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03080082 CITY OF CUPEWFINO nm1.D1Nc Drv1s1oNPERMIT CONTRACTOR INFORMATION Bu V-DING ADDRESS: JUST WATER HEATERS INC PERMITN003080082 11 TDONEGAI OR r OWNER'S NAME: 1764 NATIONAL AVE PERMITISSUUEDATE PETER T.UT 2'1 ONE: (510) 293-9901 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG 0 ELECT PLUMB MECH 0 0 0 10 o LICENSED CONTRACTOR's DECLARATION ]p1J DCSCII II O}L. Emp 1 hereby afOrm that 1 am licensed under provisions of Chapter 9(commencing p F iRM with SectionlOW)of Division 3ofthc Bufinews and Professions Code,and mylianicia ' <❑i in ON tome and affCCt. REPLACE WATER HEATER HALE® j Egm Luansc Class Lk.if it: Dow—Contractor (50 GALLON GAS) ARCHITECTS DECLARATION OCT 2 3 2003 f U I mokoni nd my plans 0.1 W used a public records e�� Licensed Poor..ii nal RR 3 f la OWNER-BUILDER DECLARATION BUILDING < 1 hereby arm that I am exempt from Ne Contractor's License Law for the a O following reason.(Section 71131.5;Business and Professions Coda:Any city or county 3$ which requires a Permit to construct,iter,improve,demolish,or repair any structure Her as its hameme,.lsu requires the applicant formch familia Ill.a sigacdsutemem ESO that he is licensed pursuant to previsions of the Contracwh License Law(Chapter 9 Sq.Ft, Floor Area Valua[i 3711 ' es- (commencing with Section 7MQ)of Division J of the Business and Professions Cook)or $ that he is exempt therefrom and the bub for the alleged exemption.Any violation of �.tmwm Section 7031.5 by any applicant for.permit subjects the applicant to a civil penalty of 36161`vr4YAd&cr0 O Occupancy Type .at mom not five hundred dollars 55003. - 1,u owner of the property,or my cmployces with wages as their sole compensation, will do the work,and the,structure is not intended or offered for sale(Sec.7044,Business p� and Professions Co&The Conroctorb License Law does not apply to an owner of 5 02 - FINAL Re,uirt ddlNpections property who builds or improves thercon,and who does such work himrelfor through his G ENERGY own employees,provided that such improvements are not intended or offered for sale.If, 506 — GAS TEST however,the building or improvement is sold within one your of completion,the owner. builder will have the burden of proving that be did not Wild or Improve for purpose of 507 - FINAL PLUMBING salt.). O h as owner of the property,am exclusively contracting with licensed contractors to commuct the project(Sec.7014.Business and Professions Cade:)The Canuactor's Li- cense Law it=not pply to an owner of property who Wilds or improm human,and, who contracts for such projects with a Centncwr(a)licensed pursuant to the Contractors License Law. I am exempt under Sec. B k P C far this moon Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under Pef of perjury ore of the following Eedw ations: I haw and will maintain a Cenifcate of Consent to self-insme for Worker's Compcm ., nation,an provided for by Section 37013 of the Labor Code,fm the performance of the work for which Nis permit is issued. ❑1 have and will maintain Wet Compensation Insurance,as required by Section J700 of the labor Code,for the performance of the work for which this pernit is issued. My Workers Compensation Insurance caner and Policy numher am: Cortin: Policy No.; _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (7Tu faction recd not W complexed EtW(omit is(mane hundred dollars(SIM) car Wss.) 1 certify that in the polls m un o of the work for which this Permit is issued,1 shall not employ any person in any manner so as w Weome subjecuo the Workers Compensation Laws of Califomia.Date Applicant NOTICE TO APPLICANT:It.at making this Certificate of Exemption,you should become Subject to the Worker a Cam Pansf provisions of the labor Code,you must DZ, forthwith comply with each provisions or this Permit hall W deemed revoked. OCONSTRUCTION LENDING AGENCY (3 I hereby say.that baa its construction lending agency for the Performance of Ye > the work fur which this permit is issued(Sec.3097.Civ.C.) - 37 Q Lender's Name / I� z Lender's Address I / C) I certify that I have read this application and state that the own information is Y (✓ correct,I agree to comply with all city and county ordinances and state laws relating to V building construction,and hereby scimitar representatives of this city to enter upon the 7+U .hove-mentioned property for inspection p uprises. tili� (We)agree to save,indemnify and keep harmless the Ci ly of Cupertino against rp liabilities.judgments,costs and expcnsca which may in any way accrue against mid City Jz in consequence of theBraming of this lsermit. '—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signature of ApplicanUContractor Dsw HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle haanrdous material as definc0 by the Cupertino Municipal Code,Chapter 9.17,and the Health and Safety ode.scctlenzss3x')? All roofs shall be inspected prior to an roofing material beim Installed. ❑Yea ❑Na P P Y g g 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 it tanneries air conmminanu as defined by the Bay Area Air Quality Management all new materials for inspection. Wolin? ❑Yes. ON. .Ihavemad Nebamrdnusmewrialsmquimmen¢unt rChapter6.95oftheCalifor- niaHcalthASvfctyCo ,Scctions255f15,23533md25534.lundersWndlhatlfthe Wilding does nm cortically base a tenant,thvl it is my maponsihility w nntil'y Ne occuP.nl of Ne mquircmcnts which must W met prom issuance of a Ccrdficaw or occupancy. Signature of Applicant Date Owner or authanmd agent Date All roof coverings to be Class "B" or better City of Cupertino Building Permit Application E-Mail jobsite Address: 7531 Donegal Dr. Date: 8-15-03 Owner's Name:---Lui, Peter Phone No.(408)829-9550 APN#: 366-16-062 Project Valuation: $ 711.00 Building Permit Info: Bldg---------- Elect_-_---_- Plumb------X----- 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: 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 0— Name on Card: just Water Heaters Inc. Expiration Date: 9/05 [ j Visa MasterCard ® v Comments