06060051 CITY OF CUPERTINO ��.� • r u ^" "'' "` " '` �'�
BUILDSNCDIVISION pEgMI'I' -,I;OXY'T CT(2$TNEUR��.ATI()y1�I ^:
xis %
BUILDING ADDRESS: ` JUST WATER HEATERS INC PERMrf NO. 06060051
21456 HOLLY OAK DR
OWNER'S NAME: PERMIT ISSUE DATE
EWING DONALD 3400 INVESTMENT 51,37D OF/Or /2006
E SANITARY NO. CONTROL NO.
(510).293-9901
ARCHITEC(ENCINEER: BLOO BUILDING PERMIT INFO
MECN EIER PLUMB
l� 0 0
;op LICENSED CONTRACTOR'S DECLARATION
fi I hereby dram shat I we licewN under pmvisiow of Chapter 9(commencing Job Description
with Section 7088)of Division 3 of the Budrom ask Profession;Code,and my license Is
„ in full fame and arc«a REPLACE 40 GALLON GAS WATER HEATER
Leen.CIM, Le.g
i Dau Conmdar
ARCHITECTS DECLARATION
ecords
i a I uskarwand my Puns shall E used u public remNa
ay V
Gr^ Lican.d Pmfasomel
or 3 OWNER-BUIIDER DECLARATION
)0 0 1 hreby aRm Nat 11. emmpt from the Cssions o Lkny c Low o for Be
:0 o fallowing mama.(Section 703 1.5, t, leer. and Rofeedum Code:Any city or county 'I
j$ prim u9uisu•permit re construct,alar,knpron,demolish.ri mpdr any sevetworm=men[ a�/ $1281
-ZS^ pdormsl bmeneoruant to the
the applicant for such pmmi'mfctessle asigned smemem
Nal(commencing
Calor Sq.Ft.Floor Valuation
$ (commcndngwlNScmf 7 and um basis n3 the the Business and Profession,Any
Coal or
Net M b attempt shcmfrom and Ne bub for the allagN eumptim.Any violation of Dim, I
Section 7031.5 by any applicant fm a pemlt.bjeces the applicant In a civil pewltY ofOccupancy Type
ret more Nan Bn hundred dollars(SM.
❑T.u Owner of the property.m my employca wW wags u Neb mle compemdon.
and Profiesaons colt The Co memane,L�La renOut pplyy 7�Ono r Of Required Inspections
property who builds mimproves0urmmand wMdoessuche ark himrlf mmamgh his
awnempb buiprovidedtMtamhimprovementsart nmimm�dW moRerW fm tea.H.
bouncer.Ne building bu imp.proem b Mold within ore Sear mmmpleefar the owm-
.k.). will have the burden of proving Nn K did not Iwld m improve far Purpose of
ale.).
O I,as owner of the property,am encluively commaing wish Iicemd contractors to
cawtmet the project(See.7044.Business and Profusions Cade:)The COnummes U.
ctsm Law does out apply.an owner of property,who builds or improws freon,and.
who contracts for such projects with aconummda)licensed Pmswnt m the Communes
Lkem Law.
m
❑Iscamp,uncia See .B k P C fur this was
Owner Dau
P1WORKERS COMPENSATION DECLARATION
I hereby affirmaffirmunder p sta ty of perjury amts of the following dedasedoes:
ham and will mainuin a CeNRau ofCommnt to self-insure for Walters Cnmpen.
sedan,an provided for by Section 3700 of the Labor Code,for Ne performance of the
work for which this permit is Wood.
O 1 ban and will mdnuin Workers Compensation Worm.,u myuired by Section
3700 of Ne Labor Cade,for the performance ofshe weak ferwhich olds permit is lased
My Worker,CompeosWao bs.ranca ami.and Polity numbs are:
Cartier. Policy Na:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Clbb well mem nothemmplered if the permit Is furan t hundred dalWa($100)
Or less.)
1 cemly Net in the perfomaneo of the work far which this permit is ivucdshal
,I l am
employ any person in my manner.u m become subject In f WorYara'Compemtian
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:IL net making this CeNfiau of Exemption,you Amid
become subject u the Workers Compensation provisions of she Labor COM,You mus '
.,0 u forthwith comply with such prpvidoor Nb permit dull W dmmW revoked.
z= CONSTRUCTION LENDING AGENCY
[. I hereby at Nat Vert is a construction lending agency for the pmformuux of
IYrftwork for which Nb permit Is instead(Sec.3097,Civ.C.)
94 Q Lenders Name
MZ lenders Addrm
U0 I certify that 1 Mn read this application and suss Nu Ne above Information is
<L f~ comet I agree m comply with all city and county ordinances and mm laws relating to
pU Wilding coma rtion,and hereby authorim representatives of this city to enter upon the
>" ahow-mentioned property for inspection purpoms
j.L>, (We)agrm.un,indemnify and trop homiest she City of Cupertino agdat
Ur In liabilims,judgmca ents.costs and capenswhich may in my way areae agdut ago City
in
of this
vZ.
APPLICANTUNDERSTANDSUNDEuence,arms RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signaturt of ApplimtlCon RDD Dow
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will ft t ePPlimtnofurore Wilding e.Chantsmmor"the
material
u dcOned by sire Cupertino Municipal Cade.Chapur 9.13,ask da Health aM Safety
Conn.semi.25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
OOYu ONO
Will f applicant or in=building occupant um equipment or dcvlm Mich If a roof is installed without first obtaining an inspection,I agree to remove
mit hawknus all conlamiwnts as defined by Ne Bay Area Air Oualhy Management all new materials for inspection.
Diwrkl7
OYa C)No
I have mW the humdous maudab requirements umkr Chmwr 6.95 of the Califor.
nia Health&S lmYCode.Sections 33505.25533 and 35534.1 undersand that ITtM building
does not currently haw a wool,shun it b my responsibility u notify the Occupant of the
roqui.rmntswhich most be=Ipdmmissuance ofaccNllaaof«mpanay. Signature of Applicant Date
Owner or authadaed agent Data All roof coverings to be Class°BTI or better
CITY OF CUPERTINO
�m 2 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36202031 . 00
DATE ISSUED. . . . . . . : 06/06/2006
RECEIPT # . . . . . . . . . : 34715
REFERENCE ID # . . . : 06060051
SITE ADDRESS . . . . . : 21456 HOLLY OAK DR
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : EWING DONALD
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : JUST WATER HEATERS
CONTRACTOR . . . . . . . : .GILROY, JOHN LIC # 15128
COMPANY . . . . . . . . . . : JUST WATER HEATERS INC
ADDRESS . . . . . . . . . . : 3400 INVESTMENT BLVD
CITY/STATE/ZIP . . . : HAYWARD, CA 94545
TELEPHONE . . . . . . . . : (510) 293-9901
*EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- --=------- ---------- ---------- ----------
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BPWHEATER PER HEATER 1 . 00 10'. 79 0 . 00 10 . 79 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 84 . 02 0 . 00 84 . 02 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
oceoceoc55i
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 21456 Holly Oak Dr. Date: 06-05-06
Owner's Name:---Ewing Donald
Phone No.(408)252-2570
APN#: 362-02-031 Project Valuation: $1,281.00
Building Permit Info: Bldg Elect Plumb____X_ Mech
Job Description
Replace 40 gallon gas water heater.
Contractor Information
Company: Just Water Heaters Inc. Phone: (510)293-2012
• Contact Name: Dulce Fax: (510)293-2022
Address:3400 Investment Blvd. E-mail: permitdept®sbcglobal.net
City,State and Zip: Hayward,CA. 94545
State Contractor's Llcense# 591329 Exp.Date: 3/31/08
Worker's Comp#: C44510091 Carrier.ACE Exp.Date: 4/1/07
Credit Card Information
Credit Card #: 5474-6390-0047-8660
Name on Card: Just Water Heaters Inc.
Expiration Date: 06/08
Visa MasterCard
Comments
Community Development
10300 Torre Avenue
Cupertino CA 95014
CIN 0 Telephone(408)777-3228
OCU PEI�TI NO Fax(408)777-3333
Building Department
JOB ADDRESS: PERMIT #
21456 Holly Oak Dr.
OWNER'S NAME:Ewing Donald PHONE #408-252-2570
GENERAL CONTRACTOR: Just Water FAX # 510-783-6360
Heaters
I am not using any subcontractors: 06/05/06_
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
� -� 06/05/06
10/28/03