06090084 CITY OF CUPERTINO Pm:*. «,.�aaa: -s -""�
BUILDING DIVISION PERMIT C`UNfRAfI'nR TNF>UIiMA�TI¢
- ax N$+t?a-.;:�is ��ba«vvs��T srsPt✓�H"� , �w
BUILDING ADDRESS: JUST WATER HEATERS INC """*0609008420045 DEP
ALMA LA
OWNER'S NAME: PERMIT ISSUE DATE
BILL RASSIHUR 3400 INVESTMENT RIND ns;,j1 ';L2nnr,
NE: SANITARY N0, CONTROL N0.
(510) 293-9901
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG EO PLUMB MEOCH
pp LICENSED CONTRACTOR'S DECLARATION Job Description u I hereby alarm Nat 1 Am li¢vN under provisions of Chapter 9(Commercial
with Section 700D)oWbehadi..3 Arthe Buahmas and Prof..Ai..Cade.and my limn¢is •I
iasao and effect REPLACE 50 GAL GAS WATER HEATER
t Z Licenseic...Class
iF1 Dau Contracwr
ARCHITECTS DECLARATION
I undcrsmnd my plana shall he used as public mcmd,
1--
.trp Licensed Pmfossi...1
OW NER-BUIIDER DECLARATION
1 hereby affirm Nat I am exempt from the Contractor's License Law for the
An
p O fallowing mason.(Section 7131.5,Business and ProRnions Cade:My city as county
S$ which requires•pare,m cnnsuscet,Alan.hnpew,demoli h.w repair any awttum /81060
-�!' paiorto I"issuance,also requires the applicant for such permit to file a signed statement Value
s�nthat h<u licensed Punuantl0 ace provisions of Ne Contractor'sLicca Law(ceram,9 Sq.Ft.Floor Area
1 CA 11.1
(commencing wide Section 7000)of Division S or the Business and Prolamin..Code)ar
that he is esempt therefrom IM ate basis for the alleged exemption.My violation of
Section 7031.5 by Try applicant for a permit subjttu am applicant m a civil penalty or APPI#Mffiber U U Occupancy Type
oat mart than five hundred dollen($300}
❑1,ss owner of Ne pmpmty,or my employees with wagesas their sole compensation,
will do the work and the ttrumune is oat imadedaroRertd fertile(SAO.7016.Busiwss Required Inspections
and Prodesslom Code:The Contracmrs License Law docs not apply m an owner of q P
rampart,who build,or improv deeram,and who dew such work himself ter through his
own employe,provided Nm Inch impmwmwta am mulntended wortercll for sale.If.
however,the building or improvement Is sold within ante year of Completion,the owner.
builder will hive the burden of proving Nat he did ret build w Improve far purpose of
Ads.).
❑1,as mese,of the pmperty,am exclusively contracting with licensed Conuanon to
Conswet the project(Sec.TOW,Business and professions Code:)Tho Contracmr'a U.
emu,law dao not apply baa owns Of property who huiM,ter impows f...and,
who contracts for such pici with a commcmr(s)licensed pursuant in Ne Contractor.
Lice.law.
❑1 ern wempt under Sea ,B&P C for this mason
Owner Data
W ORKER'S COMPENSATION DECLARATION
1 hereby ailirm under penally o(perjury raw of Ne folbwinl declan0ons:
1 haw and will maintain a CaUrmm of Consent w wlf.blurt far Workers Compen-
sathm,As provided for by Section 3700 of the labor Code,for the performaku,of the
work for which this Permit is Issued.
❑1 have and will maintain Warkers Compensation Insurance,As mquimd by Section
3700 of the Labor Code,far Ne performance of the work for which this permit Is issued
My Workers Campenaation Inserance carrier and Policy number an:
Carrier. Polley No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need Out be completed lithe permit Is farane hundvAdallan(SIM)
or leu)
1 Canifv that in Ne performance of the work for which data permit is Issued.l Nell not
employ any person in any manner an As in become subject in ft War iCompensation '
fawn of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should
became subject to the Workers Compensation provisions of IM Labor Coda you mum
.J 0 forthwith Comply with such provision.or this Permit shall h deemed reoked.
v
„zn y CONSTRUCTION LENDING AGENCY
[•w Iharehya(aw that them is.Cowwed..Wclugagcncy for dee pai.manceuf
Cl, the work fur which this Permit is issued(Sec..3097.Civ.C.)
11j Lenders Name
7 Z Landers Addm..
J O 1 certify Nat 1 haw mad this application and slain Net the,bow infmmatiun i.
U.F Carmel.l agree to comply with all city and county an irrncea and sun laws relating to
0U building contraction,and hereby audeorire represenutims of this city to enter upon the
r L4 above-mentioned property for inspection purposes.
(We)AS.,to saw,out...i(y and kap hmmleins ss Ne City of Cor against
ti y habili0w.judgmcnu,cwu and expenses which may in any way scene agaiwlwid City
()azin conequence of ft swung of Mis" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicaHAZARDO Data Type of Roof
HAZARDOUS N.building MATERIALS DISCLOSURE
Wg11 ate a Cupertno fou ni lo occupant shore w handle hamdoun mnoritl
As dcMed by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
COCA,Section 255370)? All roofs shall be inspected prior to any roofing material being installed.
41 ❑Yes 0 N
Will Me applicant or future building occupant use equipment ser deviate which If a roof is installed without first obtaining an inspection,I agree to remove
emit havardnus air contaminants As dcancd by the Bay Area Air Quality Management all new materials for inspection.
Diauict7
❑Yea ON.
I have mad the humadnus materials requirements under Chapter 6.95 of th.Califor,
.is Health&Safety Cadc,Seadau 25M5.25533 and 75534.1 understand thattrace Wilding
Jaen not currently haw a mum,that It u my maponsibility to notify the aceupant of Ne
requirements which mum be met pioru issuance ala CeNaesu oroccupxncy. Signature Of Applicant Date
Owner or aathori ad agent Dam All roof coverings to be Class"B"or better
CITY OF CUPERTINO
�m 1 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36932056 . 00
DATE ISSUED. . . . . . . : 09/13/2006
RECEIPT # . . . . . . . . . : 36018
REFERENCE ID # . . . : 06090084
SITE ADDRESS . . . . . : 20045 DEPALMA LA
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BILL RASSIHUR
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
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
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
------ - --- ------------- ---------- ---------- ---------- ---------- ----------
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
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
Community Development
10300 Torre Avenue
i+ Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
SCUPEkTINO
Building Department
JOB ADDRESS: PERMIT#
20045 De Palma Ln.
OWNER'S NAME: Rassihur, Bill PHONE# 408-316-2850
GENERAL CONTRACTOR: Just Water FAX# 510-783-6360
Heaters
I am not using any subcontractors: 9-xj� �401--+ , 09/12/06_
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
09/12/06
10/28/03
nucqa*
•
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 20045 De Palma Ln. Date: 09-12-06
Owner's Name:---Rasslhur, BIII
Phone No.(408)316-2850
APN#: 369-32-056 Project Valuation: S 1060.00
Building Permit Info: Bldg---_ Elect____- Plumb__JL_- Mech_—,_
Job 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: 3400 Investment Blvd. E-mail: permitdept®sbcglobal.net
City,State and Zip: Hayward,CA. 94545
State Contractor's License# 591329 Exp.�Date: 3/31/08
Worker's Comp#: 044510091 Carrier:ACE Exp. Date: 4/1/07
Credit Card Information
Credit Card #: 5474-6390-0047-8660
Name on Card: Just Water Heaters Inc.
Expiration Date: 06/08
Visa MasterCard X
Comments