05020140 • CITY OF CUPERTINO �
BUILDING DIVISION PERMIT q -,ONTRAC-'TOR4NFORMATION
BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT N005020140
OWNER'S NAME: PERMIT ISSUE DATE
JACK HWAN
IRPONE: SANITARY N0. CONTROL NO.
(510) 293-9901
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 E t� 0
L O o LICENSED I a CONTRd under
DECLARATION
of CON Job'I�Cs.CnptlOn
ZO,r'r 1 ion 7 )of Nat 1 am alive Bd under provisions of Chapter 9(Commencingsis �Itl(l��l f
withllto=]dcrefDivinion3ofthc Busineas and Professinm Cadc,and myliccnu is LEE)irmumaandert«a REPLACE WATER HEATER fHll�
i$z License Class Lu.g
F Date Contractor (5 0 GAL GAS)
ARCHITECT'S DECLARATION MAy
I understand my plans shall W mud az re
public cords
1
w (n�
Licensed Professional Is /l 05
OWNER-BUILDER DECLARATION
I thereby affirm that I am exempt from Ne CantnaoYs Liccnu Law for IW p
i
00 following mason.(Section 703 1.5,Business and Professions Cods:Any city or county
which ex irts a permit or Ceramics.a@np
improve,demolish,or mpair any immune ®IIll�fll
Fly prior m its issuance.also meunes Me applicant rot such permit in file a signed Comment .,
F 0 that he is licensed pursuant to the provisions of Me Contractor's Lianalaw(Chapter 9 Sq. Ft. Floor Area v 1k=0ValuatiJ8 3 9
of $ (commencing with Section 7000)ofDivision 3 of NS Buaress;and Professions Code)to
Nat he is exempt therefrom and the basis fa the alleged exemption.Any violation of
Section 7031.5 by arty applicant for a pemit subjects the applicant o a civil penalty of APN Number Occupancy T
not mart than m hundred dollars(M). 32618062 . 00
p y yPe
❑1.as owner of Ne property,in my employcu with wages as their sure compaction,
will do the wok,and Ne awcwu is not intended or offered rot sale(Sec.TAM.Business
and Profession Code:The Convector's Licewe Law does not apply m an comer of Required Inspections
property who bis ills m improves Nemo n,and who does suc h work himself or through his
Own employees,provided Nm such improvements art not intended oro@red resale.If.
however.Ne building or improvement is old within am year of mmpledon.Ne owmar-
milder will haK the burden of proving Nat he did Out Wild or improve for purpose of
talc.).
❑1, a..,of the propeny,em exclusively contracting with licensed roll..to
constrect Ne project(sec.7044,Business and Professions Cade:)The Convector's Li
cease law does not apply loan owner of property who Wilds or improves Merton,and
who contracts forsuch pmjeces with aeonarmlor(s)licensed pursuanuo the Convactor'n
Like.Law.
❑I am exempt under Sec. B k P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby grin under penalty of podury am of the following declarations:
1 have and will maintain a Certificate ofConsenuo ulf-insure for WorkcYsCompen-
swim,as provided far by Section 3700 of Ne labor Cod..for Ne pcdomance of the
work for which this Permit is issued.
111 have and will maintain Workers Compensation Insurance,as required by Section
37W of the labor Code,for Ne performance of Ne work for which Nis pcmil is issued.
My W olmer Campewtion harearm s comer and Policy numher am:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not he completed if the pconit is foronc hundred"Hars(SIM)
or Mss)
1 certify Nat in Ne perfomence of Ne work for which this permit is iuucd.I shall am
employ any person in any manner ass to become subject to the Workers Compenamion
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Ccnificau of Exemption,you should
became Subjectu the Wo prneme
o Compensation provisions of Melabor Code,you nun (Y
.,O forthwith comply
ly with mb ar provision or this pals.shall W deed sed
trok .
'z
CONSTRUCTION LENDING AGENCY 1nvLA
[—r i
lately aRvm Nat More is• svuet3 lending agency for Ncperomvuof
Ne work for which this Permit is issued S«. 07,
Co,C.)
P. 0 tenderms
's Nez 4ndcrs Address
U Q 1 manly Nat I have mad this application and sum that the above information is
12..� camcL I agree or comply with all city and county ondinm¢s and sum laws relating in
OCJ building construction.and hereby"Marine temearealivCJS of Nis city to Cour open Ne
ahave-m.judged property for impeNon whichirturpomay
>. (We).9.to save,indemnify end keep harmless the City of Cupsnem.prinst
C.7z
in
es,Me Cosa andSmoing expenses whichmayin My way accrue ageless said City
in consegmna of Nc gmming of this pcmil.
F" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
SlgnnYlC of ApplicooVConuactor Data Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupmtstore or handle hmamous material
az defined by IW Captain Municipal Code.Chapter 9.12,and N.Health and Safety
ate,Section 255)2(a)?
❑Yea
C3 No All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection,I agree to remove
Will Ne applicant or future Wilding acupant tau equipment or devices which p g
iI havamous air enumerations u defined by the Bay Area Air Quality Management all new materials for inspection.
�— Dinrin?
❑Yes ONO
1 have read Ne hmaMousmateriau requiremema under Chapter G95 alone Calirm-
nia Heal"Safcty Codc.Secuas25505.25533 surd 25534.1 understood Mariana Wilding
dors net comedy have a tenant,Nat it is my memorability as nmly do occupant of Nc
nequiremems which must be met poor,,iasumcc of a Ccrdream or Occupancy. Signature of Applicant Date
Owner orauthodaxdagent Data All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
-Ile
OF Telephone (408)777-3228
� Fax(408) 777-3333
UPEkTINO
Building Department
JOB ADDRESS: PERMIT #�Z O ' D
21966 Oakleaf Ct. J
OWNER'S NAME: Hwang,Jack PHONE # 408-887-3788
GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360
I am not using any subcontractors: 2/21/05
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
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
2/21/05
Owner/Contractor Signature Date
10/28/03
r
• City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 21966 OakLeaf Ct. Date: 2-21-05
Owner's Name:---Hwang,Jack
Phone No.(408)887-3788
APN#: 326-18-062 Project Valuation: S 839.00
Building Permit Info: Bldg__________ Elect___________ Plumb------X----- Mech___________
Job Description
Replace 50 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# 591329 Exp. Date: 3/31/06
Worker's Comp#: 1626288-04 Carrier: State Compensation Insurance Fund Exp. Date: 4/1/OS
Credit Card Information
Credit Card #: 5474-6390-0026-5679
Name on Card: just Water Heaters Inc. b
Expiration Date: 9/05 _
Visa MasterCard
Comments