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08020120 CITY OF CUPERTINORP* Te.»iz '/��n �Tn�' Txv,gam ' BUILDING DIVISION PERNIIT kaV91. 1111 �1Rs' i�i-QRVS'��.I,.©N. PERMIT N0. BU PERMIT DR NST WATER HEATERS INC 08020120 HEER'SS NAME: M PERMR'L4UE DATE CAROL WU 3400 INVESTMENT BLVD 02/20/2008 PHONE: SANITARY NO. CONTROL NO. (510) 293-9901 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 u00 LICENSED CONTRACTOR'S DECLARATION Job Description 4 u ffiu I humby ae War 1 um n licensed Oscar prevision of Chapter 9(eemencin, with Semon 10f10)ofDivrlon 3 of We Busimrtanl Professions code.and my ueeme is REPLC 40 GAL GAS WTR HTR in in full force and affect. jt5 License Class Lte.0 e F Dote Contractor S ARCHITECTS DECLARATION ei I understand my plans Nall be used pe public retards 'yU o Licensed Pmtosdonal x m Ort I am exempt fr m DECLARATION S I hmoun alarm on 1 1. mcmpl from We Cenuns or'lCox License Law o for the i o o following renes a emtien construct. Business;and Pmfedans Cade:Any oily at manly $ which squire a Permit to e heat eL abet,hnpmsu damnell1. fi repair a l tamcum Z`y' that No its i licensed also mquim We applicantnlof We Contractor's p actor's cense Lnd statement FothatbeiscmnudPuesuatnOn We 7")ofDivions3oftheontmcunandPrsaadmoChaPtm9 Sq.F[.Floor Area 995 Valuation Z 9 (commencing with section TB00)ar Division r of NC alleged essand on.Anynns i.6.or Nal he 4 campy therefrom and the aper it be alleged m lumen W Any l pWlon of .1. 7031.5 With ie hundred canary(S mnR mbieets We applieanl to.civil penalty at Number Occupancy Type ret ream than Rae henama donate(s5am. 31635009 .� 1,pe owemor of die property.or my employees with wages u Neo sole compcnsatien, NdO9d the otr� nnemfor olyy�'maue predications cThCtorsiRwemappy nf Required Inspections property who Wilds or imprevee deemn.and who dmsuchworlehimeelror though his - ownempioyso,prodded Wan such improvements an,not immuded oroRerd for sale H. however,We building or improvement is suld with.cam year of mmpl.dan.the owner- bullder .will have the burden of proving tool he did not build or improve for purpose or mm,), L pe owner of Project property,,m sines rl confession,with licensed commues e mnswm de es not (Sec.7W,wner of ad Wnetsoom Cdr:)The eunvar ms,and, . cave law does r such apply to an owner of prepeny,who Wilda r improve dmmen,and who conuacu for such pregcu with a contractor(s)licensed pursuant to the Convxetors Law. 0 tae am exempt undo See .BSPC fo Nr won Dam �1 i WORKERS COMPENSATION DECLARATION I bereby aRum under pemlty of perjury arc of We following dectmadens: \ s ` ❑1 Mve and will meinuin•CedOcam o(Consem m self-imam far WorkeY,Compen- V ' union,r Provided Was far mi Section]100 0!the labor Code.for We Performance of We web for which Nis permit is mud. U ❑1 have and will maintain Worker's Compensation Inmnnce,pe required by Section 5100of the later Cade,for the pc,for rommf the wale for which this .it is 4smd. My Worker's Compensation Insueanm canim arta Policy number art: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE [This section and nmbecomplemd if the permit Is foraae Wndreddellws(SIM) or less.) I certify Nm In We performance of the work for which this Permit is issued.I shall no employ any person in any manner an u e become subject to the Workers'Compensation Laws of California.Date Appneanr NOTICE TO APPUCANI:If, net making his Cenifieate of Exemption,you should become subject th the Woeim's Compensadon provisions of We labor Code,you mot, .JO foMwith comply with such provisions m this Permit Nco all be darned veted./ y CONSTRUCTION LENDING AGENCY [n r I berebyefDrm Win dem lsacomuOdnn lending agency for We nuormemncem' Ri n�-r We.,it for which Nis permit is Ont ed(Sec.3099.Civ.C.) [Ll lender's Name z Undue,Address VQ 1 certify War 1 have read W.application and sum War the me.information is IT.!' torten.l qme W comply with all city and county oMnarem and state laws misting an Q SV^ Wildingconstruction.and hereby mNorim representatives;of Nis city to enter upon We LT.1 ,cm-mentioned property for Imptedon purposes L}.G (We)sine on peve,indemnify and leap harmless the City of Cupertino galnst itcA Ilabiliticnjudgmenu,costa and eapensns which may in any army acemea,aWUud City („)Z in conxquenm of the granting of this permit ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS, Re-roofs si,nmu a of Applicam/Contnctor Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will We applicator or future building Weupa s.atom or handle ha'uAons material defined by the Cupertino Municipal Code.Chapter 9.13.and the Health end Safety e,soden zss32(m All roofs shall be inspected nor to an roofing material beim installed. pyca ON. P P Y g B Will We applicant or future Wilding occupant use equipment or devise which If a roof is installed without first obtaining an inspection,I agree to remove emit ha ammo ail cantaminsnts as dented by the Bay Am Air Quality Management all new materials for inspection. District? ❑Yca 0N I have read the hanrdwe materiels requirements under Chapter 6.95 ofthe Califon. .is Health dtSafety Cdr,Secum x25505,25533 and 25534.1 understand Our If We Wilding dm not currently have a moment.Nat It 4 my reaponsibdiry,an notify Out occupant of We requirements which mood met Prior to ipeoanm of a Cadncate of Occupanay. Signature of Applicant Date Owner or authorized agent Dote All roof coverings to be Class"B"or better p��ao ��a City of Cupertino Building Permit Application E-Mail Jobsite Address: 19735 Merritt Dr. Date: February 19, 2008 Owner's Name:---Wu,Carol Phone No (408)379-1588 APN#: 316-35-009, 00 Project Valuation .f 995.00 Building Permit Info: Bldg Elect___— Plumb____X_ Mech Job Description Replace 40 gallon gas water heater. Contractor Information Company: Just Water Heaters Inc. Phone: (510)293-2012 • Contact Name: Fax: (510)293-2022 Address:3400 Investment Blvd E-mail: permits®Justwaterheaters.net City, State and Zip: Hayward,CA. 94545 State Contractor's License* 591329 Exp. Date: 3/31/08 Worker's Comp#: 01DKRM11O01O70 Carrier: Nelos Exp. Date: 4/1/08 Credit Card Information Credit Card #: Name on Card: Just Water Heaters Inc. Expiration Date: 6/08 Visa ❑ MasterCard Comments • CITY OF CUPERTINO 4 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31635009 . 00 DATE ISSUED. . . . . . . : 02/20/2008 RECEIPT # . . . . . . . . . : BS000003984 REFERENCE ID # . . . : 08020120 SITE ADDRESS . . . . . : 19735 MERRITT DR SUBDIVISION . . . . . . : CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : CAROL WU ADDRESS . . . . . . . . . . : 19735 MERRITT DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2406 RECEIVED FROM . . . . : JUST WATER HEATERS CONTRACTOR . . . . . . . : GILROY, JOHN LIC # 15128 COMPANY . . . . . . . . . . : JUST WATER HEATERS INC ADDRESS . . . . . . . . . . : 3400 INVESTMENT BLVD CITY/STATE/ZIP . . . : HAYWARD, CA 94545 . TELEPHONE . . . . . . . . : (510) 293-9901 FEE ID UNIT - QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 995 . 00 0.50 0. 00 0 .50 0. 00 1PPERMITFE FLAT RATE 1 . 00 40.79 0. 00 40.79 0. 00 1PRWHEATR UNITS 1. 00 24 .48 0. 00 24 .48 0. 00 ITRAVDOC FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00 --=------- ---------- ---------- ---------- TOTAL PERMIT 106 .56 0. 00 106 . 56 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 518 WATER HEATER • . Community Development 10300 Torre Avenue ' Cupertino CA 95014 IS �^ CITY OF TelephFax(408)777-3333 CUPER,TINO Building Department JOB ADDRESS: PERMIT 19735 Merritt Dr. D OCOa 0 (a(7 OWNER'S NAME: Wu, Carol PHONE #408-679-1588 GENERAL CONTRACTOR: JustWater Heaters FAX # 510-783-6360 I am not using any subcontractors: ��` '4a ^ 02/19/08 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 1 -51 Z8 Roofing Septic Tank Sheet Metal Sheet Rock • Tile 9 af-Q ' o 02/19/08 Owner/Contractor Signature Date 10/28/03