04020168 CITY OF CUPERTINO P ,tr&R- r'>�
BUILDING DIVISION PERMIT CONTRACTQR INFORMAT,�bN`
BUILDINGADDRESS: JUST WATER HEATERS INC "MIT"'04020168
OWNER'S NAME: PERMIT ISSUE DATE
ONE: SANITARY NO. CONTROL NO.
(510) 293-9901
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 � 0
Lop
LICENSED CONTRACIOWSDECLARATION JobDescription
m 1 hcrcbY affirm that l am li¢Med under provisions of Chapter 9 marnmemingA,
�®
SZs wiN Section 70(shofDividoo3of NC Busineuand Profcuions COCe.and myliceneis
immnmm and effect. REPLACE WATER HEATER r ,tl�FIIIAw
ZY n License Clan Contractor
�`❑ Date COmrdC ($0 GAL)
Y ARCHITECTS DECLARATION MAR 1 0 2004
Y¢� 1 underaanJ my plans)hall be used u public records
DaU
3 w to Limmuld Professional 1 1 1
5 OWNER-BUILDER DECLARATIONContro BUILDING
+� 1 hereby.(firm that I am.usin from sac Com..Co e:Any C law for sac
i p o following season.(Saito comar s,shell, and improve.
&is Code:Any city i county
K'm which its out•outlines,
m croswc4 alio.improw,dcmmrh,fi repair ed ammmum
FZi
that
ht he itsuiamamP also.,I.ds theapplicant for such perm's o file a Uctrm Lawdmammcm
ESC maims,nci gwithSrstion7 )ofDiviosorNCConuacmr'andPromaw(Chap¢r9 Sq. Ft. Floor Area Valuat 000
pH$ (camme1 eamor with 70n d the
Division r tf me qcd Business inti on.Any
Code)or
.. ion he is 31.5 b Bmrtfrom and the bur for be alleged Gumption.Any it Penalty
of
Selling 7071.5 five
airy red dolt fora Admit subjects me applicant a civil penalty Of ppN Number Occupancy Type
Out mart Nan Rw hundred dollen($30(3).
❑LssawmrOf sae proprny,amY cmployw with wogs ume'v sole compensation, 36230052 . 00
will dothssim..and The
Character',
Lawiid fm apply
Owner
Required Inspections
pro erty wh ou Code:The Ces thenon.Ekes.Law don not apply m m owner of q P
cam
property who builds or f mpmses thereon,and who dos soh work hf mselr Or through We h ii
own c in,the uiprovided mdsueh impmwments art not ou of completion,m leaW for ownen-.
�uilder Nebuilding orimprovement rsolde did none Wild Or iproor the owned
Euildcr will have Um burden Of proving mel he did mol build or improv for purpose of
sat.).
I.as Owner of the pmpmty•am ucluively conmdting with licensed Contractors in
,...I the project(Sec.70x4.Business orad PrufsLos Cade:)The Conuumri U.
ccue Law dos not apply to an Owner of property who builds or improves mamon,and
who contracts Its such pmjecu with a com ucter(s)licensed porton m the Commiserate
License Law.
❑l am esemp,under 51. ,B&P C fm this..an
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hemby alarm near pesRy of pesjury she Of the following hclantimu:
1 have and will maintain a Coloring,of Consent IO ditfor Winter's COmpen-
1M37W
ing.u provided(m by Session 3700 of the labor Code.for dm Performance Of the
rk for which this permit is issued.
1 have and will maintain Worker's Compesamn Insurance,u required by Section
of the Labor Cade.for she pcsformance Of me work fm which this permit r owed.
y Worker's Compensation InsuranceCartier and Policy number me:
rver. Policy NO.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(pillunion need not xcomplead time permit Is for One hundred dollars(51110)
Or las.)
1 sinify mol in the perfmmance Of me wart for which this permit r issued,I shall nm
employ any person ire my manners.as m become subject to the Workers Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this Ce.ificam of Exemption,you should
,come subject on me,Workee Compensation previsions of IM Ia wr Code.you rota
.,Z foMwim comply With such provisfnu or this permit shall be darned nevnkcd.
ZO CONSTRWCTIONLENDING AGENCY
E Ihcxby aRrm that iia N Esports,for me pefmmdmof i /�
✓��
> be work for which mid permit Is issued(Sue.3097,Civ.C.)
LLl Q Undoes Nanta
O. I.cnder's Addrrss
U O I cenfry mat I haw mad said application and sum that the about m(mor on r
IL E Comes,1 agree to Comply wish all city and county mdinames and sum laws relating to
C) Wilding ard Of this city menmrupon sae
[Ll aWn-memdmmd property fm mopletion pure L
G (Ne)egmc m save,indemnify and keep harmless the City Of Cupertino against
I,) Iiabili0u.fudgmcna.toxo and expeus whit,may in any wily eccroe agelnn said City
U Z in consequence of me granting Of this permit.
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicuVComracter Doe
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant store or handle hoodoos material .
Idols
defined by me Cupertino Municipal Code.Chapter 9.12.and me Ncalm and Safety
de,Seem.25552()7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes C3 No
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or rums.Wilding by me Br me equipment or Mim which
it havartlnus ear conaminanu u defined by me Bay Arca Air Quality Managcmcm all new materials for inspection.
stic,7
❑Yea 0 N
I haw mal the bound.mamrilds"I iremcnu under Chapmr&95 ofine Califig
Nealth&SafmyClam.SeciiOu 25505,25575 am25534.I undersand thaifue building
net currently haw a tenant that it r my rsponsihilily m runty me occupam Of me
tbememawhichmumismelpriortodivamceOfiiConsfmmeOrOcsvpancy. Signature of Applicant Date
wmmmaemoripedasem Dam All roof coverings to be Class"B"or better
City of Cupertino Building Permit Application
E-Mail
jobsite Address: 20702 Garden Crest Ct. Date: 1-25-04
Owner's Name:---Scheel Eric
Phone No.(408)255-51 72
APN#: 362-30-052 Project Valuation: S 2,000.00
Building Permit Info: Bldg----------- Elect---_------ Plumb----_X----- Mech-----------
Job Description
Replace 80 gal 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
Name on Card: Just Water Heaters Inc. 6 6I
Expiration Date: 9/05 4L_
Visa MasterCard
Comments
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