as public trends
OO Lmenacd Profceninnnl -
„�i Oat lamBUILDER DECLARATION _
C 1 hereby.(Eon that I fan exempt from the Contractor's c Anse city
o for the
N < following reason.(Section 7o3L5,Business and Pmrdeno li h,or Any city or county
Y O winch requirespermit also
construct,alter, p I chirepairrye sum
�3m hath its
l J Inacquires
id"ro applicant, such r, is L (Chapter
oa p n, 1 d c t t ... L Ica 1c) S Ft. Floor Area -Valuation
rata s' antes, moan r e ,st 3 nn Basin...ondim.A.'m.eode) q' - $1043
nr sue he 7 exempt therefrom and the basis for the alleged csemant to Any violative
of Section 7NL5 by any npplicam for a pernnL subjects the applicant m u civil penalty
of not favor than five traded dollar,($500) APN Number Occupancy Type '
❑I,a,owneranneprnpsaysvrmrempmyae.w'In
wages astheir samaompemehis, 15616050. 00 .
will do the work,and the structure is not imendad or offered for sole(Seo.7044,
Bnsmecs all Profession,Code:The Contractor's Lian.re Law does ad apply to as _ Required Inspections '
owner al property Who builds(or improves thereon,and who doe,mutt Work oneself —
or yh his own employers,prnvidea ilia,such in,pmvcmeats ore act intended or 50.2' FINAL PLUNH T.NG ENERGY
offvred for sole.If,hnwevar,,he hoilding or impmven,en,i,sold within one year of
complelmatlmowaea-nwwerwdlnavrinennmenarprav'mgma,neaianatntoaar 506 — GAS 7-EST-
intpmrerarpamo.eafsde). 507 —: FINAL PLUMBING r
❑I,as owner aftua pntpeny,ant e"Imively cammning with licensed enmme....to
consumer,he moves(Sec.7044,Basin...and Pro@ss.on,Cale:)The Commmnr'.
hhcncr Law does no,apply to an owner of property who builds or improves thamon,
and who contntm,in,such projects wmh u amweror(,)licenced personal m,he
Contractor's License Law. - -
❑1 ore exempt under Sec. ,R&P C far this moon '
Owncr Dme
WORKER'S COMP17NSATION DECLARATION
Ihereby official ander penully of perjury one of the hollowing declarations:
I I have and will maintain a Cunineate of Consent to self-imure for Worker's
ompensntlnn, as provided for by Section 3700 of,he Lahor Code,Tor ,he +
performance of the work for which this penal,is issued.
Cl I have and will fn cousin Worker's Cnmpematinn Insurance,us required by Section • -
37(10 of the Labor Cade,far the performance of the work fnr which this permit 1,
sated,My Workers Compensation Insurance currier lmd Policy nundic,or.: `
Carrier: Policy Nn: -
CERTIFICATION OF EXEMPTION PROM WORKERS'
COMPENSATION INSURANCE
(This section need no,be camplemtl if the permit 1,for one hundred dollars
(5110)ar le,$) -
I renihy(nm in the performance arthe work till which this permit is Island,I
shell..or employ any pe¢nn in city manner se,vs to become object to,he Workers' -
Cuntpcurcha a Law,of Californiv.Dme
Applicant -
N(H ICE TO APPLICANT;IL nitenmaking this Cenipaw of Exemption,you should
become subject to Bre Worker's Compensation icons of the labor Code
Z prav i ,you mu., -
00 mrnwahcontplr whnsuch provi,n,as radio,prnnit,fit l be aeennw mavkw. -
h CONSTRUCTION LENDING AGENCY '
a 1 hereby of ori dot there is it coast...ann lending agency for the perfnmmnce
W of the work far which,his permit is issued(Sec.307,Cr,C.)
Q Loader',Name
z Lender's Address "
1 codify that l have read this application and Stam that tw eeseve information is o -
[r correct.1 ugrw to comply with all city and«nnty ordinances and smm Incas relating _
O 'J
to bttilding construction, city
authorize representatives(If this city at enter upon
'y WQ ,he above mentioned prnpeny,Par inspection purposes.
rA. We)agree In save,indemindy and keep hornnless the City of Cupertino against
Ln liabilities,jtd,rearp,crisis and esPemes which army in any way vague agnimt said
V nzi City in consequence of the granting of this permit. '
APPLICANT
UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
SOURCE ' Issued by: Dale
Signature of Applicam/Conhnc,or Date Re-roofs
'
HAZARDOUS MATERIALS DISCLOSURE. "
Will the applicant or natio building exetpam near or lamdle hamahms material Type of Roof -
oc dunned by tae C.,ammu Municipal Code,Chnpmr 9.12,and the Hedro and Safety
Code,Section 25532(n)°
11 Yes ❑No ' All roofs shall be inspected prior to any roofing material being installed.
Will Ihevppllcnmonan".1 ,fired coccaripbell,n,useeaAa,(mordeviceswhlch If a roof is installed without first obtaining an inspection, 1 agree to remove
cntlt ha2aNnus art comm o nems , defined by,hv Rny Area Alm Quality evices which
h
Of.ta,,,,Ya, ❑Na all new materials for inspection. Applicant understands and will comply with non-point source regulations.
-
I have read the haza does radiants requirements under Chapter 695 of,he
cwirnanm Hahn&Safety coact sw,mn.25505.25533 end 25534.wnaro.taad roar'
if the builtling docs net currently have a mnunh that h is toy responsibility to mousy the
events a,of the requirements which must he nett prior to issuance of a Certificate of
Occupancy. Signature ofAppiicant Date
ow�ermcardornkd ossa, Data All 'roof coverings to be Class.`B"or better '
OFFICE
w t
• City of Cupertino Building Permit Application
E-Mail 000 000 3
Jobsite Address: 11063 Bel Aire Ct.
Owner's Name:---Balabine Igor
Phone No.(408)252-9067
APN#: 356-16-050-------------- Project Valuation: $1043.25-------
' Building Permit Info: Bldg----------- Elect----------- Plumb......C..... Mech--_-----_
Job Description .
Replace 40 gallon gas water heater.
Contractor Information
Company: Just Water Heaters Inc. Phone: (510)293-2012
• Contact Name: 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: 3/31/02
Worker's Comp#: 03KR0001018 Carrier: Clarendon Exp. Date: 4/1/01
Credit Card Information
Credit Card #: 5474-6331 -7168-6326
Name on Card: Just Water Heaters Inc.
Expiration Date: 9/02
Visa ❑ MasterCard
Comments
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