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05090082 clTv of currxTm° PERMIT aC0NTRACTOR�INFORMATIQN BUILDING DIVISION BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT NoO 5090082 21760 LOMITA AVE OWNER'S NAME: PERMIT ISSUE DATE BIRAN DORIT 3400 INVESTMENT2005 ONE: SANITARY NO. CONTROL NO. (510) 293-9901 ARCHITECT'/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH F__1 (� yOp LICENSEDCONTRACIOR'SDECIARATION JobDescri tio—ir C I hereby affirm Nat 1 am licensed under provisions of CM1apter 9(commencing wish Section 7")or Division 3 of the Business and Professions Code.and my license is n_ow m full rarteand effect. REPLACE WATER HEATERtj_.`IT,'L�pT. a? Liccnv Clav Lk.N P� `k�`v^�'++® Z—c Date Cmmalor 50 GAL GAS ty ARCHITECTS DECLARATION SEP �-r 1 uMu erstand my plans shall W used public meafds 20 0 C �yU J 30.E Licensed Pmfeuiunal ���+++���,,, Fl F� ^oI OWNER-BUILDER DECLARATION �� T-TiA'g$A I ,f�ybs d00 1 meteerebyaffirm that exempt from the Cssions o :Anycense Law for the IfadPll✓a]ry iCj�✓,'(ry{���s`�Sm��.`+'n. p o following mason.Permit t 7031.5.Business and Professions Cude:Any city m county C� K m which requires a pernit us cnnswcL alter.Improve,demolish,or repair any swcwm prior u its iuuancc.alw rrqunsitc applicant(orsueh permit to plc asigned statement That W is licensed pinsom to din provisions of the Contractor's License taw(Chapter 9 Sq. Ft. Floor Area ValuatioO 918 C,- (commencing with Section 700B of Division 3 of the Business and Profeuia sCode)or i $ Nal be is exempt tbcmfrom and one basis for the alleged exemption.Any violmion of Section 7031.5 by any applicant fon permit subjects On applicant to a civil penalty of APN Number Occupancy Type not mom than live hundred dollar:(S5O0). 35718040 . 0 0 Ido the wcr .the property, remy otinuncee with wages u theiSec.mmpenm0an, will do the work,and the swam:is user Li eed oro mored s nate(Sect oa6,wner of and er,whioW Gude:The canmcwrs ucene law deet not apply lf rt rough or Required Inspections own eny who builds provided Oat ech imps and who am not workerhimelfor through sad his awn employers,provided Nal vemimproscmenu arc not xist o c or leered for Owner. however,the building bu improvement is ab within one year of completion,the owwr builder will have the burden of proving Nat he did not Wild or improve for purpose of salt.). ❑h as owner of the property,am exclusively contracting with licensed contractors to construct de project(Sec.7044.Business and Professions Code:)The COntruwr's Li- ,,s,taw does not apply to in owner of property who Wilds or improves demon,and who contracts for such projects with a conmetof(s)licensed pursuant in the Convector's License law. ❑I am exempt under Sec. .B h P C for this Cooked Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the fallowing Qchosioru: I have and will maintain a Certificate of Consent ti elf insure for Worker's ComKn. ration,as provided for by Section 3700 Of the labor Code.for the performance of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Inwmbec,m required by Section 37W of the Labor Code,for NC Performance of Ne work for which this permit is issued. My Wmkcr's Compcusatiar Insurance Cartier and Policy number art: Carrier. Policy No.: CERTIFICATE OF EKEMMON FROM WORKERS' COMPENSATION INSURANCE ODds section need not W completed if sbe permit is portion hundred dollars(Sl W) or loss.) , I ccnify thus in the perf torsts c of On work for which this permit is Wood,I shall not employ any person in my mortician u to Wcome subject to the Workers'Compensation Laws of C.1if anis.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate Of Exemption,you should become subject to the Worker's Comp nsiolon provisions of Nr.Labor Code,you mum poMwi0 comply with such previsions or this Permit shall W deemed mvoked. Z O CONSTRUCTION LENDING AGENCY 't•+� IWfehy eRon Nat Vert iso construction lending agency for ft performana of ^ (� C � the work for which this permit u issued(Sec.309],Civ.C.) W 25 Lender's Name a Z Lender's Addreks U O 1 ccnify that 1 have mad this application and music that Ne move information is ry correct.I agree to comply with all city and county ordinaries and some laws relating to O U building consimaLion.and hereby millpond rcpreumative of this city m cater upon Nr. �W above-mentionW pa,eny for inspection purposes. C (We)agree to save,indemnify and keep hi mlev the City Of C9PCf1100 against y Iiabilitie.judgmenu,coms and expmue which may in any way accrue against mid Ctry orthe U Z in r. APPLICANT eUNDERSTANDS AIND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signature of ApplicanUCanDate HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Oe applicant or fuwrt W ilding aceupantmort orhandle hamNous material e dC1ned by the Cupanino Municipal CoQ,Chapter 9.12,and the Health and Safety ewe,secties 2ss3x.)] All roofs shall be inspected nor to an roofing material being❑Yea ❑Na P P Y g g installed. Will thea scant or future building Occupant tie equipment or devices whim If a roof is installed without first obtaining an inspection,I agree to remove pp g p .AirQn it havrdnus air conominanu u QOncJ by On Bay Arta Air Quality Managcmcnt all new materials for inspection. IaIfICI] ❑Yea El No I have mal the yomminus materials requirements under Chapter 6.95 of the Califor- niaHC.1 &Safety Cade,Sccuoro 25505.25533 and 25534.1 undersand tho roe Wilding d.not eurenlly haw a tenon Out it is my respoasibility m routy the occupam nI Ne rccomments,which must W met poor it)issuance ofa Certificate of Occupancy. Signature of Applicant Date Owner Or authorircd agent Dale All roof coverings to be Class "B" or better Community Development C ` 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax (408)777-3333 ®CUPEkTINO Buildin9 Department JOB ADDRESS: PERMIT# 21760 Lomita Ave. p O U OWNER'S NAME: Dorit Biran PHONE k 408-257-6173 GENERAL CONTRACTOR: Just Water FAX # 510-783-6360 Heaters I am not using any subcontractors: 9-)--dco- �-t& Ckk0a/v - 9/12/05 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 1 _ n 9/12/05 10/28/03 City of Cupertino Building Permit Application E-Mail jobsite Address: 21760 Lomita Ave. Date: 9-12-05 Owner's Name:---Dorit, Biran Phone No.(408)257-61 73 APN#: 357-18-040 Project Valuation: S 918.00 Building Permit Info: Bldg Elect Plumb-----X— Mech .Job Description Replace 50 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# 591329 Exp. Date: 3/31/06 Worker's Comp#: 1626288-05 Carrier: State Compensation.Insurance Fund Exp. Date: 4/l/06 Credit Card Information Credit Card #: 5474-6390-0047-8660 I o Name on Card: Just Water Heaters Inc. Expiration Date: 06/08oC�l Visa MasterCard ® Comments