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04070149 CITY OF CUPERTINO re`' BUILDING DIVISION PERMIT ICONTRACTUR INFO#gRIATIQN BUILDING ADDRESS: JUST WATER HEATERS INC PERMITNO04O7O149 741 OWNER'S NAME: PERMITISSUEDATE Alk NICK PAGONIS 1764 NATIQNAT, AVT?. 2 C)04 NE: SANITARY NO. CONTROL NO, (510) 293-9901 ARCHITECGENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 I'm LICENSED CONTRACTORS DECLARATION lob Descfipti(;p��(�II�� <Fu C I Wroby i f0rm the.I am licensed under provisions of Choper 9(commencing p u�', crid Senion 7Ulg1)of Division 3af de BusirressaM PO(essimns CoM.and myliceraseis „ inru11to.and afrem REPLACE WATER HEATER r 2 04 zqz LDe�nseclaes cnnuamr (40 GAL GAS) AU\l IC, ^tug ARCHITECTS DECLARATION I understand my plans shall he used as public record tlII Is1lt1 �jII a11�a(,IA t��f��ppr1�� ;off Licensed Pntfaai...I �V�tLs�tl•' OWNER-BUILDER DECLARATION fi 1 heathy affirm Nat I am uempr Imre Ne Contract License Law for the a 00 following rtuon.(Schon IID 1.5.Business and Prof ssm.Cc&:Any city ter county g(vi which requires a permit to consumer.alms impale,demolish,Or reryir any structnrt r• poor mus ssuat¢c,dw re quire Jte applicant for such permit to(lea signed statement �< Net he is lice used Pursuant to the Previsions or the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuatiog 946 (commencing with Section 7")of Division,3 of the BusioussarW profusions Coic)or i Nat W a exempt decrcrrom and the basis for the alleged exemp0on.Any violation of Semon 7031.5 by arty aprii eent for a permit subjects the spplicanno a civil Penally Of APN Number Occupancy Type runt mare than fire hundred dollus(s500). 35928055 . 00 ❑I.a owner of the pmpmy.in my employees with wages u their sole compensation. wiBdO thework,and the swaure isnot intended oroRered formle(Sce.7061.Busircss Required Inspections and professions Code:The Contractor', ww Liee ladoes eat apply m an oral Of q P properly who Wildsor imps es thereon,and whodneasucb work himn1fortbmugh his own employers,provided mal such improxemenls are,nmintendd antlered for We.If. however,the building or improvement is sold within one year of completion,the owncr- builder will Mse the burden of moving that he did trot build of Improve for purpose of sok.). I.as owner of the properly.am exclusivcly contracting wit licensed courem"drs to cotuwct de'no ttt(Sec.7061,Brumeas and Pnfica mns Code:)The Contractor's U. e Law censdoes not apply to as owner of property who Wilds or improves Iheseon,and, who contracts for such projects with a contractor(s)ticaned pursuant or the Comm,30es License Law. 0 1 Out exempt under Sec, B&P C for this reason Owner Dam WORKER'S COMPENSATION DECLARATION 1 hereby+(fire under family of perjury one or the following dalantlmns: I hive and will maintain a CeNfiae or Consent to self-moue for Worker'sC..,n- auion,as provided to,by Section 3700 of me Labor Cod.ran the PONmnnance Of the work for which this permit is issued. 1 have and will maintain Worker's COmpe e a ma Insurance,a tortured by Section 000 of the labor Code.for the peeformanee Olde work for,which this permit is issued. My Workers Compensation Insurance artier and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE rlTis section need not W completed if the permit is frroue hundred dollars(SIM) or less.) I Monty that in the parformanee of to work for which this Permit is issued,I shall not employ any fiction in any mannerist u to become subject 10 the Workers'Compeusentlon Laws of California.Dam Applicant NOTICE TO APPLICANT:If,after making this Conifucae of Eaamloom you should become subject to the Worker's Compensation previsions of the Labor Code.yw mus ,J 7, fotawith comply with such provisions or this Permit shall W deemed revoked, fY z O CONSTRUCTION ilhor lNG AGENCY 'e. thereby affirm that dr.I,. IONLEN lending agmrcy farted fcrformance of Iha work for which this permit is issued(Sue.3097,Civ,C.) ILl Q1<redor's Nuns D• Lend r`3 As VC) ddres1 amify that 1 have read this application and sue thrd the above information is PcOrtecL 1 agora to comply with all city and county ordinances and scam laws elating to V building construction,toslndheebyaify ad eprexnmisps of this city upeteroaga the ahovo-mentianed property for inspection purposes. C cs.ju gine to ave,ddmnily and kith yI.harmless;the City of Cupertino against y liabiliuu.judgmcnts,costs andaxponses which may In any way aceeue against said City V z incetsequcnceofthegrantingofthispermit Date APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. Re-roofs Signature of Applicamu COnuacmr Dela HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or tome building occoPam stem a handle harardous merorial as difrned by IW Cupertino Municipal Code,Chapter 9.12,sued the Hcam and Safety ode.S ,mn25532(.)7 All roofs shall be inspected prior to any roofing material being installed. Yes No 7D6uiWill the aPplicanl or future Wilding occupant tax equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove ct7 heszrdnus air conuminanu as darned by the Bay Arca Air Quality Management all new materials for inspection. Yu ❑Nu 1 have road the hvardms m ionists"cimments under Chapter 6.95 of the C lifor- raldt&SarctyCod,Sections 25505,25533 and 8534.1 undersand that if drc Wilding Trot currenly has,a tenant t u itis my responsibility m timely the axuPant of IWiremato'_'uhmuuxmetpduru,iauaamracedratemfaapancy. Signature of ApplicantDate ner ter ammmdmd agcol Date All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 � CITY OF Fax(408)777-3333 UPEkTINO Building De artment JOB ADDRESS: PERMIT # / 7410 Heatherwood Dr. 0 <:T1070 !T a o / OWNER'S NAME: Pa onis, Nick PHONE # 408-252-7558 GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360 I am not using any subcontractors: 'D--&O- 6/20/04 Signature Date Please check applicable subcontractors and complete the following information: 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 �40"'+0-6--C� 6/20/04 Owner/Contractor Signature Date 10/28/03 t Q/ O 7O ( q / • City of Cupertino Building Permit Application E-Mail jobsite Address: 7410 Heatherwood Dr. Date: 7-20-04 Owner's Name:---Pagonis, Nick Phone No.(408)252-7558 APN#: 359-28-055 Project Valuation: S 946.00 Building Permit Info: Bldg----------- Elect_--------- Plumb------X----- Mech---------- Job Description Replace 40 gal 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# 591 329 Exp. Date: 3/31/06 Worker's Comp#: 1626288-04 Carrier: State Compensation Insurance Fund Exp. Date: 4/1/05 Credit Card Information Credit Card #: 5474-6390-0026-5679 / Name on Card: Just Water Heaters Inc. 7ifj�2s Expiration Date: 9/05 Visa ❑ MasterCard Comments •