03050060 CITY OF CUPERTINO '•'� AI "`�'
BUILDING DIVISION PERMIT .�,� �"T., P 'MI r�'^''
BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT"x03050060
OWNER'S NAME: - 1764 NATIONAL AVE P°v''n bV714/2003
AIhIKE HONG
NE: (510) 293-9901 SANITARY NO. CONTROL NO.
ARCHITECffENGINEER: BUILDING PERMIT INFO
BLDGLUMB MECH
01=
fl1ECT P= 0
LOO LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am limmu d under provisions of Chapter 9(commencing Job Descriprt�ionr�II ^ p 1r�I�T
n�1 with Sectim 7")of Division 3 of the Business and Professions Coda,and my llcenac is fI—�II�tM Gst'U 1Ssal�aedJ
in full
reacto=mdenea REPLACE WATER HEATER
j'Z Licensu Class Lir.
Z. Dam canwcmr (50 GALLON GAS) JUN 1 7 ZOOS
ARCHITECT'S DECLARATION
I understand my puns shall W used as public records;
u
5 Licenced Pmfcui...I BUILDING 1 a p'
o OWNER-exemptRm,theCATION BUILDIfiIG
I 1 W feM1y,(See that 11. exempt from me Ca oss Cos Liana Law for the
my
O O following mama(Section FDLS,Business and Professions Cole:My city or aunay
$ which mquircs a Permit to ennumeL.lief,improve,demolish.of epaif any swnum
prior of its iuwnex.abut nxuims the applicant for such permit to file a signed ammount
FF <
that he is limated purmani to the provisions of the Commerce.Lim.Law(Chapter 9 Sq.Ft.Floor Area Valuation
tl�th (commemdng with Semon 71100)of Division 3 ofine Business and ProRmhom Cods)or
$ this he is exempt therefrom and me bleu for the alleged exemption.My Autumn of $652
Smdon 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not moa dun flus hundred dollars(SSoo).
01,uOwner ofineProperty,ormyemployees wide wages atheir somcompensndot, 36651044 . 00
will do the walk and the swcture is not intended or offend far auto(Sec.70th.Business
and Professions Code:The Contractors Llano Law does not apply to an MW of r CCp
pmpenywho builds nrimproes Buwo
rson.and whodoassuch rk himselfortiaough his 502 - FINAL P�VMBI EMRGY
own employees,provided that such impnewmauarc notimeMed aoffercd furWe If, 506 — GAS TEST
however,the building at improvement is sold within am:year of compteuan,the owner. -
builder will have the trrtlen of proving that W did at Wild or improve for purpose of 507 — FINAL PLUMBING
sate.).
❑ I,as comer of the property,am exclusively contacting with Imessed centnmms to
construct the project(Sec.711/4,Business and Professions Code:)The Contractors Li-
sense Law does not apply he an owner of property who Wilds or improve Neeen,and,
who mntmw for such pmjena witin a contrrtmr(s)licensed pumema to the Convenor's
Lim.Law.
❑Iam.reptunikes. ,BkPCfmthi...
Owner Dam
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of pmps y one of me following declamtlone:
1 have and will maintain a Certificate or Consent tosetf-Insure for workersCompen-
ution,as provided for by Section 3700 of the Labor Cade.for me performance of the
wort for which Ws permit is issued.
❑1 have and will maintain Workees Compensation Insurance.as required by Section
3700 of the labor Code,for the performams of the work for which this permit is Wund.
My Workers Compensation Inwnence curia and Polity,numWr lee:
Cartier. Policy No.:
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
('Thu section need not W completed if me permit is for one hundred dollar.(SI W)
or Ica.)
I unify that In the pmformance of the wart for which this Penni)u Wised,I"I not
employ any person in any manor an as rc become subject to IW Workera'Compemedon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Exemption.you mould
became subject to de Worker's Compensation ptwisio s of the Isha Code,you mus
,J O foMwith comply with such provaions W this permit shalt be deemed revoked. p
z► CONSTRUCTION LENDINO AGENCY
'[r Thar which
matmerc isarofmrucllon len dine agemy rte me perfurmamc of
pi 7 the wort(ler which rola permit is wad(Sec.3(57,Civ.C.)
Own A Lender's Name
=z i<nder's Mdnw
U O 1 certify that I haw rend this Application and toe that the shove Information Is
H. co mm I agree to empty with all city and county ordinances and some laws muting to
0 SV^ building construction.and hereby authorize representatives of this city to enter upon me
W shove-mentioned property for Inspection purposes.
F!^^a (Wc)sptu to ave.Indemnify and keep harmless the City of Cupertino aPimt
In liabilities,judgments.cow and expense,which may in my way amue aguwaid City
U z In consequence of the grating,of this parent.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature o(AppliuRDau
HAZARDOUS
US MATERIALS DISCLOSURE Type of Roof
WIII theapplicantm future Wildinge,c haptstoreaand the
Healloasmeed)
u defined by me Cupertino Municipal Code.Chapter 9.11.and tie Health Intl Safety
one,Section 355324)4 All roofs shall be inspected prior to any roofing material being installed.
❑Yrs ON.
Will the applicant or future building omupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit haatdnm air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes ON.
Ihavemad mehm dousmaterialsmquimmontsunderChaper6.95oftha C.lifoo
nlaHcalmkSafcty Coda Sectiom35505,25533ar 25534.1 estam"thatirthe Wilding
Jam not currently have a moat.Net it u my responsibility Or atify me occupant of the
requirements which must W mel prior to wnsme ref.OmtiMae of Occupancy Signature Of Applicant Date
Owner or authorized agent Dale .y All roof coverings to be Class "B"or better
03 oS-Uv � a
City of Cupertino Building Permit Application
E-Mail
jobsite Address: 11512 Country Spring Ct. Date: 5- 14-03
Owner's Name:---Hong, Mike
Phone No.(408)861-1278
APN#: 366-51-044 Project Valuatlon: $ 652.00
Building Permit Info: Bldg------__ Elect___________ Plumb__—X----- Mech_—________
fob 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# 591329 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 .�,c
Name on Card: dust Water Heaters Inc. -rf Z l 8 ��
Expiration Date: 9/05
Visa MasterCard X v
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