05050132 CITY OF CUPERTINO 0. maki'n<»s
BUILDING DIVISION PERMIT i:CONTRACTOR�INFURMATIQN
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BUILDING ADDRESS: JUST WATER HEATERS INC PERMfr"005050132
A71 R7TT,Tm
OWNER'S NAME: PERMIT ISSUE DATE
AML
ONE: SANITARY N0. CONTROL N0,
(510) 293-9901
ARCHITECPENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
_oo LICENSED CONIRACTOR'S DECLARATION OO O O
mC I hereby affirm the I am limood under provisions of Chapter 9(commencing Job Desert �
iW with Section 7")of Division 3 ofdu Business and Profnde
essioCo ,and my license is
^ NALED
may in full force and effect.
sy? LicenseClas Lle.a REPLACE WATER HEATER
12, 'J`i Dam Contractor (5 0 GAL GAS) 7 l8- 7005
ARCHITECTS DECLARATION
�i ee—I 1 undersunu my pbms shell be used ispublic reminds
GyU
o t, Licensed Professional �� p�p ;9r®
3 OWNER-BUILDER DECLARATION rpfvl8l {I{]ti9 tlpst�q/II
c c I Withy.sIct NW
that I em cBusin from the Cssions Co License Law for tW
O O following moon.(Section 703 L5,Business and Professions Code:Any city or county
m f which requires a permit in eowruct,slur.improve.dcmoliR or repair any structure
to prior in its issuance,also mi ores the applicant for such permitto file a signed suumem
�0 that he is licensed pursuant be provision of die Conuactuh License Law(Chapter 9 Sq. Ft. Floor Area Valuat 060
¢�a (commencing with Section 7")of Division 3 of the Business and Profession Ceuc)or Y�
3 that he is exempt themfrom and B¢basis for the alleged exemption.Any violation of
Section 7031.5 by atry applicam for a permit subjects the applicanuo a civil penalty of APN Number Occupancy Type
not mom Nan five hundred dollars(SS(K). P y YP
❑I,as owner of the property,or my employees with wages as their sole compensation, 36927026 . 00
will do be work and one structure is not intended car named fouale(Sec.TBLI,Business
and Prafesslon Code:The Conuanors Lice=Law docs not apply to in owner of Required Inspections
property who builds or improves fireman.and whodees such work himself or through his
Own employtts,provided that such improvements are out intended or offered fertile.IL
however,the building or improvement is sold within one year of eomplction,the owner-
builder will tine the Wrden of proving Nal he did not Wild or improve for purpose or
salcJ.
Q I,as owner of the pmpcny,am exclusively contracting with licensed mntr ctom to
construct the project(Sec.70a,1,Business and Professions Code:)The Contractor's Li.
cents Law docs not apply in an owner of property who Wilds or improves themon,and
who contracts for such pmjecm with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑1 am exempt under Scc. .B&P C for Nis mason
Owner Dale
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
lip
I haw and will maintain a Ceniricate of Consent to self-insum for WorkersCompen-
sellon,as provided for by Section 3700 of the labor Code,for the performance of bm —
work for which this permit is issued.
❑1 have and will maintain Wortses Compensation Insurance,as required by&cion
37W of be Labor Code.for Ne performance of the work for which this permit is issued.
My Workers Compensation Insurer¢carter and Policy number am:
Carrier: Policy No.:
CERTIFICATE OF EX EMP TION FROM WORKERS'
COMPENSATION INSURANCE
(Thio section reed not he omplcuddur permit is for one hundred dollars(SIM)
nr leer.)
I certify that in the performance of Ne work or which Nis permit is ismed,1 shall not
employ any person in any manner¢as u become subject o the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Cenificam of Exemption,you should
became subject to the Workers Compensation provisions of Ne Labor Code.you most
.JO foMwith comply with such provision Or Nis permit shall W deemed Cwted
z.�. CONSTRUCTION LENDINCA ENCY
agony
[—� Iber which
that them iavnd(See3M7,Cending agency for the Performance of
Ci the work for which this permit u usucd(Sec.l09],Civ.C.)
DW
Q 4ndcrs Name
=2 Lender's Address
U p 1 certify that 1 have read this application and sum that the about information is
"P emmeL I agree to comply with all city and county ordinances and sum laws relating in
0U building consuumion.and hereby amhorin rcprtsenmives or this city in enter upon the
�tll .hove-mcmioned property for inspection purpose.
H 6 (We)agree to save,indemnify and keep harmless Ne City of Cupertino against .
pl liabilides,judgments,costs and expenses which may in any way same against said City
U in consequence or Ne gaming of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. 3
Re-roofs
Signature of ApvlicaH one
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Willy dr,Cuamor future buildingoccupantstoreorand the
Health and
as defined by the Cupertino Municipal COM.Chapter 9.13.and esu Health and Sa(ny
code. 6 Yes en1ss32(a)? ❑No All roofs shall be inspected prior to any roofing material being installed.
❑
70wncIf a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or forum building by ft B rex equipment of devices which g
itharardnus airconumimnu as defined by tW Bay Area Air Quality Management all new materials for inspection.
r
trin?❑Yea ❑Ne
1 havemad Ne hannums materialsreyuiremenu under Clupurri.95ofthe Califor
Hwbh&SafetyCode.section 35X)5.15533 and 25534.1 vnucrstand that done Wilding
cs not coren0y have a moan Nat it u my reaponihility to nmily dte acupa t of die
uirements which must W mel Our to Issuance nr a cerdneato of ampancy. Signature of Applicant Date
or authnrizm agent Date All roof coverings to be Class "B"or better
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 871 Betlin Ave. Date: 5-24-05
Owner's Name:---Watson, Blanch
Phone No.(408)253-9340
APN#: 369-27-026 Project valuation: S 2,060.00
Building Permit Info: Bldg_ Elect----------- Plumb------X----- 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/l/06
Credit Card Information
Credit Card #: 5474-6390-0026-5679 �S-
Name on Card: just Water Heaters Inc.
Expiration Date: 9/05
Visa MasterCard ® Q
Comments
AAA Community Development
10300 Torre Avenue
Cupertino CA 95014
CITY OF Telephone(408)777-3228
11CU PEkTINO Fax(408)777-3333
Building Department
JOB ADDRESS: PERMIT #
871 Betlin Ave. 0 1.3 2—.
OWNER'S NAME: Watson, Blanch PHONE # 408-253-9340
GENERAL CONTRACTOR: Just Water Heaters lFAX # 510-783-6360
I am not using any subcontractors lJX �-�- �° } � 5/24/05
Signature Date
Please check applicable subcontractors and complete the following information:
[, J SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
o 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
5/24/05
Owner/Contractor Signature Date
10/28/03