04020126 CITY OF CUPERTINO
BUILDING DIVISION PERMIT i!kMAT 9"
BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT"b4020126
42n MANN T)P
OWNER'S NAME: PERMIT ISSUE DATE
HAMID
ONE: SANITARY N0. CONTROL NO.
510 293-
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
yoij
LICENSED CONTRACTOR'S Job Description
1 hereby ail o.Nal 1 am licensed under provisions of Chapter 9(Or mmcoeing
width Sendon 7mm)of Division 3 ofthe Businem aM Praised...Code,end my license is n
I.fa.=clesntl e(fecL REPLACE WATER HEATER FUNALE®
5 R z Licenm Class tic.a
Z Data Com,mmr (4 0 GAL GAS) Q�]
2004
ARCHITECT'S DECLARATION AUG
�i I understand my plana shall he used as public records 2,3
3`
3sed Licensed Profeagonal
y OWNER-BUILDER DECLARATION BUILDING
I hereby affirm Ism 11. exempt from Nc Canons Co License Law for the 9Wu7
iOO whicfolloh. reason.permit
7031.5.Business and w.demolish,
Or Any city o,county
$� which myulms a pmmit to cnngmet alter,improve,demolish,nr repair any atmdum
F Prior to its issuance,also requires the applicant for such Permit to rile a signed statement
<
that he is licensed pursuant to the previsions of Ns Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valua[io lggg
as (commencing with Section 700M of Division 3 of the B sadden and Professions Com)or
that M Or exempt therefrom and the basis for Ne alleged exemption.Any violation or
Section 7031.5 by my applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
oat mem Nan five hundred dollar,(550Q. 32645012 . 00
❑I,an owner oftIve property,or my employees wine wages So their sole cempenretion,
will Professions
and the ah Cad na nor intended,Law den not,(Sec.70th,owner
of
and Profusions Codc:The Centomon, male Lew dans not apply lf an awmr is Required Inspections
progenywho builds Orimprovesdhfimpr antlwho doesouchwork himselfe,through his
own employers,provided that such improvements ase not intended moRaad momIe rat.
however,the building mimprovementisheldwithin one ildofcompletion,Neowner-
builder will have du burden of proving Nn he did not build Or Improve for purpose of
m1eJ.
❑1.as..,of the property,we exclusively contracting with Ilemand comemum m
convect the project(See.7044,Business and Professions Cade:)The Cnnvmers LI-
,nae law dors not apply to an owner of property who builds or improves Reason,and
who command,for such projects with a contractor(s)licensed pursuant o the Con ouctofa
License Law.
❑I are exempt under Sec. ,B&P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury can of the following declarations:
I haw and will maintain a Certificate of Consent res self-imurefor WorkeesCompcn-
Sudan.as provided for by Section 3700 of the labor Code,for the performance of the
work for which this permit is issued.
❑1 haw and will maintain Worker's Compensation Insurance,as required by Section
J700 of Ne labor Code,for the performance often work forwhich this permit Is issued.
My Worker'.Compensation canis,and Polity number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Cronsection need not Mcompagod if the permit is finenc hundred dnllus(gimB ,
less.)
I certify that In the performance of to work for which this permit is issued.I shell not
employ any Person in any moneran an to become subject to the Worker'Compensation
Laws of California.Do¢
Applicant
NOTICE TO APPLICANT:If,after making this Comfialc of Exemption,you should
become subject m to Worker'.Compensation previsions of the Labor Code,you mug /or
.^J Z forthwith comply with such provisions or Nis permit shall he damsd necked. s fJ
z O CONSTRUCTION LENDING AGENCY
[-i Ihembym@m Nat there iaac.annuolinn larningagency fm the perfituro mof
> the work for which this permit is issued(Sec.3097,Civ.C.)
W� Q Lenders Name
Z Lenders Address
U Q I artify that 1 have read this application and sum Nat the show information is
UL F correct.1 agree to comply with all city and county Ordinances and sou laws relating to
DU building convection,and hereby auNodre representatives or this city So tour upon the
W above-mentioned pmperty for inspection purposes.
(We)agree to an,indemnify and keep harmless the City of Cupertino against
r,y ti liabilities.judgments,costs and expenses which may in any way ammo against mid City
C,1 7 in consequence of the granting of this permit.
i� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicaDData
HAZARDOUS boding MCLSDISCLOSURE Type of Roof .
Willy t applicant or(serum'.pal Co e.Chapter
or handle Health
material
as defined by the Cupertino Municipal Code.Chapter 9.@,and the Health and Safety
,MOLCule,S plias ❑No
zss3z(a)9 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or future building occupant on equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Wit hamolcor air contaminants as dcnned by the Bay Arca Air Quality Management all new materials for inspection.
D,St,ic,9
❑Yes C]No
I have real the h®ardrms materials requirements under Chapter 6.95 or the Colifor.
.is Health&SafctyCOde,Scodom 25505,25533 and 25534.1 undcrsund that ifde Wilding
does net currently hew a mnanL Nat it is my maponand ity to notify Ne wxupmt of Ne
mgairements which must IS mel poor to issuma Oft Certificate of Occupancy. Signature of Applicant Date
Owner or authadaed agent Date All roof coverings to be Class"B"or better '
1
City of Cupertino Building Permit Application
E-Mail
J
jobsite Address: 10420 Mann Dr. Date:
Owner's Name:---Shoaee Hamid
Phone No.(408)253-8913
APN#: 326-45-012 Project Valuation: $ 899.00
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)293-2022
Address: 1764 National Ave. E-mall: permits®justwaterheaters.net
City,State and Zip: Hayward,CA. 94545
State Contractor's License# 591329 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 ^ S�� 2-
Name
Name on Card: just Water Heaters Inc.
Expiration Date: 9/05
Visa MasterCard X �P
Comments