03050065 1
n CITY OF CUPERTINO � TM �'�" --
BUILDING DIVISION PERMITiCONTRACTUR INF,URMATIQN .ffi
ee:'v,9,t #:.;:'i^'
BUILDING ADDREM: JUST WATER HEATERS INC PERMITNO03050065
OWNER'S NAME: 1764 NATIONAL AVE P6R13RL NnS/2003
UFENG WANG
NE: (510) 293-9901 SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
p 0 0 0 0
+10o LICENSED CONTRACTOR'S DECLARATION
V I barely of on that[am licenead under provisions of Chapter 9(commencing Job DCSCfIpIIOn
ith Suction 7.10)of Division 3 of Ila E.A.and Professions Cade.end my license is
^� in rull farce and effect.
'qz License Class Lk.a REPLACE WATER HEATER
Dam conA r (50 GALLON ELECTRIC) MIYALEr2
ARCHITECTS DECLARATION
2 1 understand my plans.lull he dead As Public records
. MAY 2 7 2003
el reit Licensed Pmfcuianal
OWNER-BUILDER train
DECLARATION
I krehy.(lure that 1 1. exempt from the Conlnem o License taw far sk
n O O following won.(Sation 7M str t..iner.and Improve,
de tans Code:Any city n county
ante UI
$� which require•parent re cnnstrua,alar,impress,deermit t m repair any almemm
FEC that he
or itsiauanrcalmmgo the prevision of thefor CosuchPenni) License
Lo (Chaps eel
< IhetkislinnudpunuanlmthcProvislonsofthcCmtncmr'sLI¢nselaw(Cheper9 Sq. Ft. Floor Area Valuation
F B (commencing with Section 70BB)or Division of the Business and Professions Cade)or
Nat he is exempt the rfrom it the basis far Ile alleged eaempd...Any violation of O
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
nes mom Ilan five hundred dol Ws(5300).
0l,uownerof Wepmpeny,amyemployeuwiNmguufte wlewmpcw0on, 36944015 . 00
will do the work and the structure is not lnmnded.snored Imselc(Sm.7001,Business j� (� p
and Profeseimu Carlo:The Conmcror's License Lew dans not apply m an owner of 502 — FINAL P -UMB I NIie ENERGY
property who Wilds or improver thcomm.mr1who doessuch workhimselfar through his
own employees,provided that such imp msemenu are not intended or.ffmcd for ale.If. 506 — GAS TEST
however,the building or improvement is sold within aro you of completion,the owner.
builder will have the Written of proving Out k did not build or imprme for purpose of 507 - FINAL PLUMBING
sale.).
❑ I.as owner of the property am exclusively contracting with licensed ounce=to
construct to pappa(Sec.7044.Business and Profusions Cade:)The Contracmr's Li.
cense few does not apply to an owner of property who Wilds or improves,thereon,and
who contracts for such projects with a canuumr(s)licensed pursuant An the Canitama/s
License law.
❑l amexemptunderSec .Bk PCfmthismasan
Owner Dam
WORKER'S COMPENSATION DECLARATION
I heroby anirm under penalty of perjury on of use following declarations:
IWwenow illmainWa•Ca a mof Consentmeal6insumforwor SCampcm
anon,As Provided for by Soodon 3700 of the IoW,Cade,for use erfna me,of the
work for which this parent is issued.
❑I have and will maintain Worker's Compensation Inmmnce,as required by Section
37W of the labor Cade,far the performance of the work for which this permit Is Issued.
My Workers Compensation Insurance carrier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMFTTON FROM WORKERS'
COMPENSATION INSURANCE -
(This section need not be completed Hthe permlt is fmonc hundred dollamalil 0
kaJ
I renify that in the perform..of the work for which this permit is issued,I shall nut
employ any person In my mmMr an as to became subject to ft Workers'Compensation
Laws of L'allfarphs.Dale
Applicant
NOTICE TO APPLICANT:If,after making this Ccniricam of Exemption,you should
become subject ro the Worker's ComPcnsatian previsions of the Ise Wr Code,you must
,JZ forthwith comply with such provuinns or this permit shall k dmenal revoked.
'ZO CONSTRUCTION LENDING AGENCY
-F' (hereby efrum that Nem is a construction lending agency for lie performance or
7,.: Ne work fur which this Permit a issued(Sac.3097.Co.C.) /l
4 Q Lender's Name
,z London's Address
f,Q 1 certify that 1 ban mad this application and sum Na the own information is
F conal I agree to comply with all city and county on irmsees and sum laws mlating(a
O V building comsmaction,and hereby authom,orposeenutims of this city to met upon ft
mon-mentianad property for inspection purposes.
(Wc)agree to ave,indemnify and keep humleu the City of Cupertino against
o-4 n liabilitin.judgmcmacosts and expenses which may in any way acmm against mid City
V 2 In consequence of the granting of permit.
Fi APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signazum of ApplinD
rOe
r De
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant tar future building occupant nom m handleallous material
ft defined by Cupertino Municipal Code.Chapter 9.13,re
it the Health and Safety
N0
Scotian n533(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes ❑No
Will the applicant or future Wilding occupant use equipment or devim which If a roof is installed without first obtaining an inspection,I agree to remove
II hnrallous air contaminants as defied by the Be,Ana Air Quality Mmilemenl all new materials for inspection.
Dinrict?
C]Y., ❑No
I have road Ile heartens maenals requiremcnu under Chapter 695 of the Califon
nieNnith de Safety Cade.Scetions 23303.25333 and ZSSll.l mderssand thuif the Willing
1.not CYnemly he.a Imam,Nal it 4 my nspanslblloy m MYfy Ile occupant of the
mquiremcros which most be met prior to issuance of a cemnne of occupancy. Signature of Applicant Date
Owner or authorized agent Date All roof coverings to be Class°B"or better
' J
City of Cupertino Building Permit Application
E-Mail
jobsite Address: 20280 Pacifica Dr. Date: 5- 15-03
Owner's Name:---Wang,Yufen
Phone No.(408)741-5989
APN#: 369-44-015 Project Valuation: S 760.00
Building Permit Info: Bldg---------_ Elect_-_-_--- Plumb------X----- Mech-----------
Job Description
Replace 50 gallon electric water heater.
Contractor Information
Company: just Water Heaters Inc. Phone: (510)293-2012
• Contact Name: Dulce Fax: (510)293-2022
Address: 1764 National Ave. E-mail: permits®justwaterheaters.net
City, State and Zip: Hayward,CA. 94545
State Contractor's License# 591 329 Exp. Date: 3/31/04
Worker's Comp#: 1626288-03 Carrier:State Compensation Insurance Fund Exp. Date: 4/1/04
Credit Card Information
Credit Card #: 5474-6390-0026-5679
Name on Card: just Water Heaters Inc.
Expiration Date: 9/05 o 1
Visa MasterCard
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