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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRAGT.OR INFORMATION '-,�
.
BUILDING ADDRESS:
JUST WATER HEATERS INC
PERMIT ND. 05080043
22345 CARTA BLANCA
OWNER'S NAME:
PER UT ISSUE DATE
GREG CUTLER
3400 INVESTMENT BLVD
08/OS/2005
NE:
SANITARY NO. CONTROL NO.
(510)293-9901
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
I! 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 heuby affirm Nat I am licensed under provisions of Chapter 9 (commencing
with Section 70X6 of Division 3 of the Business and Professions Code, and my license is
infnumrceandeffeel.
REPLACE WATER HEATER a I>� A
License Clan Ls. a
Dam Contractor
- 4
50 GAL GAS B�6Zxa
ARCHITECTS DECLARATION
1 understand my plans shall bo used as public raords
enn
, Q/� v05
Licensed Professional
OWNER -BUILDER DECLARATION
1 Wmhy .(firm on 1 L5 eBusin from Nc Cortins Co :Anyc Law fur the
d 'tins Code: Anyail
ctien 703 L5. Buai.r.si
inquires
prProfessionsYonructurr
pooch re utmts a emit rat ennswct, alcor. improve. demoam, nr my structure
which a F vet
poor fie
for such Contrarmiuuicense Law (Chapter
its tensed e.alsoreyuithe lnovisio
Lm
Sq. Ft. Floor Area
ORD' B L�bSKI B B Val'u`ati$ti320
so
Nal me cingwitpursuantaNcofDiviomofthe BuinesiLicenseLaw(Chapmr9
tat he
Scai9m 1") Division 3 of en. Coco) Or
Proon.
(coOat
alleged exemption. Any
Nat he u ucmpt Ncafmm and the bail for Nc allgcd cumpuon. Any violation of
ba 4 excompN the
APN Number
Occupancy Type
Sccdon 7031.5 by any applicant fon Permit subjects tie applicant to a civil penalty of
act mom Nan five hundred delta. (5500).
32613057.00
❑ I. u owner of the property, a my employe with wages u their sole compensation.
Required Inspections
will do the work. and the swage is not intended or offered for sale (Sec. 7014, Budrcss
and Pmfossions Code: TW Conuttues License Law dna .1 apply to In owner of
property who Wildsor improves Nefeon, and whodoes suchwork himself or thmugh his
own employe, provided that men improvements am not intended at offered forsale. If.
however, Ne building or improvemem is sold within one year of completion. the owner -
builder will Tuve the burden of proving that he did not Wild or improve for puryose of
sale.).
1, as owner of the property, am exclusively contracting with licensed comment; to
cons.... the project (Sec. 7044, Business and Profc omm, CWC:) The Contractors Li.
toe Law docs nes apply in an owner of property who Wilds or improves themon, and
who contracts for such projects with a eonuacmr(q licensed pursuant to IW Convector's
Llceve Law.
I am exempt under Sec. ,B&P C for Out reason
Owner Dam
WORKER'S COMPENSATION DECLARATION
I Wreby alR,m under penalty of perjury one of dee following mewations:
1 ham end will maintain a Cenifiam of Consent or self-insum for WodmrsCompen-
n.ion, as provided for by Section 3700 of the Labor Code, for the performance of true
work for which this permit is issued.
❑ 1 have and will maintain Workers Compensation Laurence, as myulmd by SCNon
3700 of Ne Labor Code, for the performance of the work for which this permit is issued.
My Workers Compeer tum Inu. carie, and Policy morter me
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section ncc0 not M compkmd If the F..it is fnranc hundred dollars (glo0)
or las)
1 certify that in the perfofmancc of the work for which this Permit is issued. I shall net
employ any parson in any manner an as to become subject m the Work.ra Cionfor thin
Laws of Caiimorm. Dau
Applicant
NOTICE TO APP LICANT:If, after making this Cerins iodyoushoos
TO A t of
to of ion, y
become u the Worker's Compensation or Labor
provisions Labor you most
fold vilb comply with such provisions or this emil shall W deemed mvoked.
j CONSTRUCTION LENDING AOENCY
Nat Nem is a constm.tinn lending agency far Ute perfotmana of
I Wmwhich
Oi
' thoLo work for which Nis permit is issued (sec, 109'!, Civ. C.)
lenders Name
,
Lender's Address
I certify Nal 1 have read this application and sum Nat the above information is
' corm. I agree to comply with all city and county onlimances and sum laws relating to
-
Wilding consuumion, and hereby aumorim mpresenutiws of this city u cner upon the
alwve-mentioned property for inspection purfnses.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities. judgment, casts and expenses which may in any way accrue against sod City
in consequence of the granting of this permit.
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Type of Roof
Signawrc of ApplicaDau
NAZA0.DO0005 MATERIALS DISCLOSURE
HAZARDOUS
Will IW apphcant W forum Wilding e. stom or handle
as defined by du Cupertino Municipal Code. Chapmr 9.12, mtl Nc Health antl Safety
Char Health Safety
Cale, Section 25532(a)?
All roofs shall be inspected prior to an roofs material beim Installed.
P P Y g
❑Yea ON.
$
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or &vie which
emit b. ardna air contaminants as dcfincd by de Bay Amo Air Gullibly Management
- District?
all new materials for inspection.
❑Yes ON.
I have read the havamous materials requirements under Chapter 6.95 of the Califor-
nuHealth h SafmyCom. Suctions 25505.35533 and 25534. 1 umlcravd thm if the Wilding
docs not currently have a mount that it is my responsibility in nodi fy the asupant of that
requirement. which mug or, met poplin issaaoceofaCcrgfiesmofeccupanep
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner orau.horivedagent Out
(,�D;
L,
�CITY OF
CUPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
22345 Carta Blanca St.
PERMIT #
o S'v s- "
OWNER'S NAME: Cutler, Greg
PHONE # 408-732-5618
GENERAL CONTRACTOR: Just Water Heaters
FAX # 510-783-6360
I am not using any subcontractors:
7/05/05
Signature Date
Please check applicable subcontractors and complete the following information:
7/05/05
Owner/Contractor Signature Date
10/28/03
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
7/05/05
Owner/Contractor Signature Date
10/28/03
•
LIJ
C
E -Mail
of Cupertino Building Permit
jobsite Address: 22345 Carta Blanca St.
Owner's Name: ---Cutler, Greg
Phone No.(408)732-5618
APN#: 326-13-057
Building Permit Info: Bldg --
Date: 7-05-05
Project Valuation: $
Job Description
Replace 50 gal gas water heater.
Contractor Information
lication
1320.00
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 #: 5474-6390-0047-86603 v6s�
Name on. Card: Just Water Heaters Inc. /
Expiration Date: 06/08
Visa MasterCard X
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