04070147 ' CITY OF CUPERTINO "
BUI LDINC DIVISION PERMIT 'C
ONTItACTOBUILDING ADDRESS: JUST WATER HEATERS INC PE """04070147
ON AIM.
OWNER'S NAME: PERMIT BIUS DATE
SUSAN
RO NE: SANITARY NO. CONTROL NO.
(510) 293-9901
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
'oo LICENSED CONTRACTOR'S DECLARATION 'lob Description we/I"ys
m C I hereby affirm that I am liansW under provisions of Chapter 9(rnmmcncing Y IVT
U with Section 7000)of Division 3 of Ne Bmunesand Pretensions Code,and my license is °V Q
imm�mreeamderr t REPLACE WATER HEATER
Ll i License Class Lic.If
—o
Do
Co.,., (4 0 GAL GAS) JUt g?
ARCHITECTS DECLARATION O 20pA
< 1 undersand my plans shall he mat u public records A� 7
J i U �GDAII II
e Licensed Podcssiond
a.0j OWNER-BUILDER DECLARATION
.� S I hereby alprm that 1 em acnin from dm Contractors License Law for the
s00 borrowing mason.(Scedon 7(n1.5.Business and Pref•idore Code:Any city of county W
$� which requires a permit m,eonstdet.alar,improve,demolish,er repair any s natum
print us its issuance.also requires the applicant forsuch Permit to file a signed su intent
��< that heI,Became! ursuam0otheprovisions ofthe Contractor's License Law(Chapmr9 Sq. Ft.Floor Area ValuatiJ944
f$ (commencing with Section 7")or Division 3 oflhe Busuessand Profession Cede)m
.. Net he is exempt therefrom and the basis for the alleged exemption.My violation of
Section 7031,5 by any applicant for a permit Subjects the applicent to a civil penalty of APN Number Occupancy Type
not mese than fiva hundred dollars(6500).
37528031 . 00
of.u owner of the gropeny.or my employees with wages as their som compensation,
will do the work and the sumdum is not inanded or offered to, .to(S..7046,Business Required Inspections
and Probations Code:The Contractors License Law don not apply to an owner of 9 P
property who bei Ids a improves tiercmn.and who das such wart himself or through his
awn employees,provided that such improvements are not intended oro@red missile.IL
however,the building Or improvement is sold within one year of completion,the owner.
builder will have dm burden of proving that he did nor build or Improve for purpose of
axle.).
0 1,as Owner of the property,am aclusively contracting wit licensed contractors to
consumer rise poled(Sec.7014.Business and Professions Code:)The Contractor's Li.
amc taw does not apply to an owner of property who builds or improves thereon,and,
who contracts for such projects with a eomraetorod licensed pursuant to the Contractors
Lice=law.
0 1 um are.to under Seo. B&P C for Nis on
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby ire under penalty of perjury one of the following dndidinionc
1 have and will maintain a Cenifcam of Conant to silt-insure for Werear'sCorrigan.
sation.az provided for by Section 3700 of the Labor Code,for the performance of the
wok for which this permit is issued
0 1 have and will maintain Workers Compensation Insurance,as enquired by Section
3700 of dm labor Code.for the performance of the work for which this permit is tuned.
My Workers Compensation Insurance carier and Policy number sm:
Cartier. Policy No.: '
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('This section need not beeomplead if rhe permit is fortune hundred Mllars(SIM)
or leas.)
1 certify that in the performance of me work for which this permit is issued.I shall not
employ any pecan in my manner so w w become subjcet to the Workers'Compmaadan
Law.of Call(..ie.Dam
Applicant
NOTICE TO APPLICANT:If,after making has Cenifioa of Exemption,you should
become subject in the Worker's Compensation provisions of the laW Code.you most
forthwith comply with such previsions or this permiuhall be mortud nevaked.
ZO CONSTRUCTION LENDING AGENCY
�-. l hereby chum Natmem issued(Seconstruction. 01lending agency for the perfurmvmc of
h(7 Le work for which this permit Is issued(Sec.3097.Civ.C.)
Iq Q lenders Nam.
IL l<nder's Address
U 1 ccnlfy that I have read this application and sum mal the above information is
Il r- comet 1 agree On comply wire all city and county oNinsnas and sma laws rsts0ng to
0 u building construction,and hereby authmrse representatives of this city m enter upon the
W shove-mentioned property for inspection proposes
1 (We)agree to save,indemnify end keep Winless the City of Cupertino agaimn
V) Iiabilida,judgments.costs and expenses which may in my way accrue against said City
U Z in consequence of me gaming of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicmOCommmor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building emupanr store or handle herardous material
az de(Incd by the Cupertino Municipal Code.Chapar 9.12.and the Health and Safety
Co dc,Section355320)7 All roofs shall be inspected prior to any roofing material being installed.
Yes ONO
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment in devices which
mit hoxardom air contaminants az defined by the Bay Arca Air Quality Management all new materials for inspection.
7ro0woor
D Ycs ❑Nu
I have mad thc nexammuemaariaHrequirements untierChaper 6.95 of0c Calif r
a Halth&SafetyCodc.Seen=25515.25533 md25534.I undersandmu ifthe Wilding
ao our currently have a ansae mat it is my responsibility tofy Nrenotie oupant of the
quitements which must be met prior tu issuance Of a Cenihcate of occupancy. Signature of Applicant Date
or amhnrncdagent Date All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
OCITY"OF Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
10584 Johnson Ave. 19 el4 o "
OWNER'S NAME: Fro d, Susan PHONE # 408-253-9271
GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360
I am not using any subcontractors: 0`A"W- �40�+ 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 ' l 1
''10"`'t 6/20/04
Owner/Contractor Signature Date
10/28/03
t
v a7
City of Cupertino Building Permit Application
E-Mail
jobsite Address: 10584 jonhson Ave. Date: 7-20-04
Owner's Name:---Froyd,Susan
Phone No.(408)253-9271
APN#: 375-28-031 Project Valuation: 5 944.00
Building Permit Info: Bldg----------- Elect----------- Plumb------X----- vech-----------
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 2,�(L, 2, �
Name on Card: just Water Heaters Inc.
�{ 7`�/
Expiration Date: 9/05
Visa MasterCard X
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