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05090078 CITYOF CUPERTINO BUILDING DIVISION PI✓RIVIIT CONTRACTOR INFORMATION''> BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT NO.O5090078 1,,TTM4 VT4TA nP OWNER'S NAME: PERMIT ISSUE DATE DENISE COLLIER 3400E 2005 NE: SANITARY NO. CONTROL NO. 510) 293-9901 ARCHITECrIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 =1111 LICENSED CONTRACT'OR'S DECLARATION x u C I hereby affirm that I am licensed under previsions or Chapter 9(commencing Job Description Szin with Sccsion7")of Diviuon Sof the Business and Professions Code,and my license is in mumneandeffect. REPLACE WATER HEATER �? License Clan Lic.is t 0m Dam contractor 40 GAL GAS ARCHITECTS DECLARATION �8{}(I�� (r rte® y' I mider.Gand my plans shall IM used as public RCor14 rl\\ r� a �t{l fL'Irlby9, �yU 3 'Cin Licensed Professional y OWNER-BUILDER DECLARATION .�<f 1 hereby affirm Nat 1 am exempt from the Contmnors License Law far 0lo Co following reason.(Scctiun7031.5,Business and Professions Codc:Any city orcounty SEP 1005 K which requires a permit to cnnsruct.alter,impmw,demolish.Or repair any suunom .in_�, P60Tto its issuance.also require the applicant for such permit to file a signed sediment < that hcislicensed purman to On,provisions;nrthe Contractor's License Law(Charter 9 Sq. Ft. Floor Area Ualuatio$822 ¢ (commencing with Section]0n0)nf Division 3 or NC Bisirusand Professions Crede)sers - i $ thin he or exempt therefrom and Um ha ds for the alleged exemption.Any violation of l. 1 NaisM Tr�T SaBon]031.5 by any applicant for a Permit subjects the applicant in a civil penalty of APN Number "' "' "'Occt3"erste' TYP' •e-�V' not mom than five hundred dollars($500). P Y I ssmwner ter Nero 35616024 . 00 ❑ p Dmciuccmyempended withcmdImahevec.compewness will neo the wok,and the he Con is not intended s or Law do forsak(Sec.ina4,Buser of and Proresslom Code:The cmnmxmrs License uw axe trot apply m an reverser ter Required Inspections propcny who Wilds orimDrorcs Nemon.and who doessuch work himself err through his ohowever,the building or improvement mprmwmenn u mid within oneyear of completion,the ower. Guilder will ham the Wrdcn of proving that k did not Wild or improve for purpose of sale.). ❑1,as owner of alo property,am exclusively convecting with licensed contranars to consumer IN,project(Sec.7044,Rusiness and Professions Cade:)The Contractor's Li. cense Law docs not apply in an Owner of propcny who Wilda or impmms Merton,and. who somans for such pmjccs with a conuactorfs)licensed pursuant in the Convectors License law. ❑I am axempt under See. .B&P C for this vson Own Dat WORKER'S COMPENSATION DECLARATION 1 hereby aRlno under penalty of perjury one of the following dxluations: I Its and will maintain a Certificate of Consent to ul6insum for WokcrsCompen- 1E33737.' on,u provided for by Section 3]00 of the Labor Code,for the Performance of tW rk for which this permit is issued. 1 haw and will maintain Workers Compensation Insurance,as required by Section 00 of NC labor Code,for Ne performance of Ne wok nor which Nis permit is issued. Workers Compewtion Insurance artier and Policy number am: mcc Policy Na.: CERTIFICATE OF EKEMP ION FROM WORKERS' COMPENSATION INSURANCE This section need not W complemd it the permit is fmranc hundred dollm($1011) or Ice.) I emmfv that in the performance of Ne work for which this permit is issued.I shall net employ any person in any manners as to become anhecuo the Workers'Compemuion laws ofcelifri ia.Date APPlicam NOTICE TO APPLICANT:If,after making this Cenifiate or Exemption,you should become subject in not Worker's Compemarien provisions of the Labor Code,you most ,J O foMwuh amply with such prcvisiom or this Permit shall W dcemcd revoked. Z CONSTRUCTIONceisaconstruction LENDING ngagerAGENCY F Thor which thi thmdtere issed(Se.imnlending agcney fm tilo perfurmana of C the souk for which this pernit is issued(Sec.J09],Civ.C.7 W� 0 Lenders Nam. z Lender's Add. V Q 1 certify Nar 1 have mad this application and sum thn the about information is fL Fcovets I agree m comply with all City and county ordinances and sum laws relating to C) building construction.and hereby auNmrix mpresenedircs of this city to color upon the tancel r aWve-m.nudghunmp.nr randepcmes which may (we)agree to saw,indemnify and keep harmless the City of Cupertino against .�•t h liabilities,judgmcnta.coss and expenses which may in any way accac against said City V z APPLICAnce Of this permit.DS eNT UNDERSTAof the NtAND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Signature of Applicaua nVConcmRe-roofs r Dem - HAZARDOUSMATERIALS DISCLOSURE Type of Roof Will the applicant or forum building occupant mm or handle havardous material as dcEncd by the Cupertino Municipal Code,Chapter 9.12.and the Health and Satiny cmde.Section,25532(a)9 0Yes 0 N All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building Occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove it haeardnus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. ismer? ❑Yes ON. 1 have mad the honrdnus materials requirements under Chapter 6.95 of the Califor- maHealth&Safety Code,Sections 155115.M533 and 25534.1 understand Nat if the Wilding dors net currently ham a tenant that it is my responsibility to untily the occupant mf oc mquuemens which must W met prior to issuance or a Certificate of DearNer' Signature of Applicant Date Owner or authorized agent D,te All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue t �.� Cupertino CA 95014 Telephone(408)777-3228 CITY 01 Fax (408)777-3333 ,CUPEkTINO Building Department JOB ADDRESS: PERMIT# 11066 Linda Vista Dr. rD�-7) s 0/ OWNER'S NAME: Collier, Denise PHONE # 408-253-4332 GENERAL CONTRACTOR: Just Water FAX # 510-783-6360 Heaters I am not using any subcontractors: ���cR. � � 9/12/05 Signature Date Please check applicable subcontractors and complete the followinginformation: 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 ,.xs�r�' 4 �gvCAQt-sCCiv�� 9/12/05 10/28/03 o S'D City of Cupertino Building Permit Application E-Mail Jobsite Address: 11066 Linda Vsta Dr. Date: 9-12-05 Owner's Name:---Collier, Denise Phone No.(408)253-4332 APN#: 356-16-024 Project Valuation: 5 822.00 Building Permit Info: Bldg— Elect Plumb__ 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)783-6360 Address:3400 Investment Blvd. E-mail: permitdept®sbcglobal.net City, State and Zip: Hayward,CA. 94545 State Contractor's License# 591 329 Exp. Date: 3/31/06 Worker's Comp#: 1626288-OS Carrier:State Compensation Insurance Fund Exp. Date: 4/l/06 Credit Card Information Credit Card #: 5474-6390-0047-8660 `�(a Name on Card: Just Water Heaters Inc. 3 Expiration Date: 06/08 Visa ❑ MasterCard ® Comments