05020019 CITY OF CUPERTINO �d+ ' e"W v , W' is
BUILDING DIVISION PERMIT -fiCONTRACTQRINFORMATION �,
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BuILDINGADDRESS: JUST WATER HEATERS INC PER6Irr"'05020019
OWNER'S NAME: PERMIT ISSUE DATE
NO.
ONE: SANITARY CONTROL NO.
510 293-9
ARCHITIiCT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t�
or LICENSEDCONTRACIOR'SDECLARATION JobDescri Description
UC I thereby arcum that 1 am licensed under provisions of Chapter 9(commencing p
�W with Sa"ion?q%a)pr Division 3o dm Rusin...and Profusions Cade,and my license is
rento
in andercme REPLACE WATER HEATER
5 q i License Class Lk.g
-'c DateContraction (5 0 GAL GAS)
�',f' ARCHITECTS DECLARATION
�iI understand my phn,shall he used as Public rocards
to
Ir �; Licensed Pmfusional
U
3 OWNER-BUILDER DECLARATION
I I hereby affirm that I em exempt from the Cmuranots Lima.law for the
i p O rallowing mason.(Section?(131.5.Business and Professions Calc:Any city or county
m which m,uircs a pcsmi"m mos"rm1.alter,imprave,dcmoluh,or repair any =to.
r x i prior m its issuance.LLsu requires the applicant for such permit to flit a signed sulomen"
pp o that heuliccnsodpursuant tothe provisimnofthe ConuacmriUcoracLaw(Charon 9 Sq.FL Floor Area ValuatiT950
k $ (commencing with Section 7")of Division 3 ofum Business and Professions Code)or
—
that his is cramp"dcrtfrom and the basis for tis alleged c.pd.Any violation of
Semon 7031.5 by any applicant for a permit subjects the applicant to a civil pointy of APN Number Occupancy e
not mom than rw hundred nonan($500). p y Typ
356-1-1036 0.01 _
❑Laaownmhe k and pestruc,army ,intones wiN.mdfas they sok compcwness I .l'
will pr f..I..ander sfmmureisnmsLiceseed aw does.1
water of l t s t.
nW property
h on,Cade:The otantramoPs Liew•law doss wart apply lf an war of \ Required Inspections
pmpeny I.yms,pNorimpmw themprove who.netihwpckowloelforNmugh his
h.,w,.loyces,pmvided that such improvemenasamnot ear Of,d or offered for sale.IL 'I . i _ y
braver.the buil the tanimprovemennuhat wiiinn, year of improvean
the owuer- II /`\
Wilder will have de Wrdm of proving that W did rot dtild m imPmw fa purpose of 'I• .r^+.`.l !U/J/ \F\4\,
oak.).
O 1.as Owner of the propeny,am exclusively conuacting with licensed contractors N
construct the pmjem(See.7049,Business and Profusion,Code:)The Contractor's Li.
ttme Law does not apply to an owner of property who Wilds or improws thereon,and
who contracts rot such pmjecu with a contractor(s)licensed pursuant to the Com acmYs
License law.
❑IamesemPlumder Sep ,B&PCf.%1ris son
Owner Date
WORKER'S COMPENSATION DECLARATION
I hemby a?nn under pmW"y of red.,true of the following dmiantimm,
1 have and will maintain a CcrrOcak of Consent in self-imum far Worker's Compete
7[137W
as provided far by Section 3?BB mf Ne I1kr Cade,for the perran nna Of the
rk for which Nis permit is issued.
I have and will maintain Worker's Cumpentation Insurance,u roqulmd by Semon
mf Ne Mbar Cade,for Ne Performance or the work fm which Nu Permit is issued.
y Worker's Compensation Insumna camicr and Policy number art:
rrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section reed not he camPlemd if the permit Is for ane hundred dollars(I IM)
nr kssJ
1 ecnify that in the Performance of the work for which this permit It issued,I shall Out.
employ any proton in any manner as as to become subject to the,Workers'Compensation
Laws of California.Data (Cp
Applicant V
NOTICE TO APPLICANT:If,after making this Cenircam of Exemption,you should
become subject to the Worker's Compensation provision,or the labor Cad,you most
wJ,Z forthwith comply with such provision,m this Permit Air Wdecmed nrvoked.
'Z'O CONSTRUCTION LENDING AGENCY
[—� I hereby alum that Vert is a construction lending agency for dm performance of
!Yi the work for which this permit is issued(Sit.309?,Civ.C.) -
GQ Lenlces Namc
Z)z Lend,esnddress
U C) 1 angry that 1 have mad this application and share that the abow inmmsnian Ice
!L F cormaL I agree in amply with all city and county Ordinances and state laws relating to
DU Wilding construction,and hereby authorise mp.."Orm,or Nu city w color upon the
Fv) shove-memioncd pmpc n for ndc pcctian which s.
6, (We)agree m saw,indemnify and Imp harmless dlo City of Cupcnino again"
y in
of the cans and eapcn,cewhichmryin any way acrnm againsusid Cly
Uz in consegmnec al Nc grunting of this permit.
'—� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Stgnuuro of ApphunVac
Conutor Date Re-roofs !
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or form building Occupant store or handle hamNuus material
"a derated by 0r Cupertino Municipal Code,Chaplor 9.12,and the HURh and Safety
Code,Semon 255J2(a)?
❑Yu ON. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
telt haw mlous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
istrkV
Q Ycs ❑No
I haw rtad Nehvawdntsmamricels mquimments under Chap tr6.95ofdu GIifor.
7docs
a Health&Safety Cedc,Smuom 25505.25533 and25534.I undemm,J thatifthc Wilding
ata cunemly haw a tonm4 Nn it u my mspomibiliy to notify the occupant of the
gpimmentawhichMMbemetPriorItissuanceoraCutiresteofoccupanq.
Signature ofApplicant Date
Owner or authorisE agent pate All roof coverings to be Class"B"or better
aiO
CommunityDevelopment
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
F Fax(408)777-3333
lCUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
929 Old Town Ct. 0 S 6a O-o
OWNER'S NAME: Chuang, Connie PHONE # 408-252-8614
GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360
I am not using any subcontractors: ��+ �40At0ZLI� 2/2/05
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
2/2/05
Owner/Contractor Signature Date
10/28/03
O��a 001
City of Cupertino Building Permit Application
E-Mail
jobsite Address: 929 Old Town Ct. Date: 2-2-05
Owner's Name:---Chuang,Connie
Phone No.(408)252-8614
APN#: 356-11-036 Project Valuation: S 950.00
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
SContact 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: 4/1/05
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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