03070140 5 CITY OF CUPERTINO x rs ',"• m ",s E"' E ~s. r �si• . S'
BUILDING DIVISION PERMIT �CONTRAGTUR NFOR�MATIO
BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT NO 03070140
0066 BYRNE Aug
OWNER'S NAME: 1764 NATIONAL AVE PaRMrr Lsue DATE
NE:
(510) 293-9901 SANITARY N0. CONTROL N0,
ARCHITECT ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 0 0
400 LICENSED CONTRACTOR'S DECLARATION JobDescri tion
v 1 hereby affirm that I am horsed under provisions o(Chapur 9(commencing P
<� with Section 70f0)of Divixion 3 orde Business and Professions Code.and my license is
n in full force and offset. tl
Zg ? License Claxa Li,.11 REPLACE WATER HEATER , BUMAIra.EP
Dale Contractor (5 0 GALLON GAS)
�e ARCHITECTS DECLARATION
y Iunderstand myplans shall Wused aspublic recorda AUG 1 5 2003
I, Licensed Pmfcssi...I
O OWNER-BUILDER DECLARATION
iu 1 hereby affirm that I am exempt from lie Cn uractor'a License Law for the BUILDING
OO following reason.(Scction 7031.5,Business and Professions Code:Any city at county
§� which requires a permit to ennstmes,alter,impmw,demolish,or repair any slructum
FZy prior o its issuance,also requires the applicant for such Permitw filea signed statement
< that he isnsMpursuant In he provisions of theContnetA
ur'&Uccus, w(Chapter9 Sq. Ft. Floor Area Valuatio$973
e�� lice(commencing with Section 7030)of Division 3 or the Business and PfofessinmCMl)or
Net he is exempt therefrom and the basis for the allegM exemption.Any violation of .,,y
Section 7031.5 by any applicant for a Numitiubjeets Napplicant e applicano a civil penaltyof 39.Y1N8`1l4*er00 Occupancy Type
not more than five hundred della.
1,a owner of the property,or my employees with wages a their sole compensation,
will do the work,and the structure is not Intended or offered fonale(Sm.7W, Required Inspections
and em wh ono DMC:The venthemon,License Law doh not apply to rt owner of 502 - FINAL PLUMB I NU ENERGY
propertywhonsCooriThe Contractor's
and who doessuch wink throttler an
Ms
own employees,provided that such impmwments art not Intended oroRhed for sale.If. 506 — GAS TEST
however.she building or impmwmmt it into within ane year of completion.the owner.
Wilder will bete the burden of proving that he did not build or improv for purpose of 507 - FINAL PLUMBING
sale.).
1-1 I,a owner of the propeny,am exclusively contracting with licensed conlnetdns to
construct the project(Sec.7044.Business and Professions Code:)The Contractors Li.
come law does ret apply In an owner of property who bulltls or improver thereon.and
who comms for such projects with a cont.etor(s)licemed pursuant to the Contractor's
License law.
❑I am exempt under Sec. .B At P C fm this mann
Owner Dam
WORKER'S COMPENSATION DECORATION
. 1 hemby affirm under penally of perjury oro of the following dn
eclaratio .
I ban and will maimin a Cenificam of Consent to atMnsure for Wont's Compact.-tion,u Provided for by Section 3700 of the labor Code.for the Performance of the
work for which this permit is Issued.
❑1 ban and will maintain Worker's Compensation Insurance,an required by Section
3700 of the Labor Code.for the perfotmma of the work far which this Permit is issued.
My Worker's Compensation Insurance envier and Policy number am:
Carrie Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mossectim Dad not M completed if the Permit is for one hundred dollars($IR))
or len.)
1 cenify that in the performance of the work for which this Permit Is issued.I shell not
employ any person in any manner in as to become subject m the Wmker'Compensalum
Laws of Califomia.Dam
Applicant
NOTICE TO APPLICANT:If.Nor making this Cenifma t of Exemption,you should
become subject to the Workers Compensation provisions of the labor CMC,you must
Qforthwith comply with such Previsions or this Permit shall M deemed revoked.
Z-i M CONSTRUCTION LENDING AGENCY
[-+ I hereby offrm Nal there is mnswetinn lending agency far the Performance of
sari the work for which this permit is issued(Sm.3097,Cie.C.)
W� Q
Lenders Name ^
�z Lender's Addirmnrfy t
L)Q I cenify Nat I have read this application and sum that the be.infommuiun is
U.F correct.I agree to comply with all city and county ordinances and sum laws relating to
O V building construction,and hereby authorize mpresentatiws of this city to enter upon the
I2t almvomentiened property for inspection purposes.
(We)agree to saw,Indemnl ry and keep harmless the City or Cupertino against
fop liabilities,Judgments,costs and rostrum which may in any way amme against aid City
fJ7 in consequence of the granting of this permit.
.•77 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: do Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApploonUContnnor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will NI applicator or forum building occupant an..or handle hshrdous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code.scetiea 25532(a)7
❑lila 0 N All roofs shall be inspected prior to any roofing material being installed.
t Will the applicant or future building=.pact tie cquipmcnt.,devices which If a roof is installed without first obtaining an inspection,I agree to remove .
It hannous air contaminants as dermcd by the Bay Arca Air Quality Management all new materials for inspection.
ut"clT
❑Yea ❑No
I have mad the hmNrmt materials requirements under Chapter&95 of the Gliren
nes flalth&Safety CMc,Sectlum 25505,25533 and 75534.1 underwntl that ifthe building
doh Dol currently haw a coat.Nal It u my fapomibitity m ned(y the occupant of Nc
requirements which mon he met PH.,I,,ismace.r.cemre.ta or Occup-cy. Signature of Applicant Date
Owner or authomctl agcni Dam
All roof coverings to be Class"B"or better
0370
City of Cupertino .Building Permit Application
E-Mail
jobsite Address: 10066 Byrne Ave. Date: 7-17-03
Owner's Name:---David,Greenstein
Phone No.(408)255-2580
APN#: 357-16-144 Project Valuation: 5 973.00
Building Permit Info: Bldg___— Elect__-__- Plumb__-1----- 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: 3/31/04
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. Z 2 S`37
Expiration Date: 9/05 /p 6/
Visa MasterCard X 60
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