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06030150 CITY OF CUPERTINO ' Iwo BUILDING DIVISION PERMIT ��CONTRACI'�C1R,INTUI�IA`CIN. BUILDING ADDRESS: Quz,1 viPERMITNO. 10327 COLD HARBOR AV OWNER'S NAME: PERMIIISSUBDATE In BAKER CHARLES A AND CAROLINE L3400 INVESTMENT BLVD 03/27/2006 ROME: - (510) 293-9901 SANITARY NO. CONTROL NO. ARCHI'IECT/EJGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH +O i] LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that 1 am licensed under previsions of Chapter 9(commencing with Satimn]IXMB of DIN,Ion 3 of the BUYtxasnd Profesaio"Code,aM my Iicnase b i� InmRforoeandeBea. REPLACE 40 GALLON V11VA - HEATER ;i- DaenmGl", Cog LED se Q� Dam ARCHITECTS DECLARATION e a I understand my plans shall used Despubl crecoNs �+ Licensed Professionaloa 5 OWNER-BUILDER DECLARATION JUN 70 YYRR i I I hereby affirm that i am exempt from the Contractors License taw for the O 0 following reason.(Section 7031.5,Business and Pmfeasluna Code:Any city or county lin #%Elk $925 5$E which mquims a permit to construct,stmt,impraw,demolish.or repair any In"Wre i prior to its ismnce,also requires the applienl for such permit to III easignedsrammcm e that he is licensed pursuant mthe Pnl9lAlnn,ofthe Corm cure,License Law(Chapter 9 Sq.Ft. Floor Area Valuation (comm acing with Section 7000)of Division 3 of the Business and Professions Code)or .. that he o exempt Nvefmm and the bub for the alleged exemption.Any violation of Sectlor,7031.5 by any applicant for a permit,objects the applicant to a civil penalty of umber Occupancy Type net come Nn five hundred dollars($500). ❑I,as owner of the pmpeny,or my employees with well"as their sob compensation. will do the work end theswuurt I, or intended or offered for W.(so 7W.Busiws Required Inspections and Professm.Code:The Costumes Lt..law doss rat apply to n owner of - q p property who builds or i nmows Nemon,endwho doessuerh work himselforthrough his own employers.provided that such improvements art nolinuo de d nafferad for We If, however.the building or improvement Is mid within as you of completion,the owner• builder will haw the burden of proving that he did not build or improve fn purpose of um.). ❑1,Is Owner of the property,am exclusively contracting with licensed contractors an construct the project(Sec.70",Business and Prefestlau Code:)The COntemes U. «"e taw does nm apply m an owns of proper who builds or improves damn,and, who coraco for such pmjecm with a contcrar(s)licensed pursuant an the Comnctor's License law. ❑I am exempt under Ser. .B k P C for this reser Owner Dam WORKERS COMPENSATION DECLARATION I hereby affin under peWty,of perjury one of the fallowing dechat dmu: ❑1 haw and will maintain a Cenlfi"k of Consem to self-i"um fur Workeea Compcn. sedan,as provided for by Section 3700 of the labor Cade,for the performance of the wart for which this penis isIssued. ❑I have and will maintain Workers Compensation lunance,as mquimd by Section 3700 of the labor Cade,for the perfonanceaf the work for which this permit is Ismail. My Workers Compensation Insurance artier and policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (fhissatlnn ash nothecomplemd Hthe permit Is parent,hundred do0ara(SIM) or icer.) I certify that in the performance of the wart for which this Permit is issad.I shall not employ any person in any mnnerm as to became subject to the Workeri Compeuation laws of Califomia.Dam Applicant ,^I / NOTICE TO APPLICANT:If,after making this Cenificam of Exemption.you should V haeme .J subject m Wohee Compensation iaiau of the Labor Code,you most O forthwith comply with soh previsions or tis Permit shall he domed revoked. 6 'Z rcol., CONSTRUCTION LENDING AGENCY P I hereby aRrm that there its nstm eoction lending agency for the performance of a the wor k for which this penis 4 issued(Ser.J077,Civ.CJ a ` LsOulo's Name ] z Zanders Add. U Q 1 ceNfy that 1 haw mad this application aha sum Out the above information is i,, (~ conn.I agree to comply with all city and county ordinances and state laws misting to Q V building convection.and hereby amhoeire representatives of this city to cnmr upon the iT7 above-mentioned properly for inspection purposes. L��1 gy (We)agree to saw,indemnify and keep harmless the City of Cupertino against Q liabilities,judgments.costs and expenses which may In my way aces agal"t Lid Lely V in consequence of the panting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signature of ApplicamtCommoor i Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant stare arhandlc Intonations material as defined by the Cupertino Municipal Cade.Chapter 9.11.and time Health and Safety Cache,Section 255320)? ❑Yu 0 N All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building Occupant use equipment or device,which If a roof is installed without first obtaining an inspection,I agree to remove It Mardon air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Y" ❑Nu I I ban mad the ha,aNas materials requirements under Chapter 6.95 of the Cali foo nix Heal d:Safety Code,Sections 15505,15533 and 25534.1 understand tot irdw building dors not currently haw a mnnt,that It b my nexpomibillty to ratify 0m aceupnt of the nxp1ma entswhichmustWmelpriorwissuancesuraCcAdmamsuroccupancy. Signature of Applicant Date Owner or amhorissd Agent Dam I All roof coverings to be Class nBn or better CITY OF CUPERTINO 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw COPY # 3 Sec: Twp: Rng: Sub: Blk: Lot: APN 36910006.00 DATE ISSUED. . . . . . . : 03/27/2006 RECEIPT #. . . . . . . . . : 33741 REFERENCE ID # . . . : 06030150 SITE ADDRESS . . . . . : 10327 COLD HARBOR AV SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : BAKER CHARLES A AND CAROLINE L ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3329 RECEIVED FROM . . . . : JUST WATER HEATERS CONTRACTOR . . . . . . . : GILROY, JOHN LIC # 15128 COMPANY . . . . . . . . . . : JUST WATER HEATERS INC ADDRESS . . . . . . . . . . : 3400 INVESTMENT BLVD CITY/STATE/ZIP . . . : HAYWARD, CA 94545 TELEPHONE . . . . . . . . : (510)293-9901 OE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL _____ _____________ __________ __________ __________ __________ __________ BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BPWHEATER PER HEATER 1.00 10.79 0. 00 10.79 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 __________ __________ __________ ---------- TOTAL PERMIT 84.02 0.00 84.02 0.00 METHOD OF PAYMENT AMOUNT NUMBER _________________ ____________ ________________-_ OTHER 84.02 MASTERCARD TOTAL RECEIPT 84.02 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING • Community Development 10300 Torre Avenue Cupertino CA 95014 ITY OF Telephone(408)777-3228 Fax(408)777-3333 WUPEkj,JN0 Building Department JOB ADDRESS: PERMIT # 10327 Cold Harbor Ave. OWNER'S NAME:Charles Baker PHONE #408-252-8942 GENERAL CONTRACTOR:Just Water FAX # 510-783-6360 Heaters I am not using any subcontractors: 03/21/06_ 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 • UeQ ' ^� 03/21/06 10/28/03 oc�o 30► 15D City of Cupertino Building Permit Application E-Mail Jobsite Address: 10327 Cold Harbor Ave. Date: 03-21-06 Owner's Name:---Baker Charles Phone No.(408)252-8942 APN#: 369-10-006 Project Valuation: $925.00 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: 1764 National Ave. E-mail: permlts®justwaterheaters.net City,State and Zip: Hayward,CA. 94545 State Contractor's License# 591329 Exp. Date: 3/31/04 Worker's Comp#: 1626288-02 Carrier:State Compensation Insurance Fund Exp.Date: 4/11/03 Credit Card Information Credit Card #: 5474-6390-0047-8660 Name on Card: just Water Heaters Inc. Expiration Date: otola& Visa MasterCard Comments r