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06050244 CITY OF CUPERTINO rt�awr r + � "• ' ' t BUILDING D�VIEION PERMITC1N'TRACT�)R"I1VrII.t1 `IOfi1Vvf Mt ,eco A• „r =j't , _• BUILDING ADDRESS: PERMITNO. JUST WATER HEATERS INC 06050244 OwNiija OAMWERBPERMIT ISSUE DATE \tel NE: 3400 ITIVEST ENT BLVDSANITARYN l.NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDOO O MUMB ip LICENSED CONTRACTOR'S DECLARATION Job Description F I hereby efRrm Nn I am licensed under provisions of Chapter 9(commencing P t with Section T(NN))afDivision 3ef the Business and Professions Cade.and my license is in full farce and street. �3 License Claes Llc.« REPLACE 40 GALLON GAS WATER HEATER Dau Contractor 2 ARCHITECTS DECLARATION 2 I wWenund my plans.hall he used as public recmda O in Lic,nscd Prolcuienal 3 OWNER-BUILDER mexempt from DECLARATION e 0 I hereby aRtm on I I.S.exempt from tee ContrectCo License Law for tee Z o which re mason.(Saeon 7831. .Ow,Improve.Profusions Ca u:Any city err caumy 3 which mqus u•permit re conumcL slur, for sudemnits4 m repair any eni �Sn prior in its tssuence.alm requltuparovi the licanrchancchnstar'roicense rile a ga(chapwm �< tiw he tslicenmd pursumtmthe provisions of the Conuatafe License law(Chspur9 Sq.Ft. Floor Area Valuatio also he mine WU Sentlon)Oe0)mDivuion 3Of al eueirxss and Professions latme)or L$ Sc k u exempt any and Br tura it the alleged exemPdon Any violation of Sec Bon them IM airyched della far a permit subjau IM appliant nc a dull pensvy,of _ppK}StVAb6r 0 0 Occupancy'Iype not man Bun Ow huMm0 dollars(53001. -S 0�LSU SFO ❑1,an,war of the property,a my employees with cages as ask mucompemWes. WR do the work.and sex nmemm is tent amounted Or offered fersak(Sm.7114,Businw Required Inspections and Pmfeselom Code:Tim ConuaaaY License Law does MI apply to an owner of q P pmpenywho Wlldsalmprovesthuenn,aM whodoesswdwart hvnulfa through his ;sem hmm owever,thea,pmgOurIvided thonating rovaremProwmanu uenainuMedaortered lassie.If. theownr. ��:? y �nza owns. however,the avebuilthegwimprowmenttsmld Wthmaayma mproefortion,tee Owe r- R\p Yj'�'iy builder will have the burden o(poving that W did rot berm a improv for POTom of , use.). 10 ❑1.as owner of the property,am exclusively comraning with licensed anwnom u comtmet the Profen(Sec 7040,Buslnw and Prefeesimu Code:)The Commences U (�,1'1 Q,.a- come Law does not apply M an owner of property who build,or Improwa damon,ad, "y`1V- {U2 who contracts for such projects with s contractor(,)liemed pursuant in the Contractors License Law. ❑1 sm exempt under Sea .B&P C for this mama Miliza- WORKERS COMPENSATION DECLARATION UIL ®�trytq t]t 1 hereby a01rm under pemlty of perJmro y oof the following decd Wmtc ``��'' ham and ill malnW a•CeNfiate of Consent to self-insure for WorkeesCompen- u provided for by Seu wet 3700 of the labor Code-for the perefunbco of the werk loo which this permit is issued. ❑1 Mw and will mainWn Workees COmpmsadon Insurance,an required by Section 3700 of the later Code.for the pceformana oftiu work for which this permit is issued ' My Workees Compensation Insurance artier and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This Baum need nothecompleted if the permit is faun,hundred dollen($imi Or C...) I cenify,that In the performance of the wart for which this parfait is issued I shall not employ mypcmon In any mannersu as en become subject en tis Workca'Compenudon Laws of California.Dau Applicant NOTICE TO APPLICANT:IL afer making this Certificate of Exemption,you should become subject nc the Worker's Compensation provisions of the labor Code•you mute O forthwith comply with such provisions a this permit shall he deemed revoked. CONSTRUCTION LENDING AGENCY 1 hemby afrnm that dem Is a construction lending agency for ac performance m ds work for which W$permit is issuW(Ser.31197.Cih,C.) Lenders Num lsndees Address t Q I a Teen dist 1 have mad this city ad county W sus cut the show infommtiun he ' mrtem l agree u comely with Ali dry and eoonry nminsn¢s and sus law r upon he e Wilding a donned ioq um heron echoes a rpows. uuws of this dry m enter upon tiN W show-menconedprogeny for inspection loop t W es ju Agra nc cows indemnify and hap hay in m the City of Cupertino against tZ in Consequenemenu,emuand of do grooling of this eswhtch may in any wyamue against laid City 0 Z APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signuurt of ApplicaHAZARana Date HAZARDOUS funum MATERIALSDISCLOSURE Type of Roof Will the applicant or future building ampaptsmm a handle h eardoa mstenal u de0ad by the Cupertino Municipal Code.Chapter 9.12,roti the Health and Safety Code,Secdon 2553247 All roofs shall be inspected prior to any roofing material being installed. ❑Yes 0N Will the applicant or future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove t hwadma air contaminants as donned by the Bay Ams Air Quality Management all new materials for inspection. vin? ❑Yen ON. C - Ihavemad thehvaadnw mucnatsrtqulmmn....under Clupurd93ef the Glifon ei HUI"SafatYC de Ssmons25505.23533and 15530.I utmcnuM Uut ifdc Wilding dao rot cuwncY Mw a Ienanl this It u my mponsihility en ratify dr acupanl of the rmquimmsnuwhkbmu Wmetpaiorwiuuues OfaCcnieaxaracapm,y. Signature of Applicant Date Ownermanthm'ved.ens DateAll roof coverings to be Class"B"or better � .\ CITY OF CUPERTINO !m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36221040 . 00 DATE ISSUED. . . . . . . : 05/30/2006 RECEIPT # . . . . . . . . . : 34618 REFERENCE ID # . . . : 06050244 SITE ADDRESS . . . . . : 1098 DERBYSHIRE DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : WAGNER GEORGE 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 •EE 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 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 Telephone(408)777-3228 CITY OF Fax(408)777-3333 .CUPEkTINO Building Department JOB ADDRESS: PERMIT# 1098 Derbyshire Dr. OWNER'S NAME:Wagner, George PHONE# 408-253-7442 GENERAL CONTRACTOR:Just Water FAX # 510-783-6360 Heaters I am not using any subcontractors: �� 05/30/06_ 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 05/30/06 10/28/03 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 Owner/Contractor Signature Date • • 10/28/03 City of Cupertino Building Permit Application E-Mail lobslte Address: 1098 Derbyshire Dr. Date: 05-30-06 Owner's Name:---Wagner,George Phone No.(408)253-7442 APN#: 362-21-040 Project Valuation: $650.00 Building Permit Info: Bldg Elect Plumb----.X— Mech Job Description Replace 40 gallon gas water heater. Contractor Information Company: lust 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: 3/31/09 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 Comments