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04020125 CITY OF CUPERTINO '` ` �` W 1� BUILDING DIVISION PERMIT COkvTRACT(SRTIVF(SRMATIO,N BGILDINGADDRESS: JUST WATER HEATERS INC """"04020125-`19 XTIRWIN IN 0 WNER'S NAME: PERMITISEOE DATE ONE: SANITARY NO. CONTROL NO. ARCHITECTIENGINIER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH + oa LICENSED CONTRACTOR'S DECLARATION lob Description ZF (hereby affirm Ito, em liwnud undo provisions of Chapter(commencing ^��D <U with Secsiun]WO)of Divixlon Sof Ne Business and Professions Cotle,and mylicense is ILIA w in full forte and effect. H� license Class uc.x REPLACE WATER HEATER pro Dam contractor (40 GAL GAS) MAR Z6 204 QQ� ARCHITECTS DECLARATION I understand my plans shall W used m public see ody JyU S o n Licensed Pmfcssinnal O U DPHS g OWNER-BUILDER DECLARATION LUJ LV u�'f 0 I hereby maso .(feta on 1 1. exempt from the Cssionso :Anycose law for the 2 0 which rem a Permit I 703 1.5,Business and Improve. de Professions Code:Any city or roomy K$� which reyuim oa pcmtit m cnnumm,altar.improve,demolish.ns repair any strucwm m—m prior to its issuance,also reyuires the applicant forsuch permit to file a signed statement �x�xa that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area ValUatl yF$ (commencing with Section 7030)of Division 3 of the B usions and Professions Cynic)or g8a2 y Nal he is exempt themfrom and the basis for Ne alleged exemption.Any violation of Section]031.5 by any applicant for a permit mikes,the applicant to a civil penalty of APN Number Occupancy Type not mom than five hundred dollars(S500). 01,as owner of the property,or my employees with wages as their sole compensation, 35923002 . 00 will do the work,and the awcmre is not intended or offered forsale(Sm.7044,Business and Professions Code:The Conuacmr's License Law does not apply to an owner of Required Inspections property who builds or improves Hereon,and who does such work himself or through his own employees.provided that such improvements ere not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to consumer the project(Sec.7044,Business and Professions Code:)The Contractors Li. cense law does not apply to an owner of property who(wilds or improves thereon,and who contracts for such projects with a morme or(q licensed pursuant in the Cnntrecmrb License Law. ❑l am exempt under See. ,B&P C for Nis mason Owner Dam WORKER'S COMPENSATION DECLARATION 1 hereby affirm under Penalty of perjury one of the following decimations: I have and will maintain a Certificme of Consent to self-insum for Workers Cumpcn- 7301W um,as provided for by Section 37W of the Lzhor Code,for the p.rtos nicom Of the rk for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,ss required by Section of the Labor Code,far the performance of the work for which this permit is issued. yWorker's Compensation Insurance carrier and Policy number am: rrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE mde,oction need not bccompleted if the permit is fortune hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,l shall not employ any person in any manner an as m become subject to the Workers'Compensation Laws of Califomia.Dam Applicant NOTICE TO APPLICANT:If,after making Nis CertiOcam of Exemption,you should became subject to the Worker's Compensation provisions of the Labor Code,you must ,J Q forthwith comply with such provisions or this permit shall be deemed revoked. forthwith don Won CONSTRUCTION LENDING AGENCY Q [—tom I to,which that ndi isa.tungroc.3097lending agency lm the perfurmansm of a the work fur which this permit is issued(Sec.3(19].Civ.CJ _ W Q Lender's Nam. 6. Lender's Address U Q I certify Nat I have read this application and sum Net the about information is lagrcemcomply with all city and county ordinances and&rate laws mining to �O building construction.and hereby amhorim representatives Giulia city to enter upon the fdl ahovcm.mioned Property for inspection purposes (We)agree to save,indemnify and keep harmless the City of Cupertino against iF—t r�A liabilities,judgments,costs and expenses which may in any way accme against mid City C)z Aconsequence of the ranting Of t LICANT UNDERSTANDS WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs HAMR SigneSignatureof Applicacmr Dem HAZARDOUS MATERIALS DISCLOSURE Type OF ROOF Will the applicant or future building uccupam stem or handle haysNuus material as do Cd by Nc Cupeniw Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(.)? No All roofs shall be inspected prior to any roofing material being installed. ❑Y ❑ Will Nc applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit hazardous air Condominiums as defined by the Bay Area Air Quality Management all new materials for inspection. District] ❑Yes ON. I he.read the havaNeus materials requirements under Ch nor 6.95 of the Califor- nieHcalth&Safcty Code,Sections 25505.25533 and 25534.1undcrsund thaifthc building does not curt.mly have a unam,that it is my responsibility in notify the mention of due myuircmmas which must Im met priurm issuance of.Cenificate of Occupancy. Signature Of Applicant Date Owner or authorized agent Date All roof coverings to be Class"B"or better I � U� 6 City of Cupertino Building Permit Application E-Mail CYC'/// � J jobsite Address: 7532 Kirwin Ln. Date:�1.�5=04� Owner's Name:---Donez Marty Phone No.(408)873-0632 APN#: 359-23-002 Project Valuation: $ 882.00 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)293-201 2 ® 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: 3/31/04 Worker's Comp#: 1626288-03 Carrier: State Compensation Insurance Fund Exp. Date: 4/1/04 Credit Card Information Credit Card #: 5474-6390-0026-5679 {2�S—S 2- Name Name on Card: just Water Heaters Inc. Expiration Date: 9/05 Visa E:l MasterCard Comments