03080138CITY OF CUPEXIINO--ter''�
'CONTRACTOR INFORMATION
--- -
BUILDING DIVISION PERMIT
;t
BUILDING ADDRESS:
JUST WATER HEATERS INC
PERMrr NO 03080138
OWNCWSNAME:
1764 NATIONAL AVE
PERMIT ISSUE DATE
NE:
(510)293-9901
SANITARY O. CONTROL NO.
ARCHITECT(ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACT'OR'S DECLARATION
Job Description
1 hereby that 1 Intended1dr.Bunder provisions of Chapter 9 (commencing
p
with Section )).f Division3of do Busincu and Pmfcssiuna Cadc, and my license is
3
I,and effect.
lse Claass"d`ffeCL Lic.a
REPLACE WATER HEATER y�
Cell
Date-c°"`Town
(4 0. GALLON GAS) �'0.l��o eroLE0
ARCII DECLARATION
I undersand in, plans shall be used as public records
QF /�
SEF 1A 20M
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm 'hot I am exempt from the Contractor's License Law for the
following reason. (Scnion ]in 1.5. Business and Prefeuiaas Code: Any city or county
ILLI
which requires a permit to comswa, alter. improve, demolish, or repair any structure
un
�(� 1r G
prior to its issuance. also requires the aPPlieanl for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area ValuatioA 864
(commencing with section ]0(0) of Division 3 of the Business and Professions Cole) or
4
that he is exempt therefrom and the basis for Ne aILc,Od exemption. Any violation of
Section ]031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of
3 er00
Occupancy Type
not mom man five hundred dollars ($50(y.P
Y
O I, as owner of the pmpen,, or my employers with wages as their arle c..'rol an,
will do the work, and the awnum is not i Livens ora apple] oa n, Business
and Professions Code: The Contractor's License Law docs
doesapply to an owner
Required Inspections
w not
not of
propenywha huildsorimprovcstwreon.andwhodacaauchwark himself orthrougM1 his
502 - FINAL PLUMBING ENERGY
owncmployess, provided that such improemenu am notinu:ndedoro0cred forum. If,
SO6 — GAS TEST
however. the building or improvement is sold within one year of completion.doowner-
Wimer will have the burden of proving that be did not wild or improve far purpose or
507 — FINAL PLUMBING
alc.).
O 1, u owner of me propeny. am exclusively contracting with licensed canvassers to
construct the project (Sec. 70". Business and Professions Code:) The Contractors Li-
cense law docs not apply to an owner of property who builds or improves Merton, and
_
who contracts for such projects with a convactor(s) liumed Putnam to use Com mustori
Lorena Law.
O 1 am exempt under Sec. , B At P C far this reason
Owner Dale
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
1 haw and will maintain it Cenifcsm of Consent to self -insure for Worker's Compen-
ution, as provided for by Section 37M or the laser Code. for the performance of to
work for which this IPirmit is issued.
I haw and will maintain Workers Compensation Insurance, ss required by Secuo r
JT00 of on, labor Code, for the performance of the work for which Nis permit is issued.
My Worker's Compensation Insumuce carrier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EX EMOTION FROM WORKERS'
COMPENSATION INSURANCE
(Thisxeti"n aced not be complcwd if tbe permit is foronc hundred dollars (SIM)
or less.)
I certify Our in the performance of the work for which this Permit is issued, I shall not
employ any personn any manner an as as become subject o the Workers' Compensation
Laws of California.
Applicant
NOTICE TO APPLICANT: IL after making mis Certificate of Exemption, you should
become Subject to the Worker'a Computation provisions of the laver Cole, you most
forthwith comply with such provisions or this Permit shall he deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that dere is a construction lending agency lot the Performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lenders Name—
Under 'sAddress�—
I eagree der 1 hawply read this applicationandordinances state dot the ewer information is
corten. 1 agree to comply with all city and county Stam laws minting
building construction,rmareand hereby sudtodmrposeunatiws of Nis city to enter upon the
ntaivsf oandur e
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
costs ando(thissca which may in any way aeeme against Mid City
mns.of
inwines, nce
in eorsryuenm of the granting o(this permit.
the
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
(157
Re -roofs
Signature of Appltc DataType
HAZARDOUS MATERIALS DISCLOSURE
of Roof
Will the applicant or future building Occupant store or handle havuduus mntcnal
as defined by tie: Cupeniao Municipal Code. Chapter 9.11, and the Health and Safety
Cuda. Section 25532(a)l
L:) Y. ONu
Will be applicant or future building occupant use equipment or devices which
mrdous air contaminants is defined by the Bay Arca Air Quality Management
C] Yes _ ONO
1 have read the hmaNtms arsenals mquiremcns under Chapter 6.95 of the Califor-
nia Health & Safety Code. Sceuuus ]55)5.25533 an! 25534.1 undersand ds ird, wilding
does not cumcn0y haw a tenant, our it is my responsibility to Doti ly the occupant of the
requimmcna which mus be rocs prior w issuance of a Ccmricam of Occuparey.
"ll tuute ,Hall tic ulspecicu prior ro any rooting material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant
Date
All roof coverings to be Class "B" or better
a
t
t
•
C
E -Mail
of Cupertino Buildinq Permit
Jobsite Address: 10173 Empire Ave.
Owner's Name: --- Bonetti, Bob
Phone No.(408)968-2469
APN#: 326-24-034
Building Permit Info: Bldg -----------
Date: 8-25-03
Project Valuation: 5 864.00
Elect ---------- Plumb X_
Job Description
Replace 40 gallon gas water heater.
Contractor Infnrmatinn
�) 3 0 /.3 , P -
lication
Company: Just Water Heaters Inc. Phone: (510)293-2012
Contact Name: Dulce Fax: (510)293-2022
Address: 1 764 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 Infnrmatinn
Credit Card #: 5474-6390-0026-5679
Name on Card: Just Water Heaters Inc. l�lf
Expiration Date: 9/05 S. 6/
Visa MasterCard ® I
Cnmmpntc