05040150 CI'T'Y OF CUPERTINO �'✓ r hr xiat: .f Y n gq�la r.
BUILDING DIVISION PERMIT CONTE XTO INFORMATION
BUILDING ADDRESS: PERMIT NO.
JUST WATER HEATERS INC 05040150
E ' M PERMIT ISSUE DATE
ONE: SANITARY OLNO.
X
GHITECIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
X00 LICENSED CONTRACTOR'S DECLARATION Job DescriP"tion�
F I hereby affirm that I am licensed under provisions of Chapter 9(commencing _ /
i with Saturn?IX0)of Division 3o1'the Bmineaend Professions Code,and my license is
n In full fmaird effect.
q� License Class tie.IS REPLACE WATER HEATER
n^1 Dale Contractor
pp ARCHITECTS DECLARATION (40 GAL GAS)
'�n I understand my plans shall be used as public records
DyU
3r0. Licensed Professional (( r
a'o3 OWNER-BUILDER DECLARATION r 1� I tf 1 I
<F I hereby affirm that I am exempt from the Counselor's License law Who V ll' t I If-�, L l'I
no following reason.(Section 7031.5,Business and Professions Code:Any city marry ������ 1 V
m�+ which requires a permit to construct,alter,improve,demolish,or repair any structure
prior In its issuanac,also requires the applicant for such Permit to file a signed statement
that he is licensed pursuant o the provisions of the Comnclor'S license Law(Chapter 9 Sq.Ft. Floor Area Valuatie011
rc1-$ (commencing with Section?")of Division 3 of the Brothers and Professions Code)or 1
J — Nal W is exempt Showroom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant fon permit Subjects the applicant to a civil Penalty of APN Number Occupancy Type
not more than rim hundred dollen($500).
❑1,IS owner of the propany,or my employees with wages Is their sole compensation,
will dr the work,and the Structure is not intended or offered fortune Sec.70414.Bulinus
and Professions Csbe:The Conuacmr'S License Law docs not apply to an owner of Required Inspections
property who builds or Improves thereon,and who does such work himself or through his
own employees.pounded that such improvements are not intended or offered for Sale.If.
however.the building or improvement is sold within one year ofa urfleuon.the owner.
builder will have the burden of proving chat he did not Wild a Improve for purpose of
sale.).
I,as honer of the property,am exclusively contracting with licensed Commctors m
concoct the proper(Sec.TOW,Burr ev and Professions Cade:)The Colosseum'Li
muse law does not apply to an owner of popeny who Wilds or improve thereon,and
who contracts for such projects with a contractors)licensed pursuant 10 Ne Conuaclor's
Lieaose La,
lam exempt under See. B R P C for this lesson
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby afire under penalty of perjury one of the following declaration:
JIC371W'
I have and will maintain a Certificate of Contin m ul6imum for Workeri Camper
on,as provided for by Section 37M of the labor Code,for the Performance of the
�-- rk for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
of thr Labor Code,for the performance of the work for which this Permit is issued.
Worker's Compensation Insurance carrier and Policy number artrier: I Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not becompleted Vince lrrmit is forms,hundred dollars($100)
or less.)
1 anifv met in the performance of the work for which this Permit is issued.I shall nm
employ any Person in any manner so IS to become subject o the Workeri Compensation
Laws of California.Dem
ApPlicem
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you Should
become subjaL to the Worker's Compensation provisions of the Labor Code,you must
O Zforthwith Comply with such provisions or this Permit shall W a dermad several,
ZO� CONSTRUCTION LENDING AGENCY
F I hereby affirm that there is a construction lending agency lot the Performance of
LQthe work for which this Permit Is issued 1Scc.J(19),Co.CJ
W� A Lender's Name
U z Lcndcr's Address _.
U 0 1 cenify that I ban reed this application and sou that the above information is
kk.P correct.I ague to comply with all city and county oNinswas and Rate laws relating to
0 U building construction,and hereby aahorire repreacratives of Nis city to colt,upon the
fA k.m.reanimadi property for inspection poppers.
(We).,me to Sava,indemnify and keep harmless IW City of Cupcnum against
faq
liabilities.judgments.costs and expenses which may in any way accrue against said City
U in consequence of the granting of this pamit.
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs 6-k
Signature of ApPlicor amDau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will SO,apCu applicant or(Muni building Occupant nose or handle Health and
as dcfmcd by IW Cupertino Municipal Code,Chapter 9.13,and the Health and Safny
Code.Section 25533(a)? ❑ o❑Yrs All roofs shall be inspected prior to any roofing material being Installed.
Will the applicant car future building naupant on equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
,Incl?
❑Ycs [J No
How
mad the h000dous materials requirements under Chapter 6.95 of the Califor-
nisHealthskSofety Calc,Sexual,25!15.15533 and 35530.I undersmM this if the Wilding
does not currently hoe a tenant,that It u my rerponsihility 10 mrdly the Occupant of Ne
requierents womb must W mel poor to issuance Ma Cenif¢au of Occupancy. Signature of Applicant - Date
Owner m aififi.xe agate Dale All roof coverings to be Class "B"or better
Community Development
a�4
, 10300Torre Avenue
Cupertino CA 95014
Telephone (408)777-3228
SCIF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
22883 Long Down Rd. q- a �SU
OWNER'S NAME: Rao, Nandini PHONE # 408-873-8412
GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360
1 am not using any subcontractors: Da Q- 4/25/05
Signature Date
Please check applicable subcontractors and complete the followinginformation:
0 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
Owner/Contractor Signature Date
10/28/03
C) o
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 22883 Long Down Rd. Date: 4-25-05
Owner's Name:---Rao, Nandini
Phone No.(408)873-841 2
APN#: 342-40-001 Project Valuation: $ 1,011.00
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 #: 5474-6390-0026-5679 t/
Name on Card: just Water Heaters Inc.
Expiration Date: 9/05
Visa MasterCard
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