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CITY OF CUPERTINO'r%
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION 5,
„sdSlne ;_ ,�t t.v.? 'Yvi!std',�''• c -a Zv
BUILDING ADDRESS:
JUST WATER HEATERS INC
PER "It 5040104
V
7464 D
OWNER'S NAME:
PERMTT LSSUE DATE
MARION LEE
3400 INVESIMENT RI -37)
9
ONE:
SANITARY CONTROL NO.
(510)293-9901
ARCHITECDENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
1 hereby amrm that I am licensed ander unwiamns or Chapter 9 uommenclog
-11 Il
Job Description% ) I
with Section 70f10)of Division 3 oflbe Business and Professions Code. and my license is
_x'11
t,
in raandercK
full
REPLACE WATER HEATER
License=Lic.g
Dale Contractor
(4 0 GAL GAS)
ARCHITECTS DECLARATION
7�G5
I undnrsund my plans sltsll be used as public meet&
-
Licensed Pmfcssional
OWNER -BUILDER DECLARATION
1 hereby affirm that I from the Comms License Law for the
I.S.exempt
io o ons Co oc: Any city or county
following reason. (Section IIA LBusiness and
which in, demolish, repair any atucturna
isa a pcwil m ciansunuaumsthe plus, improve,
nPerlafile iment
prim m its issuance, also requires the applicant for wen permit to file signed summent
its
he to w)ofDiamnsnr thc
Sq. Ft. Floor Area
Valua�oI1100
(that
commincingwiJparction7oftheBusines,uanxhw(=hadc)or
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the buts for dm alleged exemption. Any violation of
APN Number
OccupancyType
YP
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mom Nan Fin hundred dollars ($50B.
35926013.00
1, m owner of the property, or my employees with wages as their sole compensation.
Required Inspections
will do the work and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law dors not apply to an awtmr of
propenywha buildsorimproves Merton. and whodoes sucM1 workhimself orNrough his
own employ ea provided dim such improvements art not inmMW oroffertd for sale. If,
however. the building or improvement is sold within one year of complchon. the Owner.
builder will have the burden of proving that he did not Wild or improve for purpose of
sale.).
❑ 1, as owner of the property, am "elusively contacting with licensed cammtors to
continual the pmjea (Sec. 7044. Business and Professions Code:) The Conmaetors Li
came law dos not apply to an owner of property who Wilds or improves Ucmon. and
who contracts for such projects with a conuactor(s) licensed pursuant to the Contractor's
Lima. Law.
0 1 am exempt under Sec. B & P C for this myon
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby of ind under penalty of perjury One of the following declarations:
-
I have am will mainuin a Certificate of Consent in selGinsurt for Wariori Compeo.
sation, as pmvided for by Section 3700 of the labor Cade, for the ce formanum of the
work for which this permit is issued.
❑ 1 have and will maintain Workers Compensation Insurance, as required by Section
3700 of Nc Labor Cade, for the performance of the work for which this permit is issued.
My Workers CompensatlOn Insurance carrier and Policy number am:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mus senior reed not beeomplemd if the permit is forom hundred dollars (SIM)
or lass.)
1 ccnify Nat in the performance of the work for which this permit is issued. I shill not
employ any person in any mannerso az to become subject to plc Workers' Compensation
taws or California. Data
Applicant
NOTICE TO APPLICANT: If, afar making this Certificate of Exemption. you should
become subject to the Worker's Compensation pmvisions of the Labor Code, you must
forthwith comply with such provisions or this permit shalt be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 herebyich thi Ne Vert is • id (Section lending agency for Ne performamx of
Ne dark for which this permit is issued (Sec. Y)17, Civ. C.)
lender's Name
r
lender's Address
I ccnify that I ban read this application and sum that the aWve information is
'
coma. 1 agree to comply with all city and county ordinances and sum laws snlating to
building construction, and hereby authorire repracnutiwa of this city to enter upon Ne
abovcmalitmed property for impaction purposes.
(We) agree to save, indemnify and keep berm less Ne City of Cupertino against
Liabilities. judgments, costs and expenses which may in any way amew against said City
in consequence of Ne granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS,
Re -roofs
Type of Roof
Signature Of ApplicaDam
HAZARDOVS MATERIALS DISCLOSURE
HAZARDOUS
Willy tapplicant ser fMuni buildingoccupantatomor handleh
az de.Sac by the Cupertino Municipal Code, Chapter 9.13, and the Health and Safety
Health ad
oda. section 15532(,)]
[j Y.. ON.
All roofs shall be inspected prior to any roofing material being installed.
- If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or rotate Wilding Occupant use equipmat ar dcviaa whim
mil hazardous air contaminants u Ucfined by the Bay Area Air Quality Management
all new materials for inspection.
Distric@
0Yes ❑Nu
I have real the, hrrardnua materials toquimmen s unde,CWpmr 6.95 of plc Califon
nice HcnIN & Safesy Cock, Secdons25N)5.25533 and 8534.1 understand the if the building
Jags nor currently have a tenant Nal It Is my respomlblllty b notify the occupant Of the
requirements which must bemal prior oniaaana of a Cetifiau of Occupancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner Data
orauanonvedugcol
�CITY OF
CUPEkTINO
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
7464 Dumas Dr.
PERMIT #
o �--b C>
OWNER'S NAME: Lee, Mariam
PHONE # 408-252-4600
GENERAL CONTRACTOR: Just Water Heaters
FAX # 510-783-6360
I am not using any subcontractors:
4/18/05
Signature Date
Please check a22licable subcontractors and complete the following information:
3/18/05
Owner/ Contractor Signature
Date
10/28/03
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
3/18/05
Owner/ Contractor Signature
Date
10/28/03
t
t
C) S-15 q- 0 1 0 ?
Uly OT t-uperuno tsmiaing vermlt Application
E -Mail
jobsite Address: 7464 Dumas Or
Owner's Name: ---Lee, Mariam
Phone No.(408)252-4600
APN#: 359-26-013
Building Permit Info: Bldg -----_-_
Date: 4-18-05
Project Valuation: $ 1,100.00
ect----------- Plumb ------ X----.
Job Description
Replace 40 gal gas water heater.
Contractor Information
Mech_----------
Company: just Water Heaters Inc. Phone: (510)293-2012
Contact Name: Dulce Fax (510)783-6360
Address: 3400 Investment Blvd. E-mail: permits@justwaterheaters.net
City, State and Zip: Hayward, CA. 94545
State Contractor's License # 591 329 Exp. Date: 3/31/06
Worker's Comp#: 1626288-05 Carrier: State Compensation Insurance Fund Exp. Date: 4/l/06
Credit Card Information
Credit Card #: 5474-6390-0026-5679
Name on Card: just Water Heaters Inc. ��3Srl
Expiration Date: 9/05 l
Visa ❑ MasterCard
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