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GT0 NFORMATION:
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
9A T4ynp AIT
JUST WATER HEATERS INC
PERMR NO.04080077
OWNER'S NAME:
PERMIT IS9UE DATB
ONE:
SANITARY O OL N0.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Descrl
trINALW
1 hereby affirm Nal I em licensed under provisions of Chapter 9 (commencing
with Section 7") of Division 3.f Ne Busircv and Professions Code. and my lternse is
in full force and effect.
REPLACE WATER HEATER
License Class.Lic. 0
DateCongacma
(4 0 GAL GAS) SEP X 2004
ARCHITECTS DECLARATION
1 undersand my plans shall he used. public mr.ds
BUILDING
Licensed Ptoressional
OWNER -BUILDER DECLARATION
1 hereby affirm That 1 am1. exempt from Ne Canine License Law far nW
Cod,: Any tiny our county
following reason. Co
1onamo Business and
w, dc.m
which mquima a Permit hb eanxaueL eller, impmsu ommL h, fi mash any structure
erten 1
prior its isnot., also requirce nW aof for such permit cIc signed auamem
Sq. Ft. Floor Area
Valuatio
s
NeConuactasand cnseluw(Chapter
that e, licensed pSewam vision L
the")
7 7 7
710
of Divismaf
Cock) or
(commecng of Division Code)
(commencing of i Baseg.d.n and...
bourns
Anynvi
and r Any violation Of
Nn io u ,, then m and Me -perm far to
APN Number
Occupancy Type
coram Mile-' In
Section 7o3ls-Tony appficanl Tact. permit ase -resect ate appeeant taaa.a penny our
31.5 b .1 lip
not mom about five hundred delta. (5500).
3 • O
'
rv, '
m y. or my employees with wagas as Mich MIC compensation.
p I. as owner of the ppenM
Required Inspections
9 P
will do Me work, and Me Malcolm is nat naaderd or offered for sale (sec. TOsa, Business
and Profession Cad,: The Conaa or's License Law data not apply m an owner of
prop,ny who builds or improves Ammon, and who doessuch work himselfarthmugh his
n employees, pmvided Na such improvements are not intended oroffereA for sale. It.
however, he building or improvement is said within one year of completion, Ne owner
builder will have Ube burden or proving Mat he did not build or improve far purpose of
sides).
I. as owner of Me Ptolemy. am exclmively eonuaaing with licensed one.. to
construct the project (Sec. 90414, Business and Professions Cade:) The Contractor's U.
rte law docs not apply to an owner ofpropeny who Wilda or improves Memon, and,
who conncu for such pmjece, with a canssesor(s) licensed pursuant to the Carracmr's
.
License Law.
❑ 1 am exempt under Sec. . B & P C for this rtxean
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 Wmby affirm under penalty of perjury one of Me following dcdamioo k
I have and will maintain a Cerdficme of Consent M self insum for Wort esCompel-
.tion, as provided far by Section 3100 of Me Icor Cade, far Me peafmma.e of Me
work for which this permit is issued.
1 have and will maintain Waskeri Compensation huunince, as required by Section
37W of Me labor Cook, for am performance of Me work for which Mis permit is issued.
My Worker's Cnmpenatian In.--rai r and Policy mrmber are:
,
Cartier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sectin.,d tet W eumphard if ourpermit is faro. hundred ollam (3180)
or less.)
I unify that in Me performance of Me work for which Mill permit is issued, 1 Mail not
employ any person in any mans M Is to become subject to the Warlmay Com ternatian
Laws of California. Data
/t ry
Applicant
NOTICE TO APPLICANT: If, after making Mis Cenifoate of Exemption, you should
Wcom, a Warh s Camp idose of Uc Iceedr Cade, you mux
JU/',t//VI(y/I —
or this Permit
r forthwith comply with such provisions or this permit shall W rimmed rtvatcd.
comp y it p
v\}'s
OCONSTRUCTION LENDING AGENCY
I W reby affirm Wt Mort is a emuwctinn lending agcy far Me performa.e of
a' Me work far which this permit is issued (Sec. 3 W, Civ. C.)
QLender's Name
.
Under's Address
z
Q I ..try that I have read ads application and sato: Must Me Move information is
correct. l agree to comply with all tiny and county oninances and sum laws slating to
Wilding ck)vection,andhen:emniby yand representatives of this da nmrupnnnst
U
abova-mentioned pm,lty lar important purposes.
OfCapiy
(wc) agree to serve. indemnify and tech harmless am City ofe a
gamin id City
q liabilities. judgments, toss and expenses which they in any way accme against mid City
Z Incameque.earBut granbngafOil lNonnit.
r. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Type of Roof
Signature of AVpBuntlConoa air oak
HAZARDOUS MATERIALS DISCLOSURE
Will Me applicant or future Wilding Occupant tore our handle haallous makfial
as defined by nW Cupertino Municipal Coe. Chapter 9.11. and Me HeaIM and Safety
Code. Section 15531(ar!
All roofs shall be inspected prior to any roofing material being installed.
[3 Yes ❑No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant our future building Occupant use equipmcnl or dcvitta which
for inspection.
it bo ardous air comaminan t as defined by Me Bay Arca Air Quality Management
all new materials
ismer?
0Yes ONO
I have mad Me hatardouemakria9 requirements under Chapter 6.95 of the Califoa-
niaHealM&SaretyCoe, Seetias253115, 2553] and M5N. I undcmund Mu ifnM Wilding
docs nut cunbnly hoc a mote, Mot it u my responsibility. ally dm cavi of am
Date
requirements which muxW-at pdarwssuanecanCeraecateOfOccupancy .
Signature of Applicant
All roof coverings to be Class "B" or better
Ownerseraumori., apMt Das
i
*CITY OF
UPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
898 Hyde Ave.
PERMIT #
v qog O D% 7
OWNER'S NAME: Arnold, Claire
PHONE # 408-996-1746
GENERAL CONTRACTOR: Just Water Heaters
FAX # 510-783-6360
0
•
I am not using any subcontractors:
8/10/04
Signature Date
Please check applicable subcontractors and complete the following information:
8/10/04
Owner/ Contractor Signature Date
10/28/03
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
8/10/04
Owner/ Contractor Signature Date
10/28/03
0
C
E -Mail
of Cupertino Buildinq Permit Application
jobsite Address: 898 Hyde Ave. Date: 8-10-04
Owner's Name: ---Arnold, Claire
Phone No.(408)996-1 746
APN#: �2=0i�003� roject Valuation: 4 777.00
Building Permit Info: Bldg -_-------- Elect--------- Plumb-----X-----
Job Description
Replace 40 gal gas water heater.
Contractor Information
Mech-----------
Company: just Water Heaters Inc. Phone: (510)293-2012
Contact Name: Dulce Fax: (510)293-2022
Address: 1764 National Ave. E-mail: permitsC@justwaterheaters.net
City, State and Zip: Hayward, CA. 94545
State Contractor's License # 591329 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 a 6 I q
Name on Card: Just Water Heaters Inc. l
Expiration Date: 9/05
Visa F-1 MasterCard
mments