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05020128 BUILDING DIVISIONPERMIT 6$�-,ONTRACTORINk'ORMATION , BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT NOD 5020128 OW NEWS NAME: PERMIT L55UE DATE RICH BE '1400 TMT 05 ONE: SANITARY NO. CONTROL NO. 10 2 ARCHIIEC'VENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 >05 LICENSED CON RACIOWS DECLARATION up 1 hereby"fuse that 1 am licensed under provisions of Chapter 9(commencing Job Description �U with Section 7")ofDivision]argue Business and Profcssiom Codc,and my license is 5nn L ense1eanderrcl REPLACE WATER HEATER j Ya{? License Clan Lk.Y "qq� Date ARCHITECTSDCLARATION (40 GAL GAS) 1 undcnund my plans shall w used az public records JyU G G Licensed Professional OWNER-BUILDER m CLARATION T.a I 1 ora affirm on 11. exempt from the CanvamCb License taw for tM T.p o which mason.(Satlon]Il3 LA Business and Improve. ile to l Code:Any city or aunty which rets Wei s permit us enmlrveL alar.impmsu demolish,or mash any structure H$N that hor e its issuanec,also mmin to res lwvision of dor such permit fileng,signed em s< that he is ing with puntion 7 Nc of Division 3 Nc Comrsiness Lkrense law(Chapter 9 Sq.F[. Floor Area Valua[i1850 rc�$ (ammcncing with section 7000)of DivuionJofmc Business and Profetiom Code)or _ that he is exempt themfmm and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penally of ppN Number Occupancy mol mom thro ane fin hundred dollars(S50o). P yTYpe ❑Las owns oftn<propmy.«my employee wise wageaz thele dela cmnpensadon, 37534014 . 00yes- willdOthewe&,and the swctum is not intended or offered for sale(Sec.7044,Business and Profession Code:The Conuacmb Liame taw dors nos apply in an owner of Requiredi" A nspections propenywho builds or improvethumon.mel whodas such work interstellar through his U NI �� Own employees.provided thalsuch improvements are not intended oro@rW forsal�If, V however.the building or improvement is mid within one year of complcOur,the owner. builder will have the burden or proving that the did not build or improve(or purpose of sal 0 1.I,as owner of the property,.Bexclusivelysinend Poona boo;with:)Theed comncmm U. A n ecromcOmstnMt the Amnon(Sec.]1144,Business rope property whtians Codeh Thews domain. Li- � �� DJ Lace law due not apply m an owner of property who wills or improves thereon.aM who contracts for such projects with a euaromorud licensed purwant in the Contractors '/j/��//�J� a, (�//\��\�� 0Lace.am Law. �//Jy�\J ❑lose exempt under Sea .B&PCfar this moon Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury arc of the fallowing declaradom: 1 Ins and will maintain a Certificate of Consent in self-insure for WorkersCmaNn- sation,as provided for by Section 3700 of the labor Code,for the performance of the work for which this permit is issued. ❑I hale and will maintain Workers Compensation Insurance,az required by Section 3700 of the labor Codd,for the performance of the work for which this permit is iu sed. My Worker's Compensation Insurance carrier and Policy number art: Cartier. Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu section need not tecomplcmd if Ne permit isforonc hundred dollars(3100) on,less) I Lenity Nat in the performance of the work for which this permit is issued.I shall not employ any person in any manner an as m assume subject to me WOrl is''Compensation Lswa of califomia.Data Applicant NOTICE TO APPLICANT:If.arm,making Out Cenifcam of Exemption.you should became subject in the Wall Compcwtion provision or the Lake Code,you mug .J O foMhwi o comply with such provisions Of this Permit shall w deemed revoked. z`+ OIL OCM is LENDING AGENCY rte-. agency z 1herby alfnm Nu NereU aTION LEN lending ENCY I'nn the perfunmroce of f 6L> Ne work for which this pnmit is issued(Sec.3097,Civ.CJ W 0 Landers Name z Lender's Address U0 1 unify that I have read did,application and sum Nat me awvu information is "Pcorrect.l agree to comply with all city and county ordinances and sum laws rotating m 0U building construction.and hereby aumome rtpresenutises of this city to came upon d, above-mentioned property for impareas purposes F y (We)agree to save,indemnify and loop harmless the,City or Cupertino against Z Iia consequence cru,cosbanpe eapemesmit. may in anyway accrue against said City Uz in consequence of to graining Of Nis permit ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Signamrt a(AppliaHO Data Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the a Cupar or fuuni building e.Chapter or handle hwardous and az defined Dy the Cup Municipal Code.Chapmr 9.12,roti @e Health and Wety 7Mniaotic.Section 35532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Ya ❑No Will the applicant or future wilding Occupant use equipmam or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit aarardnm air sanumioants as declined by NL Bay Area Air Quality Management all new materials for inspection. isvic,l 0Yes ❑Nu I have read the haaasdornma arials requimments under Chapmr6.95 arms Cali(or Icahn&Safcty Cade.Sectors,255)5,2553]and 25534.1 undersand matifthe wilding oes not currently have a tenant,Nat it u my resparigbility m nndfy the occupant of the quirtmeatswhichmugxmetpriortulssuanceOraCardficamofOccupany. Signature of Applicant Date Owner or authorized agent perm All roof coverings to be Class "B"or better t� Community Development 10300 Torte Avenue �. Cupertino CA 95014 Telephone(408)777-3228 ICITY OF Fax(408)777-3333 NPEkTINO Buildin Department JOB ADDRESS: PERMIT # 10665 Moren o Dr. C2 S) 0 OWNER'S NAME: Beerman, Rich PHONE # 408-221-2444 GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360 I am not using any subcontractors: 2/17/05 Signature Date Please check applicable subcontractors and com fete 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 Vajco �0'v�-+Gt- 2/17/05 Owner/Contractor Signature Date 10/28/03 p S-v 2 o 2- City of Cupertino Building Permit Application E-Mail Jobsite Address: 10665 Morengo Dr. Date: 2-11-05 Owner's Name:---Beerman, Rich Phone No.(408)221-2444 3?r APN#: 33%-34-014 Project Valuation: S 850.00 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: permits@justwaterheaters.net City, State and Zip: Hayward,CA. 94545 State Contractor's License# 591 329 Exp. Date: 3/31/06 Worker's Comp#: 1626288-04 Carrier:State Compensation Insurance Fund Exp. Date: 4/l/05 Credit Card Information Credit Card #: 5474-6390-0026-5679 Name on Card: Just water Heaters Inc. Q6� q Expiration Date: 9/05 GO I - oZ Visa El MasterCard X Comments