05080039 CITY OF CUPERTINO
BUILDING DIVISION PERMIT yCONTRAGTOR INFORMATION
BUILDING ADDRESS: JUST WATER HEATERS INC P""'NO05080039
10143 LOCKWOOD DR
OWNER'S NAME: PERMIT ISSUE DATE
t' \ PAKMAN WONG 3400 INVESTMENT BLVD 08/05/2005
ONE: SANITARY NO. CONTROL NO.
(510) 293-9901
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
naa o 0 0
vg LICENSED CONDiACIDR•S DECLARATIONN/f or 1 R
m❑ I hereby affirm Mlicensed I am nsed under previsions of Chapter 9(commencing Job Descri or 1i
�
iW with Section]INN))of Division 3 ofthe Busirmsand Profusions Code.and my liccnti is a -s•
"3H inrwfn=andaffect. REPLACE WATER HEATER,
3nK Lice nm ClassLi..M 0
c Dare Cmanamr 40 GAL GAS
FF'J` ARCHITECTS DECLARATION �� O
Y< I understand my plans shall he used m public records A ?O (v
aLL� Licensed Professional S a/
JasU �
e.5 OWNER-BUILDER DECLARATIONq
1 hereby affirm that I on exempt from Ne Cmurommes License law for the
as
a o following reon.(Seeuun 7031.5.Business and Pmfeaioru Code:Any city or County
t= which acquires a permit m ennnmet,alma improve,MMMIL h,or repair any ssrvcam,
-zipoor it its issuance.also requires the the applicant for such permit to file a signed augment
that he is licensed pursuant to to previsions of the Contncmr's License Law(Chapter 9 Sq.Ft.Floor Area Valuatio 850
,HM (commencing wi th Section 70f)(1)of Division 3 of Me Business and Professions Cache)or
y
that he is exempt storefront and the basis for to alleged exemption.Any violation of
Section 1031.5 by any applicant for a permit subjects the applicant to a civil penalty of AEN Number Occupancy Type
not more Nan eve hundred della.($500). 34 214030 . 00
I,as owner of die property,a my employees wit wages as their sole compensation,
will del the work.end the strucwre is not intended or offered for axle(Sex.7W Business
and Profession, Merro
code:
The Committees License law does Wt apply to an owner.f Required Inspections
property who Wildimproves n,end whod.essuchwork himself.,through his
own employccs,provided tatsuch improvements art not intended oroffcrad for We.It,
however.Ne building or improvement is sold within arc year of completion,Ne Mwncr-
builder will have the burden of proving men he did ret build or improve for purpose of
ale I
❑1,as owner of the property,am exclusively contracting with licensed contractors to
(Michael Me project(Sec.7044,Business and Profusions CUM:)The Contractor's Li.
citing,Law dues not apply in an Monte ofpropeny who Wilds or improves Mercer,and
who contracts for such projects with a eantnetm(s)licensed pursuant to the Cor mactoh
License La-
0 1 am eaempr under sec. .B&P C for this mason
Owner Dale
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under pantry of perjury one of the film.,declarations:
1 have and will maintain a Certificate of Continuo self-insum for WorkersCorepen-
inn,m provided for by Section 3]00 of Me labor Code,for the performance of the
7M1CICL
rk for which this permit is issued.
1 have and will maintain Worker a Compensation Insurance,as required by Section
00 of Me labor Code,for the performance of Ma work for which this permit is issued.
y Workees Compemation Insurance artier and Polity number amhm.. Policy No.::
CERTIFICATE OF EXEM MON MOM WORK ERS*
COMPENSATION INSURANCE
(Thesecaion need not W completed if the permit is forme,hundred dollars DI W)
or less.)
I certify that in the performance of the work for which this permit is issued.I shall not
Employ any person in any manner an as to become subject to the Workers'Compensation
Laws of California.Dare
Applicant
NOTICE TO APPLICANT:If,after making this Ceniecae of Exemption,you should
Wrthmes comp tote Workesuch pro Coons or Compensationprovisionsof thefaWrCode,you mug
.,vz
become
hcomply wit such is Comnsosto Permit sions W eLaboceragi r Code. ✓1
Z O CONSTRUCTION LENDING AGENCY
1 thereby aRran tar then is a contracting lending ageacy for Me performance of
GC Me walk for which this permit u issued(Sec.3OD,Civ.C.)
W� A Lender's Name
Z) z Lender's Address
fJ t7 I certify that 1 have read this application and shote that due above information is
tL P correct I agree to comply with all city and county ordin rams and sate laws mladng to
0 U building construction.and hereby sushorine repnsenuuva of this city to enter upon Me
LQ s
show mentioned property for impaction purpose
Q.
(We)ogres rove,indemnify and kap humless the City of Capelin,against
F"f/l habili4q,judgments.costs and expenses which may in my way seem agalmt said City
Of the gagging O(I
V z APPLr CANTCUNDERSTANDS ArND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature Mf ApplicaData
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant ser future Wilding mcupant store or handle hanNum marctal
as deemed by de Cupeni no Municipal Code.Chapter 9.12.and the Health and safety
C]Yes CMdc.Section 25532(a)? 0N All roofs shall be inspected prior to any roofing material being installed.
/ Will Mea Brant or future WOCin If a roof is installed without first obtaining an inspection,I agree to remove
pp g occupantuseequipmentordeviceement
snider? nusair conaminantsudefined by de Bay Arca Air Quality Management all new materials for inspection.
DistrictT
❑Yes ❑Nu
I have read Me harardousmaurials requirements under Chapter 6.95 of the Califon
ma Beside&Safcty Code,Sceuom25505.25533 and 25534.1 undeamnd taillm Wilding
data not Currently have a tenant that is is my responsibility M notify the scups.(Of Me
requirements which must he met prior to mummer,ofa Certificate of Occupancy. Signature of Applicant Date
Owner or am Wri.d agent Date All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
8CITY OF Fax(408) 777-3333
1UPEkTINO
Building Department
JOB ADDRESS: PERMIT o
10143 Lockwood Dr.
OWNER'S NAME: Wong, Pakman PHONE# 408-2579592
GENERAL CONTRACTOR:Just Water Heaters FAX# 510-783-6360
I am not using any subcontractors: �� � � � � � 7/05/05
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
7/05/05
Owner/Contractor Signature Date
10/28/03
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 10143 Lockwood Dr. Date: 7-05-05
Owner's Name:---Wong, Pakman
Phone No.(408)257-5592
APN#: 342-14-030 Project Valuation: 5 850.00
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)293-2012
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#: 1626288-05 Carrier: State Compensation Insurance Fund Exp. Date: 4/1/06
Credit Card Information
Credit Card #: 5474-6390-0047-8660 ?
Name on Card: Just Water Heaters Inc. J b
Expiration Date: 06/08 0
Visa MasterCard
Comments