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05060230Vie, 0O 7�E Lp0 wrj �dF� LLt; Oe TipyJOy y.9 CITY OF CUPERTINO�F'ei BUILDING DIVISION PERMIT CONTRACTOR,,INFORMATION " BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT NOO 5060230 21901 GARDENVIEW IN WNER'S NAME: PERMITLSSUEDATE HANS SKGEHEIN 3400 INVESTMENT BLVD 06/30/2005 NE: SANITARY NO. CONTROL NO. (510)293-9901 ARCHITECDENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTORS DECLARATION Job Description 1 thereby affirm that 1 am licenseddunderunder of 9 Profen sCodc. myficcomis with Sauon 7010) of Division ] ofthe Badness aM Rafcssiana Cock. and my liccnu is tofullPeterandertecL Licence Class Lk. • REPLACE WATER HEATERI Dam Contractor (5 0 GAL GAS) ARCHITECTS DECLARATION I underaund on, plans shall W used as public ..on — 2nn5 Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the followingrtuan. (Sccdon TTY] I.S. Business and Rofcssiura Code: My city or county I` which inquia .it res Ill construct, aIle,, imprnw, demoRah, or epai, any structure i Prior to its issuance, also requires the applicant for such permit to rlc a signed statement that he is licemscd pursuant to the pmvisiou of the Contramri Lt... Law (Chapter 9 Sq. Ft. Floor Area _f _I(I "`� Valuat"025 (commencing with Section TBO() of Division 3 of the Business and Professions Code) or that he is exempt docrefrom and the buis fm the alleged exemption. My violation of APN Number Occupancy Type P Y YP Section 7071.5 by any applicant for a permit objects the applicant in a civil penalty of not more 0. five hundred dollars ($500). 36219089.00 ❑ I, u owncrk. the poper my a es wag compensation, ortA ctur intem for ask (Sure. will doethe wok andth The Onsronotintended o,a.dofarolepply un ,Business arta Prywh ora Cade: The law hoes not apply lf an owner art Required Inspections mdis an, rid who nsuch work himself art though nit property who WiHereon, and who provided Chaves son If. own employees, that such improvements art not intended forsible.the mpletooroffered however. the building ri improvement is hath within one year of own for theepose a improv builder will have the burden of proving that k did Out Wild or improve for purpose of of salt.). ❑ 1, as Owner of be pmpcny, a exclusively cmaractio, with licensed ...am. to construct the project (Sec. 7044, Business and Professions Code:) The Conbousn's Li anise law does not apply to o owner of property who Wilds or improve Iheeon. cod who contracts for such projects with a eonuvmor(sl licensed pursuant to the Commctors Licana Law. ❑ 1 am exempt undo, Sao B & P C for this wuon net Data WORKERS COMPENSATION DECLARATION 1 hereby afro under penalty of perjury can of the following colorations: 1 how and will maintain a Certificate of Consent o self -insure for Workar ,Compen- satton, u provided fon by Section 37M of the labor Coda, far the parnme en of the work for which this permit is issued. 1 have ore will maintain Wmloal's Compensation Insurance, as required by Section J700 of the labor Code, for the performance of be work for which this permit is issued. My Worker', Compensation Insorancc carrier and Policy number art: Contact: Policy No.: _ CERTIFICATE OF EXEMP ION FROM WORKERS' COMPENSATION INSURANCE (Thisaction need not W eomplcuJ if the permit is for one hundred dollus (lila0) or Ice.) employr. Nater die p any mute of as walk for which this permit is issued, I shall not anymoncrmum Womc subject the Workers'Comficnsauon Laws of Laws of Celifomia. Dam ^ Applicant V NOTICETOAPPLICANT: afar making this Cisions or of Exemption, you uboost become objccs to the Woh t- Confirmation ora of the Imedr Care, you most foMwidi comply with such provisions or this permiuhall W deemed evoked. pro this error CONSTRUCTION LENDING AGENCY I hereby aR,m that Nee is a camtmctinn lending ageay for the performance of the work for which this permit is issued (Sec. 3047. Civ. C.) Under''s Name landcri Adders ' I certify that I have read this application and sou Out Ne above informadun is correct. I ogres in comply wits all city and county oNinoces and cute laws relating in ' Wilding construction. and hereby audience epmanlatives of Nit city w enter upon the above-mentioned property for unification purposes. (We) agree to save, indemnify and keep haemlcss the City of Calvinist against liabilidcs judgments, costs and expenses which may in any way accrue aganst said City in LI`Starting APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS. Re -roofs Type of Roof Signature of ApplicaublComescuor DateHAZARDOUSRDO HAZARDOUS MATERIALSDISCLOSURE Will the applicant Or future building g=ups nom or handle h the Cupertino Municipal Code. Chapter 9.11, oh 1W HcaIN and safny Health and Safety az defiSeh e. Chapter the Section c. Section 25571(,)? ❑Yes C] No All roofs shall be inspected prior to an roofing material being P P Y g g installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant of future building Occupant tea equipment or devices which it hazardous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection. iari<t? ❑Yes 0 N I have mad the haraNma materials e,pionments under Chaper6.95 of the Califon ZniceHculth&Safety Code, Scrums)505.15533 and 15514. 1 undersand thatifthc Wilding not currently haw a avant Net it is my ehpomibility to notity the Occupant of the tcquiremcnks which must W met prior an issuance of a Cca ircae ofOccupancy. Signature Of Applicant Date All roof coverings to be Class "B" or better Owner or authorized agent Data CITaYO SCUPEkTINO 9 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: 21901 Garden View Ln. PEp PERMIT # �- , b / o 1. 3-�, OWNER'S NAME: Sk ehein, Hans PHONE # 408-735-0432 GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360 I am not using any subcontractors: 9 ` cQ- 6/29/05 Signature Date Please check applicable subcontractors and complete the following information: [y[� 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 6/29/05 Owner/ Contractor Signature Date 10/28/03 s • 6y� 6--o _)_30 II-Ity or t-upertino buiming Nermlt Application E -Mail jobsite Address: 21901 Gardenview Ln. Owner's Name: --- Skgehein, Hans Phone No.(408)735-0432 APN#: 362-19-089 Building Permit Info: Bldg _------ 3a Date: 69-05 Project Valuation: S 1025.00 Elect--_-__- Plumb-_---X_--- Job Description Replace 50 gal gas water heater. Contractor Information Company: just Water Heaters Inc. Phone: (510)293-2012 Contact Name: Dulce Fax: (510)783-6360 Address: 3400 Investment Blvd. E-mail: permitdept@sbcglobal.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: 4/1/06 Credit Card Information Credit Card #: 5474-6390-0047-8660 q Name on Card: Just Water Heaters Inc. Expiration Date: 06/08 Visa ❑ MasterCard Comments Vie, 0O 7�E Lp0 wrj �dF� LLt; Oe TipyJOy y.9 CITY OF CUPERTINO�F'ei BUILDING DIVISION PERMIT CONTRACTOR,,INFORMATION " BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT NOO 5060230 21901 GARDENVIEW IN WNER'S NAME: PERMITLSSUEDATE HANS SKGEHEIN 3400 INVESTMENT BLVD 06/30/2005 NE: SANITARY NO. CONTROL NO. (510)293-9901 ARCHITECDENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTORS DECLARATION Job Description 1 thereby affirm that 1 am licenseddunderunder of 9 Profen sCodc. myficcomis with Sauon 7010) of Division ] ofthe Badness aM Rafcssiana Cock. and my liccnu is tofullPeterandertecL Licence Class Lk. • REPLACE WATER HEATERI Dam Contractor (5 0 GAL GAS) ARCHITECTS DECLARATION I underaund on, plans shall W used as public ..on — 2nn5 Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the followingrtuan. (Sccdon TTY] I.S. Business and Rofcssiura Code: My city or county I` which inquia .it res Ill construct, aIle,, imprnw, demoRah, or epai, any structure i Prior to its issuance, also requires the applicant for such permit to rlc a signed statement that he is licemscd pursuant to the pmvisiou of the Contramri Lt... Law (Chapter 9 Sq. Ft. Floor Area _f _I(I "`� Valuat"025 (commencing with Section TBO() of Division 3 of the Business and Professions Code) or that he is exempt docrefrom and the buis fm the alleged exemption. My violation of APN Number Occupancy Type P Y YP Section 7071.5 by any applicant for a permit objects the applicant in a civil penalty of not more 0. five hundred dollars ($500). 36219089.00 ❑ I, u owncrk. the poper my a es wag compensation, ortA ctur intem for ask (Sure. will doethe wok andth The Onsronotintended o,a.dofarolepply un ,Business arta Prywh ora Cade: The law hoes not apply lf an owner art Required Inspections mdis an, rid who nsuch work himself art though nit property who WiHereon, and who provided Chaves son If. own employees, that such improvements art not intended forsible.the mpletooroffered however. the building ri improvement is hath within one year of own for theepose a improv builder will have the burden of proving that k did Out Wild or improve for purpose of of salt.). ❑ 1, as Owner of be pmpcny, a exclusively cmaractio, with licensed ...am. to construct the project (Sec. 7044, Business and Professions Code:) The Conbousn's Li anise law does not apply to o owner of property who Wilds or improve Iheeon. cod who contracts for such projects with a eonuvmor(sl licensed pursuant to the Commctors Licana Law. ❑ 1 am exempt undo, Sao B & P C for this wuon net Data WORKERS COMPENSATION DECLARATION 1 hereby afro under penalty of perjury can of the following colorations: 1 how and will maintain a Certificate of Consent o self -insure for Workar ,Compen- satton, u provided fon by Section 37M of the labor Coda, far the parnme en of the work for which this permit is issued. 1 have ore will maintain Wmloal's Compensation Insurance, as required by Section J700 of the labor Code, for the performance of be work for which this permit is issued. My Worker', Compensation Insorancc carrier and Policy number art: Contact: Policy No.: _ CERTIFICATE OF EXEMP ION FROM WORKERS' COMPENSATION INSURANCE (Thisaction need not W eomplcuJ if the permit is for one hundred dollus (lila0) or Ice.) employr. Nater die p any mute of as walk for which this permit is issued, I shall not anymoncrmum Womc subject the Workers'Comficnsauon Laws of Laws of Celifomia. Dam ^ Applicant V NOTICETOAPPLICANT: afar making this Cisions or of Exemption, you uboost become objccs to the Woh t- Confirmation ora of the Imedr Care, you most foMwidi comply with such provisions or this permiuhall W deemed evoked. pro this error CONSTRUCTION LENDING AGENCY I hereby aR,m that Nee is a camtmctinn lending ageay for the performance of the work for which this permit is issued (Sec. 3047. Civ. C.) Under''s Name landcri Adders ' I certify that I have read this application and sou Out Ne above informadun is correct. I ogres in comply wits all city and county oNinoces and cute laws relating in ' Wilding construction. and hereby audience epmanlatives of Nit city w enter upon the above-mentioned property for unification purposes. (We) agree to save, indemnify and keep haemlcss the City of Calvinist against liabilidcs judgments, costs and expenses which may in any way accrue aganst said City in LI`Starting APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS. Re -roofs Type of Roof Signature of ApplicaublComescuor DateHAZARDOUSRDO HAZARDOUS MATERIALSDISCLOSURE Will the applicant Or future building g=ups nom or handle h the Cupertino Municipal Code. Chapter 9.11, oh 1W HcaIN and safny Health and Safety az defiSeh e. Chapter the Section c. Section 25571(,)? ❑Yes C] No All roofs shall be inspected prior to an roofing material being P P Y g g installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant of future building Occupant tea equipment or devices which it hazardous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection. iari<t? ❑Yes 0 N I have mad the haraNma materials e,pionments under Chaper6.95 of the Califon ZniceHculth&Safety Code, Scrums)505.15533 and 15514. 1 undersand thatifthc Wilding not currently haw a avant Net it is my ehpomibility to notity the Occupant of the tcquiremcnks which must W met prior an issuance of a Cca ircae ofOccupancy. Signature Of Applicant Date All roof coverings to be Class "B" or better Owner or authorized agent Data CITaYO SCUPEkTINO 9 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: 21901 Garden View Ln. PEp PERMIT # �- , b / o 1. 3-�, OWNER'S NAME: Sk ehein, Hans PHONE # 408-735-0432 GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360 I am not using any subcontractors: 9 ` cQ- 6/29/05 Signature Date Please check applicable subcontractors and complete the following information: [y[� 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 6/29/05 Owner/ Contractor Signature Date 10/28/03 s • 6y� 6--o _)_30 II-Ity or t-upertino buiming Nermlt Application E -Mail jobsite Address: 21901 Gardenview Ln. Owner's Name: --- Skgehein, Hans Phone No.(408)735-0432 APN#: 362-19-089 Building Permit Info: Bldg _------ 3a Date: 69-05 Project Valuation: S 1025.00 Elect--_-__- Plumb-_---X_--- Job Description Replace 50 gal gas water heater. Contractor Information Company: just Water Heaters Inc. Phone: (510)293-2012 Contact Name: Dulce Fax: (510)783-6360 Address: 3400 Investment Blvd. E-mail: permitdept@sbcglobal.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: 4/1/06 Credit Card Information Credit Card #: 5474-6390-0047-8660 q Name on Card: Just Water Heaters Inc. Expiration Date: 06/08 Visa ❑ MasterCard Comments