03100008 ITY OT CUPER'1'INO
BUILDING DIVISION PERMIT 'CONTRACTnRgNFORMATION
9x °a d'+4 vR�� Afn.iWu°4 �.t—cB's 9p.
a BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT NO.03100008
OWNER'S NAME: 1764 NATIONAL AVE PERMIT ISSUE DATE
NE: (510) 293-9901 SANITARY NO, CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
ED
loo LICENSED CONTRACTOR'S DECLARATION
of CON
p 1 hereby 70 Brian that 1 am licensed under and
Proons of Chapter 9(commencing Job Description
iiW with ilforcnndE Effect. 3ofthc Business coil Prufcssiona Code,and myliccnsc is
'<m infullfoeeend cffnct.
;'z LicEm.eclams Lit... REPLACE WATER HEATER
-
Data Cammcer (5 0 GALLON GAS)
ARCHITECTS DECLARATION
y U 1 understand my plans shall be used as public records
o Licensed Professional
3 OWNER-BUILDER DECLARATION
a S. I hereby affirm that I am exempt from the Contractor's License Law for the
00 following mason.(Section 7031.5,Business and professions Code:Any city or county
t$ which requires a Permit to ennsrun,alter.improve,demolish,m repair any structure
Izi prior in its issuance.also requims the applicant for such permit to Blc a signed statement
:z< that heisliccnuJ pursuant to pmvisionsnfthe Contmcmr's License Law(Chapter Y Sq. Ft. Floor Arca Valuati�221T
2FC (commencing with Section 7000)of Division 3 of the Businav and Professions Code)or
that he is exempt therefrom and de basis for the alleged Exemption.Any violation of iiwwii k
Section 7031.5 by airy applicant for a permit subjects Napplicant
thae applicano a civil Penalty of 380BMM+J 2x®mT00 Occupancy
not more n f hundred dollar.n50B. IS p y Type
❑ 1,as owner of the property,in my employees with wages as their sole compen.mion,
will do the work,and the suclure is not intended or offered for sale(Sec.7614,Business
and Pmfessions Code:The Contrecim'a License law docs not apply m an owner of Required Inspections
property who builds or improves thereon,and who doessuch work himselfor through his 502 - FINAL PLUMBING ENERGY
own employees,provided thm such improvements are not intended oraffered for able.It, 506 — GAS TEST
however.the building or improvement is sold within one year of completion,the owner
builder will have the burden of proving that he did not Wild or improve for purpose of 507 - FINAL PLUMBING
Flo.).
1,as owner of the propertyam exclusively contracting with licensed contractors to
=onaua the project(Sec.704x.Business and Profusions Code)Tom Contractors Li.
cane law does not apply on an owner of property who Wilds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant a iM Contractor's
License law.
❑1 An exempt under Sec. B h P C for this Mason
Game, Date
WORKER'S COMPENSATION DECLARATION
1 hereby afnrm under penalty of penury one of the following decorations:
I have and will maimain a Certifcme of Consent to self-insum for Worker's Compete
7371W
on,as provided for by Section 37W of the labor Codc,for DEC pcormalmse of the
k for which this Permit is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
of the Labor Codc,for the performance of the work fm which this permit is issued.
Work it's Compensation Insurance carrier and Pul icy numier aartier: Policy Na.: _
CERTIFICATE OF EKEM MON FROM WORKERS'
COMPENSATION INSURANCE
ulcsxJ
(This auction need not he completed ifthe Permit is for one hundred dollars 1$100)
I ccnify that in the par irmance of the work for which this permit is issued,I shall not
employ any person in any manner sit as Or at subject o the Workcrs Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.ager making Nis Ccnincam of Exemption,you should
income subject m IW Worker's Combination provisions of the Labor CME,you must
Oforthwith comply with such Provisions or this permit shall be deemed revoked.
Z� CONSTRUCTION LENDING AGENCY
1 hereby aRrm that dere is a construction lending agency for the performance of
L' the work fur which this permit is issued(Sec.307,Co.C.)
a7 0 Lends's Name
z Lender's Address
J Q 1 ccnify that 1 have read this application and sum her the above information is
Lcorrect 1 agree to comply with all city and county on inaness and sloe laws rtlating to
=U building communion,and hereby authorim mpresenmivcs of this city to enter upon the
LU ahovo-memionadpmpcnt for iexpcnies which ma
LL (We)agree to save,indemnify and keep harmless the City of Cupertino against
JzE,iZ incoisequnce judgments,the walland expenses which may in any way scenic against said City
in consequence of the granting alibis permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Signature of ApphcanVCOmOmLr Dae Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Due applicant or future building occupant Store of handle hmardous matenal
as defined by the Cupertino Municipal Coach,Chapter 9.13,and the Health and Safety
Codc,Section 35532(.)'
❑res 0N All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant or future building a«a nt tram a If a roof is installed without first obtainingan inspection,I agree to remove
Pp g W equipment or devices which P
it ha zmmus air contaminants as dcnned by the Bay Area Air Quality Management all new materials for inspection.
ueia7
❑Yes ❑No
I have mail the haaaNnus materials myuimments under Chapter 6.95 of the Califon
nim Health 6 Safety Code.Sadons 25505.25533 and 25534.1 undersand that if the Wilding
Day not cuncndy have a tenant that a u my respomielity m notify the ciamfirm of the
requirements which must W mm prior m issuance of a Cenifcam of IXcupancy.
Signature of Applicant. Date
Owner.1.uthoriaud.,car Date All roof coverings to be Class "B"or better
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 11557 Fallcreek Spring Ct. Date: 10-1-03
Owner's Name:---Venugopal, Prasad
Phone No.(408)888-2958
APN#: 366-51-016 Project Valuation: $ 1,217.00
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# 591329 Exp. Date: 3/31/04
Worker's Comp#: 1626288-03 Carrier: State Compensation Insurance Fund Exp. Date: 4/1/04
Credit Card Information
Credit Card #: 5474-6390-0026-5679
Name on Card: just Water Heaters Inc.
Expiration Date: 9/05
Visa MasterCard
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