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04060199 CITY OF CUPERTINO •'•"` "'" '� yrr BUILDING DIVISION PERMIT CONTRAGTORANFORMATION ,r A_ .;gsnw D`ane.✓s.'z€ BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT N004060199 20597 rFnARRR0 ()K TER OWNER'S NAME: FERMIT SSUEDATE Alk DONNA LACROIX ONE: SANITARY NO. CONTROL NO. (510) 293-9901 ARCHITECTMISGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH 0 0 0 0 um� LICENSED CONTRACTOR'S DECLARATION °O Job Description C 1 ion 7 affirm Nm I em limed under provisions of Chapter 9(commencing p•� b wird Section 7M))of Division Sof Nc Business and Profession Cade,and my license is 1�I({ AU9 p12n roma Class mrcecr' REPLACE WATER HEATER ll �`vf [.. j�_ Do. Clan C.-I' '�f to Dam cmmDECL (4 0 GAL) ARCHITECTS DECLARATION JUL 21- 2004 -r I understand my plans dull W use)to public mcnrd3 to 0. ocl" Licensed Professional s'to OWNER-BUILDER DECLARATION ��BB M19NIJ//''�� '<q I hereby affirm that 1 am'ment"firm do, u. Conao/s License law for the G —°° following..on.(Section 9031.5,Business and Professions Code:Any city or County $ which requires a Permit to construct,alma improve,demolish,or repair any structure prior m its issuance,also require the applicant for such Permit a file a signed statement Nat he is licensed pursuanl lm the provisions of the Conuacmrs Heins Law(Chapter 9 Sq.Ft. Floor Area Valuai CT700 S F° (coOat he is examwish horeSection rom and the Division r she On,m Business andxempt Proon.A sinus Code)tion or of i 5� that he u exempt thenlrom and IW buil for she alleged exemption.Any violation of Section 7031.5 by ary applicant fin a permit subjects the opium'to a civil penalty of APN Number Occupancy Type not mon Nan five hundred dollars(ML ❑1.az owner of the property,or my employees with wages az their sole eompeuadon. 32345023 . 00 will do she wank,and the structure is not intended or offend for sale(Sec.7014,Business and Profusions Code:The Comenceer's Litton law does not apply in an owner of Required Inspections property who builds or improves thereon,and who dos such work himself or through his own employees,provided that such improvements en nolimmoided oroflemd Tarsale.If. however,Ne building or improvement is sold within one year of eompledon,the owner- builder will have the human of proving that W did not Wild or improve for purpose of sale.). ❑1,as owner of the property,am eatlusivdy contracting witb licensed contrecmrs in Co.,..tW project(Sec.7041,Business and Profusions Cade:)The Conuacmts Li- cense Law does not apply to an owner of property who Wilda Or improves themon.and who contracts for such projects with a contrmmr(s)licensed pursuant to the COm.elOrs Lkerue law. ❑1 am Hemp,under Site B&P C for this mazon Owner Dam WORKER'S COMPENSATION DECLARATION 1 kmby Num under penalty of perjury one of the following discussion 1 have and will maintain a CeNficas,of Consent to self-insum for Wmixes Compere 1321,D) ,ion,ss provided for by Section 37W of the Labor Code,for the Performance of the rk for which this permit is issued. 1 have and will maintain Worker's Comperuauon Insurance,u required by Section 0fthe tabor Code,for the Performance of the work for which this permit is issued. y WerkeYs Compannion Insure..Carrier and Policy number am: rtier. Polity No.: ' CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE foto section need no,W completed if the permit Is formai hundred dollars($1 00) or le¢) I certify that in the performance of the work for which this permit u issued,I shall not employ any Nixon in any manor an az to Wcumc subject to Workers'Compensation Laws of California.Dau Applicant NOTICE TO APPLICANT.It,oBer making this Certificate of Exemption,you should become subject in the Worker's Compcnsuion provisions of the labor Crede.you must 2, forthwith Comply with such provision or this pcrmilshallWdmmeA revoked. z CONSTRUCTION LENDING AGENCY E' Ih orby affirm Nat them is a enstruction lending agency for the performance of rL dm work for which this permit is issued(Sec.3097.Cih,C.) D.1 Lender's Name z LCndetS Address U C) I Certify Nat 1 haw mad this application and sum that the show infammom is t" COMM 1 agree to comply with all city and county ordinances and state laws sluing to 0 building cons..ion,and hereby aothorive representatives of this city to enter Orion the r W ahow-mentioned projectile for inspection purposes. (We)agree,o save,indemnify and keep harmless the City of Cupcninm ignitor f'r4p liabi fides,judgments,costs and expenses which may in any way scene against mid City U,Z in coremosenec of the granting Of this Permit. ^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs HAZARDOUS Signewrc of ApplicaDam HAZARDOUS MATE RIALS DISCLOSURE Type of Roof Will the applicant,or Town Wilding mcupapt store or handle haiamous and 4". defined by the Cupertino Municipal COM,Chapter 9.12,and the Health and Sa(c,y Cook.Semen 2ssJ2(a)7 All roofs shall be inspected prior to an roofing material bei. Installed. � Dyes ON. P P Y g g Will the appfinnt Or future Wilding Occupant um egairiment or Ecicu whim If a roof is installed without first obtaining an inspection,I agree to remove il le..duus air Condominiums as defined by the Bay Arca Air Quality Management all new materials for inspection. District' ❑Yes 0 N 1 have most the hem duos materials nquinmcno under Chapter 6.95 ofOc Cilifor. is Health&SafctyCode.Section 25505.25533 and 25534.1 understand Nal ifthe Wilding does not currently have a tenant,Na,it is my mepoui hilky w molly the e.ttrom Of the requirements which mus be mel Prier to issuan.of a Cerdfin¢Ofacupanry. Signature of Applicant Date Owner or atrmoriped agent DateAll roof coverings to be Class "B"Or better c Community Development 10300'forre Avenue Cupertino CA 95014 'telephone(408) 777-3228 � CITY-OF Fax(408)777-3333 UPEkTINO Building Department JOB ADDRESS: PERMIT # / / / 20597 Cedarbrook Ter. 0- - , OWNER'S NAME: Lacroix, Donna PHONE # 408-569-3161 GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360 I am not using any subcontractors: O` - 6/16/04 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 Owner/Contractor Signature Date 10/28/03 t City of Cupertino Building Permit Application E-Mail Jobsite Address: 20597 Cedarbrook Ter. Date: 6-16-04 Owner's Name:---Lacroix, Donna Phone No.(408)569-3161 APN#: 323-45-023 Project Valuation: $ 1,700.00 Building Permit Info: Bldg----------- Elect----------- Plumb------X_____ Mech___________ Job Description Replace 40 gal 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@j u stwaterheaters.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: 4/1/04 Credit Card Information Credit Card #: 5474-6390-0026-5679 Name on Card: Just Water Heaters Inc. 2l7 Expiration Date: 9/05 Visa ❑ MasterCard bQ Comments