03070099 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONT'RACTC1RtINFQRMATION
BUI LDING ADDRESS: JUST WATER HEATERS INC PERMIT No03070099
16,;)l rAQrrT.ETQN 2T
OWNER'S NAME: 1764 NATIONAL AVE PeaMrr LsuE DATE
i q/9nn-A
NE' (510) 293-9901
SANITARY N0. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDOO ELECTO PLO O
+�+oo
LICE
CONTRACTOR'S DECLARATION Job Description
I hereby affirm that 1 em licensed under previsions of Chapter 9(cnmmcndn{ p
wish Section 701111)of Division 3 of the Business and Prufessioa Code,and my licence is I
in full foss end effem. sat YN
Liccnu Class ua.g REPLACE WATER HEATER
Date-Ci mmba, (4 0 GALLON GAS 0
ARCHITECTS DECLARATION JUL
c)
Di l understand my piens shell Wood a public recnrtl, JU` 4 2009
D J
3 u,In Licensed Professional
Et' 3 OWNER'BUILDERrm tic RATION BUIL®
,y<E I herchy (fmm that 1 1. eampl from the Contractors License Law for the BUILDING
16 which ng..Co..(Sudor Ela LS, .altm, and Profession Code:Any City s county VI
$ which requires a permit fo cmotrucs,eluq impmw,deermit t m e a sig ed structure
r ty that heor slcensed Also pursuant
provisions forthe suchCon Permit mmnseLw(Chapter
Cha ter9
�<
thathewit pSecuam 7to the")ofprovisions visionf theeBusinssandPtasu C Could or Sq.FL Floor Area Valuatitk�g683 '
,S❑8
(commencing exemith Antlon70W)of load,for
the
the Bainooandan.Any
CMe)os
�3� Nat he it exempt Nertfram and the baso for Uc a11egW esemptlon.Any vinluion of
Section 7031.5 by any applicant fon report subjects the applicant to a civil Penalty of 3WlSftfti0 Occupancy Type
Am marc than rove hundred deltas,($500).
❑I,As owner of the property,in my employees with Wages u their role compensation,
will do she work,and OAWUCmm is not intended at offered for cala(Sm.7044,Business e UI
and Prof damn Cade:The Contractor's Liceve law does not apply to in owner of 502 - FINAL RequiMIed Inspections
B I NCS ENERGY
property who W ildt or improves thereon,eM who dceouch work himself or through his
Own employers,provided Oat such improvements arc not intended oroRerad formic.If, 506 — GAS TEST
however,the building or improvement is old within one year of completion,On owner.
Wilder will have she burden of proving that be did tort build or improw for purpose of 507 - FINAL PLUMBING
ale,).
1,as owner of the property,am"elusively contracting with licensed contractors to
contract the pmject(Sec.7061.Business and Professions Code:)M Contractor's Li.
scree law does not apply to an owner of property who Wild,or Improves Onmen,and
who contracts for such projects with a contntlon&)licensed pursuant o the Commctals _
License Law.
❑I am exempt under Sec. .B k P C fm this mason s
Owner Data
AIL WORKER'S COMPENSATION DECLARATION
1 hereby opium under penalty of perjury ane or she following declarations:
1 haw end wlll mainoln a Certificate of Consent to W INnsure for Worker's Camped.
,tio,As provided for by Smt hat 3700 of the tabor Code,for On fae fomume of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as"blood by Section
3700 of On labor Code,for the performance of she work for which this Pamir is issued
My Worker's Compensation Insurance artier and Policy number are:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thb senlon reed not beewnpleted If tbe permll la for one hundred dollen(510()
or kin.)
1 canify that in she performance or the work fm which this permit is Issued.I shall not
employ any person in any mandarin as to become subjul to the Workui COmpenmdon
Laws of Cabfohda.Dau
Applicant
NOTICE TO APPLICANT:If.after making this CcnlOcele of Exemption.you should
become object to the Worker's Comperdosm prevision,or that labor Code,you must
.J O forthwith comply with such previsions or this Permit shall be deemed revoked,
z y CONSTRUCTION LENDING AGENCY
(~� berchy which um Na then iseaonWc.3 lending geruy for the perfurmence of — O
the work for which this permit is issued(Sec.J097,Civ.C.) tom. _
Wti Q 4ndcrE Namc �/7 G
Z) z Under's Add.
U 0 1 Certify that I have read Nit application and sate that she show information is
IT. (✓ correct.I agree to comply with all city and county ordinances and some laws mbtingin
0 building construction.and hereby,florin rtpraenutiws Of this city to enter upon the
N a ahm
ovnerummed Property far inspection Purposes.
(We)agree to mw,indemnify and keep harmless the City of CuPerlinO against
r to liabilities,judgments,costs and eapenaes which may in any way accmc against midCity
t) in consequence or Ne gmning of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS,
Re-roofs
Signature of ApplicaMConin ctor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Wit]the applicant or future Wilding occupol store or handle haudaus mawdid
as defend by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code.Sc yd. ❑No
25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yat
Will the applicant or future building occuparl use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hu'nrdaus air contaminants a defined by the Bay Aro Air Quality Management all new materials for inspection.
idiriet?
❑Yes ON.
1 have to
Ne Wrardousmeurials um unionnu under Chapurd95 Oldie Califor.
ria Holthg:Safety Code,Seetiom 25505.25533ard 25531.1 undcaond thadf the Wilding
time not curmn0y haw a tenet,Nm it b my rtrpon,ihiliiy m notify the occupant of Oc
requirements which most
he met prior it)issuance of a Cenificare of Occupancy. Signature of Applicant Date
Owner car suthnrizcd apcm Dote
All roof coverings to be Class"B"or better
63 07c70
City of Cupertino Building Permit Application
E-Mail
jobslte Address: 21623 Castleton St. Date: 7-14-03
Owner's Name:---Hlgashluchl,Jon
Phone No.(408)255-9940
APN#: 356-18-062 Project Valuation: S 683.00
Building Permit Info: Bldg---_— Elect—__—_ Plumb__—X___ Mech_—__
Job Description
Replace 40 gallon gas water heater.
Contractor Information
Company: just Water Heaters Inc. Phone: (510)293-2012
• Contact Name: Dulce Fax: (510)293-2022
Address: 1 764 Natlonal Ave. E-mall: permits@justwaterheaters.net
City,State and Zip: Hayward,CA. 94545 _
State Contractor's License# 591329 Exp. Date: 3/31/04
Worker's Comp#: 1626288-03 Carrier: State Compensatlon Insurance Fund Exp. Date: 4/1/04
Credit Card Information
Credit Card #: 5474-6390-0026-5679
Name on Card: Just Water Heaters Inc. Z 'L�f 3
Expiration Date: 9/056
Visa MasterCard X
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