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04060201 CITY OF CUPERTINO I. BUILDING DIVISION PERMIT �,CONTRACTOR4NFORMATION BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT NO 04060201 '10240ANUBE DR OWNER'S NAME: PERMIT LSSUE DATE F.'OBERT DELORIMIER 1764 NAT IONAL AMP, NE: SANITARY NO. 9 CONTROL NO. IF (510) 293-9901 ARCHMIC'VENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 J00, LICENSED CONTRACTOR'S DECLARATION Job Description W 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Zry with Section7(O(B.f Division].(the a.m.and profeaduns Code,and my license is 2 �„ infunfinemidtmet. REPLACE WATER HEATER If'��L5E0 j t�2 License Class Lk.g -c Dau Contractor (8 0 GAL) ru ARCHITECTS DECLARATION JUL 28 2004 y e u a I undersand my plans shall he used public mcords ;LLu _y o G Licensed Professional S OWNER-exemptRDE DECLARATION BUILDING 1 hereby.(firm that 1 am exempt from the Convenor's e:Any c Low for Ibe BUILDING Oo following reason.(Section LDgr Busix,, and ve.de use Code:Any citymcounty which its hum a permit m cmuwe,almC impmw.demolish, file e a sig any swmum rZa prior to lensed p,alsurcyuithe tbeappinsof fOrSticOm Contractor's Neem signedstatement a (commecingwiit Question to the of Divimm 3 thceBusiness, nd Professions (ChapurY Sq.FL Floor Area Valuat 1190 �l—m (cat be is(commencing Section and of Division)of the Businessend on.Any Crude)lathat or y�� that he is exempt therefrom and the hose for the alleged Gumption.Any vialauon or Section 703L5 by any applicant for a permit subjects the applicant o a civil penalty of APN Number Occupancy Type not seam than fico hundred dollars($500). 36948008 . 00 ❑1.as owner of the property,or my employers with wage u Nair sole compensation. will do the work,and the atrunum is not intended in offered for sok six.7044.Butler.. and Professions Cade:TM Contractor's License Law docs trot apply m an owner of Required Inspections property who builds or improves thereon,and who doessuch work himself orthrough his own employee.provided that such improwmcnu art nminm4tlW or.RGred forsake.It, however,Ne building or improvement is sold within one year of completion.the,owner. builder will have the burden of proving Nat he did not build or improve for purpose of salt.). h as owner of the property,am exclusively contracting with licensed contractors to construct Ne project(Sec.7044,Business and Profctions Code)The Contruur's Li cense Law dao not apply to an owner of,ampeny who builds or improv thetoon.and who contacts for such project with a eonuaaoas)licensed pursuant to the Contractor's License Law. ❑1 am exempt under Sec. .a&P C for Nis Masan Owner Dau WORKER'S COMPENSATION DECLARATION 1 hereby allimt under penalty of perjury one of the following declarations: 70371W I have and will maintain a Certificem of Consenuoself-mosmforWorkcruCompen- ion,as provide!far by Section 1700 of Ne labor Cade,for the performance of Ne rk for which this pc.i,is isMcd. 1 have and will maintain Worker's C.mpansation Imuran.,as toqunad by Section of the Labor Code,for the performance of the woh far which this permit is issued. yWorker's Com Qeuadion Inwn¢carrier and Policy number am: rrier. Policy No.: ' CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu section need non becomplcied if the permit is fmonc hundmd dollars(SIM) , or less) I certify that in NG perf.On..x of the work for which this Q4rmi,is issued.I shall at employ any pers.n in any manner an as in become subject o the Workers'Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:If,after making Nis Cenificam of Exemption.you should become subject in the Worker'.Compensation provisions or the labor Code,you must .JZ faMwiNe.mQly with such CONSTRUCTION LENDING nnuit halAGENCY be damGd MwkcQ / V ZO Oat the is a conNLENDINGAOENCY F.. I hereby affirm nhis Nat rbert is construction 3 n lending agency for the perfurmance of (X 7 theLe court fur which this pertnin is issued(See.)091.Civ.C) aQ Lender's Name = Z Lcnticr's Atldmss V O I certify Nat I have mad this meting..and sum thg the shout information is F' correct.I agree to comply with all city and county ordinances and sum laws totaling to 0O building construction.and hereby ambome ropmecnutiv of this city m cnur upon the ,r W show memimmil property for immeemm purposes. (We)agree I.saw.saw,indemnify keep harmless the City or Colombo.against Fh liabilities,judgments.casts and expenses which may in any way accrue against said City V sZin•' LICthis AND APPLICANT UNDERSTANDSWILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signature of ApplicaDDam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will theapplicant ser(Muni billingk.Chaptgam nr handle Health sd Safety az Oak.Section io the Cupertino Municipal Code.Chapter 9.12,and the Health and safety ak.ScNea 25632001 All roofs shall be inspected prior to an roofing material beim Installed. ❑Yea oNt P P Y g g Will the applicant or future building occupant use cgmpmem or device which If a roof is installed without first obtaining an inspection,I agree to remove mit h.vardooa air ammminant as defined by the Bay Area Air Quality Management all new materials for inspection. Digdct7 ❑Yes ONO I have mad Oc hixaNnus materials mimum lids under Chapter 6.95 of the Calif., ria HealthA,SafnyCodc.sectors 255(15.25573 end 25534.1 undersmM that if the Wilding docs trot cmmendy haw•¢rant thin it is in,respru ihili y to noufy do rcca,.,of Oc mquimmcnt which mug be met prior to issuance or.Cemerne of Occupancy. Signature of Applicant Date Owner or authoorsd agent pati All roof coverin;=,s to be Class"B”or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 SCITY'Or Fax(408) 777-3333 CUPEkTINO Building De artment JOB ADDRESS: PERMIT # 10240 Danube Dr. a 6 C, 6 OWNER'S NAME: Delorimier, Robert PHONE # 408-517-0805' GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360 I am not using any subcontractors: �� a4 r � 6/21/04 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 I UY bvU �� l C ity of Cupertino Building Permit Application E-Mail jobsite Address: 10240 Danube Dr. Date: 6-21-04 Owner's Name:---Delorimier, Robert Phone No.(408)517-0805 APN#: 369-48-008 Project Valuation: S 1,190.00 Building Permit Info: Bldg----------- Elect----------- Plumb------x----- Mech Job Description Replace 80 gal electric 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# 591 329 Exp. Date: 3/31/04 Worker's Comp#: 1626288-03 Carrier: State Compensation Insurance Fund Exp. Date: 4/l/04 Credit Card Information Credit Card #: 5474-6390-0026-5679 Name on Card: Just Water Heaters Inc. # Z6 03 Z Expiration Date: 9/05 Visa MasterCard Comments