04080187CITY OF CUPERTINO
""t
BUILDING DIVISION PERMIT
CUT1t9it7RN„T'�U,RRR'1QN'
a�g•,a „,? ,.
BUILDING ADDRESS:
JUST WATER HEATERS INC
PERMITND04080187
OWNER'S NAME:
GREGORY BAKER
1-7r4 MATTOMAT AITR
PERMIT ISSUE DATE
12C)C)A
ONE:
,123
SANITARY NO. CONTROL NO.
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
ELECT PLUMB MECH
t� 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
hereby afOrm'hat 1 am licensed under provisions of Chapter 9 (commencing
with Seclom 700(f of Division 3 of the Busirma and Professions Code, end my licenm is effect. and
in full tome
(�
REPLACE WATER HEATER SCP
License Glia Lia. M
DaW ARCHITECTS DECLARATION
A.'hail
Z
(75 GAL GAS) Q� ?8p4
use
1 undcrntanJ my plans shell x recd as public records
v /
�®
Licensed Professional
OatNER-BUILDER DECLARATION
/A
1 hereby a(Suc that 1 exempt from the Contractor's License Law for the
]'131.5. Busenoa and Rvfee Code: Any city or county
following moan. 1.
permitt ole maser any structure
which requires a perminn construct, alba Ireforsu accent
file
also the applicant for such name' m file a signed statement
prior m its lamed
Sq. Ft. Floor Area
Valuation
tiosof
is licencedpSeuanttolheofDivionsnfthe
p nt .,he
(that commencing n
eBusinessaUcenselaw(Code)in
(commencing with Section ] of Division the
Business and Proon. vi Code) ser
$831
the alleged Any
Net he ts exempt Nem(rom end Ne base for Ne alleged eumption. Any viola'lon of
and y
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the afflicted to a civil penalty of
nut marc Nan five hundred done. ($500).
❑ L a owner ofthe property, or my employees with wages u their sole compensation,
Required Inspections
will do the work, and the atrnmum is notimended proffered (mule (Sec. 7041, Busirvae
Cade: The Comtrbnce r's LiceLaw does net apply to an owner of
and Profeaions m
prooerty who builds or i mprovea thereon, and who does such work himself or thmugh his
own employees. provided that such empmvememtsam not intended or offered formic. If,
however, in. building or Improvement I. wild widen one year of eompimmi, the be,
builder will have the burden of proving that x did not build or improve for purpose of
sale.).
/
❑ 1, as maker of the property, am exclusively contracting with licensed comments to
conswcl the project (Sec. 7041. Business and Professlans Code:) The Contractor's Lt.
came law docs not apply to an owner of propeny who builds or improves thereon. end
who contracts for such projects with a contraclaHs) licensed pubman'to the Contractor's
Lic". Law.
❑ tem exemP'unda See. ,B&PCf.,Oismawia
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury one of the following decara'ionse
I have and will maintain a Certificate or Consent to coif -insure for Weaker's Compen.
.tion, a provided for by Seen.. 3700 or the Labor code, for On ,impose. or the
W,for whim Na permit is iauca.
❑ 1 have and will maintain Worker's Compensation Insurance, a required by Section
3700 of Ne Labor Code. for the perform....( rite work forwhich this permh is oaken.
My Worker's Compensation Insurance carrier and Policy number me:
Carrier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need nolxeompleted iflhe Forest isfaronc hunamddolims(SIM)
'
or less.)
1 certify Na' in the perform.ee of the work for which this permit is Wood, l mail not
employ any person in any mannerwi a to become subject tothe Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: IL after making Nis Cenefscate of Esuornim, you should
become Subject to Ne Workers Compensation provisions of the Labor Cade, you must
forthwith comply with such provisions or NO permit shall be deemed raveled.
CONSTRUCTION LENDING AGENCY
I hereby thi Nn Bert is a construction lending agency ler do Performance of
work for which this permit u iaucd (Sec. 3097. Civ, C.)
which
Le
Lender's Nam�
Lender's AddrAdda ess
1 certify that 1 have read this application and sum Nal the above Information is
'
correct 1 agate to comply with all city ad county ordinances and suite laws meeting in
building construction, and hereby autionre mpremnu'iva of this city to enter upon the
ahove-mentioned property for inspection purposes.
(We) agrte to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in my way accme against said City
in consequence of the granting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date '
SOURCE REGULATIONS.
Re -roofs
Roof
Signature of Applicam/Co moular Data
HAZARDOUS MATERIALS DISCLOSURE
Type of
Will the applicant or future building Occupant atom or hmMle contacts mamnal
as defined by the Cupertino Municipal Code. Chapmr 9.1 z, and the Health and Safely
We, Section zss3z(a)7
All roofs shall be inspected to any roofing material being installed.
0Yes ❑Nu
❑Y
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant um equipment or devices which
atlt hrdous air conmminants a defined by the Bay Arca Air Quality Management
wiaa
all new materials for inspection.
District]
Dyes ON.
I have mad the Westerns materials requirements under Chapter 6.95 of the Califor.
nia Health &SafeiyCodc. sachem 25505.25533 sed 25534.1 makesmnd that ifrhe Wilding
data not curendy have a Wheat del it a my responsibility b noddy the occupant of the
requirements which must xmet prior mIssuance ofaCertificaWafOccup.ey.
Signature of Applicant Date
All roof coverings to be Class "B" or better
or adhodred agent Dam
WCITY OF
UPEkTINO
•
11
Buildi
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
CI9
JOB ADDRESS: PERMIT #
23615 Oak Valley Rd. OF =1�7
OWNER'S NAME: Baker, Gregory PHONE # 408-625-1800
GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360
I am not using any subcontractors: V-2--� t{o"AakX 8/20/04
Signature Date
Please check aDDlicable subcontractors and romnlPfo the fnllnwino ;nfnrm ;n,,•
Owner/ Contractor Signature
8/20/04
Date
10/28/03
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
8/20/04
Date
10/28/03
•
C
E -Mail
of Cupertino Buildina Permit
Jobslte Address: 23615 Oak Valley Rd. Date: 8-20-04
Owner's Name: ---Baker, Gregory
Phone No.(408)625-1800
APN#: 342-56-003 Project Valuation: S
Building Permit Info: Blda- - _. Flert
Description
Replace 75 gal gas water heater.
Contractor Intormation
Ilication
�(Jb 1- s
831.00 4 J I / a rd
GST
e
Company: Just Water Heaters Inc. Phone: (510)293-2012
Contact Name: Dulce Fax: (510)293-2022
Address: 1 764 National Ave. E-mail: permits®Justwaterheaters.net
City, State and Zip: Hayward, CA. 94545
State Contractor's License # 591329 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.
Expiration Date: 9/05
Visa ❑ MasterCard
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