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05020065 CITY OF CUPER'I'INOra s �roE�7F + 'ro BUILDING DIVISION PERMIT tCONTRACTOWINFURMATION euILDING ADDRESS: JUST WATER HEATERS INC PERMIT N(b 5020065 OWNER'S NAME: PERMR LSUE DATE l ONE: SANITARY NO. CONTROL NO. Sl0 293-9901 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Z., LICENSED CONTRACTOR'S DECLARATION O O O O to FC I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description IW wish Salon 70TA)o(Division3ofthe BusinevanO Fofcssians Coduard Mylimmcu infull mmewand Lk.• ercee` License ClaREPLACE WATER HEATER ,,=n Dam Gumucror (4 0 GAL GAS) ItHARCHITECTS DECLARATION re i 1 undersand my plans shall he used as public records JyU Lrcensc0 Professional 3 OWNER-BUILDER DECLARATION <F I hctoby alum Not I am exempt from Ne Contractor's License Law for the p o following mason.(Section 703 1.5,Business and Profcasimu Cade:Any city or county ym� which requires a Permit in construct,alter,improve,demobR or repair any swcbre Fieprior to its issuance,Also mquiM the applicant for such permit to file a signed statement that he is licensed pursuant to the previsions of the Contractor's License Law(Chapmr 9 Sq. Ft. Floor Area Valuati($16 5 0 (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i 3 that he Is exempt therefrom and the basis for she alleged exemption.My violation of hall Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number60cc not mom than five hundred dollars(SM). upancy Type 01.u owner ofthe propeny,or my employees with wages as their som compensation, 36932014 . 00 Y I, will do the work.and the structure is rwt intended or o0emd foraalc(Sim.7041,Business �p ac ver �Y and Pmfasoma Cade:The Contactor Liana law does not apply w an owner of Required Inspections. propeny whir builds or improvem thereon,and who does such work himself or through his 63 +5� nemployces,pmvided thatsuch imprommenuarcmnt iniondedoroReted forsam.If. y 'C however,the buildingor improvement issald within one Yearn(completion.the owner- Wilder will Bass ere burden of proving that he did not build or improve for Poppe of sale.), g 0 1,as Owner of the property am uelusively contracting wish licensed mntr¢mrs t0 q h construct the projem(Sec.7014,Business and Professions Cade)The Commctnea U ave Law dors no apply in an owner of property who Wilds or improves thereon,and. ®� who contacts for such pmjeeu who a contractor(s)licensed pursuant to the Cornerstones License taw. 0 lamexempunder Sec .Bk PCfothismanom Owar Data WORKER'S COMPENSATIONDEC RATION I hereby affirm under penalty of perjury ole,of the following declamtiov: 1 have and will maintain a Certificate of Covent to self-ivum for Wortem bor mes Comp 737W ums,as provided for by Smim.37M of de,LaCode.for the performance of she rk for which thin permit is issued. 1 have and will maintain Wurkces Compensation lnsuana,u rtquired by Section of the labor Code.far Ne pRormanec of the work for which this permit is issued. y Workers Compensation Insurance prier and Policy number are rrier. Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the Permit Is for one hundred dollars(SIM) or ICss.) I ccmfv Out in the performance of the work for which this permit is issued,1 shall not employ any person in any mannerso as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this O n Timm of Exemption,you should become subject to the worker's Compensation previsions of the labor CMC,you must ,Jz foMwith COMPLY with such provisions or this permit shall file deemed revoked. Z O CONSTRUCTION LENDING AGENCY ,e+� Ihctoby affirm that them is a construction lending agency for the perfurmance of C2 the work for which this Permit Is issued(Sme.3097,Civ.C.) W� L<ndces Name a z Lendces Address V O 1 cntify that I have Mail this application and sure that she above iialmo titin is cortex 1 agree to comply with all City and county onirames and sure laws totaling to 0U Wilding construction.and hereby authorim representatives ofthis city to enter upon We abovementioned pmrty for inspection purposes- CL urpoes- y pm, cry agree to save,indemnify and kap hornless that City of Cupertino against ' fin liabilities.judgments,costs and expertness which may in any way accmc against aid City U in consequence of she granting of this permit ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signature of APPlicaTDau HAZARDOUS US MATERIALS DISCLOSURE Type of Roof Will the applimm m M( uWilding Occupant stars o handle nMm aous arial u m.Sec the by Cupertino Municipal cipal Code.ChapterHe Om Hc Chapter 9.12.and Health and Safety Code, 1553](x)? Oyes ON. All roofs shall be inspected prior to any roofing material being installed. Oyes Will the applicant or future building occupant use equipment or dcvias which If a roof is installed without first obtaining an inspection,I agree to remove :colt hanodous air contaminants in defined by she Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes ONO I have mad the ha annus materials requirements under Chapmr 6.95 of the Califor riaHca"Safety Cod,Sections 25505,15533 and 25534.1 undcrsmnd that if the Wilding dos not currently have a tenant.that it u my oupavibility to notify the Occupant Of Ne mquirements which Must he met poor or issuance ora summer of Occupancy Signature of Applicant Date Owner or authorized agent Dere All roof coverings to be Class"B"or better aYO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 WC1TF Fax(408) 777-3333 UPEkTINO Building Department JOB ADDRESS: PERMIT # 10303 S. BlaneyAve. 0S- Z 0 d,!�s OWNER'S NAME: Chuang, Connie PHONE # 408-252-2414 GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360 lam not using any subcontractors: �� -ic�takOzAI—) 2/9/05 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 2/9/05 Owner/Contractor Signature Date 10/28/03 S-o z oohs _® City of Cupertino Building Permit Application E-Mail Jobsite Address: 10303 S. Blaney Ave. Date: 2-9-05 Owner's Name:---Sabina Haggard Phone No.(408)252-2414 APN#: 369-32-014 Project Valuation: S 650.00 Building Permit Info: Bldg----------- Elect----------- - Plumb------X----- Mech Job Description Replace 40 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: permits@justwaterheaters.net City, State and Zip: Hayward,CA. 94545 State Contractor's License# 591329 Exp. Date: 3/31/06 Worker's Comp#: 1626288-04 Carrier: State Compensation Insurance Fund Exp. Date: 4/l/05 Credit Card Information Credit Card #: 5474-6390-0026-5679285 o Name on Card: just Water Heaters Inc. Expiration Date: 9/05 Visa MasterCard X t� Comments �7