04060197CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
JUST WATER HEATERS INC
PERMIT N0.04060197
22853 L
OWNER'S NAME:
-
PERMIT ISSUE DATE
DIANE CUSANO
1764 NATIONAL AVE
nr
NE:
'/9-A,/9nn4
SANITARY NO. CONTROL NO.
(510)293-9901
ARCHITECIYENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MITCH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
o
Job Description
1 hereby affirm Nat 1 am licensed under provisions of Chapter 9 (commencing
P
with Section 7W0) ufDivislan 3 oflhe Business and Professions Code, and my license isj{�p
/� p '
nmumrceandeffect.
Liccwo Class Li,.x
REPLACE WATER HEATER Knees �0i}o�®
(4 0 GAL)
Dale CunVanar
ARCHITECTS DECLARATION
1 d W ...us
JUL. 23 2004
umicrsunmy plans shall umd public
o «
-
Licensed Prolamines]
OWNER -exempt RDECe
ContmON
1 hereby alum that 11. exempt from dm Lew for the
�'+
BUILDING
lemim. Co e: Any c
following rcuoa ]1131.5, Business and cons Code: Any city an county
improve, de repair any structuudernure
which requires a permit alter, improv,
Permit i teres
re dw h permit t file
primmits issuance.alw requires IM visions ffar mehpermitto Tilessigned anlemem
that he pursuant rete provisions of the Conuumd Li mnsclawsCode(Chapter 9
Sq. Ft. Floor Area
Valuatio9850
momecrefinnwit
Co or
(cat xempwith S.tien]rg1dth Division oftheeged euandse.
An, vi of
Wt he is exempt th,mfrom and the buss for the alleged ceemption. Any violation of
he ssl
APN Number
Occupancy Type
Section 7031.5 by any appii.nt for a permit subjects dat applicant m a civil penalty of
..I.. than rive hundred doll. (s500).
34233055.00
0 Lisownerofine property,ormyemplayc. with wag. Mlheirmiscomrecoma m.
Required Inspections
will do thewok and theslmmaat is not handed ora@red forsake(Sec. 7(164, Business
and Profusion, Cade: The Convector's License Law does not apply m an owner of
q p
property who builds or im proves Lemon. and who does such work himself or through his
own employe., provided dual such improwmenuue notinlended orefferad forule. if,
however, the building or improvement is cold within one year of completion. the owner -
Wilder will have the bund,. of proving that he did not Wild ar Improve for P.M. of
sale.).
0 1, as owner of due property, am exclusively caroming with licensed contractors to
contract the pmjmt (See. 7044, Business and Professions Cade:) The Connectors LL
_
came Law docs not apply to an owner of property who Wilds or improves theater. and .
who contracts for such projects with a contractor(s) licensed pursuant in due Contractor's
License Law.
,
0 1 em exempt under Sec. . B & P C far dull moon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby mftm under penally of perjury one of the following declarations:
1 have and will maintain a Cemlicau ofConunt to stir-tnwm farworkneacompen-
.don, o provided for by Section 3700 of the labor Costa, for the performance of ft
work for which this permit is issued.
0 I have and will maintain Worker's Compensation Insurance, u requited by Section
3100 of the Labor Code.for the performance of the work for which this permit is Round.
- -
My Worker's Compensation Insurance carrier and Policy number am:
C.Policy No.:
+
CERTIFICATE OF E.KEmimON MOM WORKERS'
COMPENSATION INSURANCE
Gul, rection need not W coreptema Ribs permit is forone, hundred dollen (SIM)
or am)
I certify that in the performance of th, work for which this permit is issued, l shall not
employ any person in any manners as to become subject o the Woraces' Compcmation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Cenificam or Exemption, you should
become subject to duc Worker's Compensation provisions of the lobe, Code, you mast
forthwith comply with such provisions at this permit shall W deemed revoked.
CONSTRUCTION LENDING
I hereby affirm that then is a cmouuctinn lending agency for the Performance of
due work for which this permit is iuuetl (5..3099, Civ.v. C.) CJ
Lender's Name
Lender's Address
1 certify that 1 have read this application and ante that me above information is
correct I agree to comply with all city and county ordinances and sate laws relating to
building construction. and hereby authorize represcmativea or this city to enter upon the
above-mcndoned property for inspection purposes.
(We) agree in save, indemnify and keep harmless the City of Cupertino against
liabllities. judgments, cents ad expenses which may in any way acerae against mid City
in consequence or the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by; Date
SOURCE REGULATIONS.
Re -roofs
Signature of ApplicaDere
HAZARDOUS
US MATERIALS DISCLOSURE
Type of Roof
Will future building e, handle al
and Safety
y the Cupertinant o
o dthe o Municipal Code, CTepmr 9.1; and the H.1@ end Safety
Municipal Chapter 9.12,, Health
Cents.zss72(a
Sue . 32(.)?
SO
All roofs shall be inspected to an roofing material bei.
❑r. ❑Na
y.
prior Installed.
P P� Y g g
- If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building eccupam use equipment or devices which
mit haraknus air contaminants o defined by the Bay Area Air Quality Management
all new materials for inspection.
O Yes ❑Nu
1 have mad the hemardnus materials requirements under Chapter 6.95 of the Califer-
aH.ldu& SafetyCode, S.dom 25N)5,25533 and 25534.1 understand best if the Wilding
oes not currently haw a temem. that it is my responsibility m notify da occap., of thequirements
which must Ito met prim to usuerec of a Certificate of Occupancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner
or m1horiad agent Date
a40 F
&UPEkTINO
C
t
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
22853 Lon down Rd.
PERMIT #v olj o(�
OWNER'S NAME: Cusano, Diane
PHONE # 408-996-3921
GENERAL CONTRACTOR: Just Water Heaters
FAX # 510-783-6360
I am not using any subcontractors: 6/14/04
Signature Date
Please check applicable subcontractors and complete the followinv infnrmntinn-
Owner/ Contractor Signature
6/14/04
Date
10/28/03
21
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
6/14/04
Date
10/28/03
•
•
C
E -Mail
of Cupertino Buildinci.Permit
Jobsite Address: 22853 Longdown Rd.
Owner's Name: --- Cusano, Diane
Phone No.(408)996-3921
APN#: 342-33-055
Building Permit Info: Bldg ---------
Date: 6-14-04
Project Valuation: $
Elect ---------_-
Job Description
Replace 40 gal water heater
Contractor Information
Company: Just Water Heaters Inc.
Contact Name: Dulce
Address: 1764 National Ave.
City, State and Zip: Hayward, CA. 94545
650.00
6-z� o &-�v (-�
lication
Phone: (510)293-2012
Fax: (510)293-2022
E-mail: permits@justwaterheaters.net
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
Name on Card: just Water Heaters Inc.
Expiration Date: 9/05 b0
Visa 0
MasterCard X
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