05020099 CITY OF CUPERTINO �sr 'M =�a rf �'`' i'�'" "'•
T BUILDING DIVISION PERMIT W-160A
BUILDING ADDRESS: JUST WATER HEATERS INC PE0.MIT"/05020099
OWNER'S NAME: PERMIT ISSUE DATE
ONE: 3-
SANITARY NO. CONTROL NO,
ARCHInTCDENGINEER: BUILDING PERMIT INFO
BIRO ELECT PLUMB MECH
30p LICENSED CONTRACTOR'S DECLARATION JobDescri tion o 0
w�(I' I krem w
by afOron 1 am licensed under provisions of Chapter 9(Commercials P
with Secticn?OW)of Division 3 of the Business and Professions Code.and my license is
In full tome and efra
Lime aa„ lx.g REPLACE WATER HEATER
coat ARCHI'IECTSDDECLARATIOn (50 GAL EELCT. )
1 understand my plans"I k used As Public records
Licensed Professional
Oat I am BUILDER DECLARATION
Q E 1 ..an.(item on 1 1. exempt from do ll mons Con License law for the
D ODS following matin.(Section 7101.;B.amus and Refusion Code:Any city m county
%$Y. pd.i mGnlms issuance.also re sire,t e4 oiler,improve,h permit o n!A.repair mi statemy ment Z-, prcormiuenseatsoalto the thovisiosof fo,sucthe Compermit beers Law(Chumml
FFa (commirlicensedpursuant70the provisionoftheeBuacmhLimnsalgom,Copue9 Sq.Ft.Floor Area Valuatip lg
S g that(coM is ial exampth Sectionreort and the
basis n 3 of Al Business and Pnoon.my
Cade)of
Wt k�emmP(dertfrom and the hasis f«the allgW emmPUan.My violation of
Section 7031.5 by any applicant for a permit objects the applicant m A civil penalty of ane APN Number Occupancy Type
not roam than rim hundred dollars(SSM. P Y YP
❑1,as ower of the property.or my employees wimp wages As their ole compensation. 36944003 . 00
and dOlmwon,,and a The lomlenc Intended Law dos Act apply ID14fww of] Required Inspections
and Profession Cudc:The Canuenors mlLicensewW Law don rot apply m an atuth is "r_ ; Q p
.marvipropertywbo Wilds provided
id thatsuch improvements
mn.odwm anondm intended
wart«thiouN his _
however.
nilding or ithauuehimprovem within
not ear ofdmo0eand for ale. 1
AMMM ,the have
she
b r improvement ts said AM did Am buil r of completion.the rrpscm f J
milder wIB lute du Wrdan of leaving But k did rot udid«improve f« rposa of
ale.), p7pL_ / �\
❑1.u owner of do property,Am uelusively contracting with Itansad run \,r1
construct do prejec((See.7014,Business sed Professions Code:)Tm Con a
Coast,law dors notapply An an owner of property who builds or improves tiurton,ad,
who eonuanh for such projects with a contractor(s)licensed pursuant n than Contractors
license Law.
[:]1 am exempt underSee. .B,1P C f«thisresson
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby afOtm under penally of perjury oro of the following declarations:
I haw end will maintain.Congregator Consent in sciNnsum for Warkers Compo.
lan,as provided for by Section 37M of the labor Code,for the performance of the
1M37
ok fm which this per ill u issued.
1 have and will maintain Workers Compensation InaurarrCe,as required by Section
00 of the labor Code,for the performance of the workfor which this permit is issued.
y Workers Compensation Inaunnce carrier and Polity number art:
nier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(7Th sand..need not k Completed Kik peamll la fmaachumbaddollan(SIM)
or tax)
1 Certify Nm In the performance of the work for which this permit is issued.I shall not
empty anypetson in any manor an as in become subject to the WorkerCompensative
Laws of CalifamiL Dau
Applicant
NOTICE TO APPLICANT:If,altar making this Certificate of Exemption,you should
become objet In Ne workers Compensation provision of the lab«Cade,you muss
.J O forthwith Comply with such provision or Nis permit shall k Maned reoked.
CONSTRUCTION LENDINGAGENCY
Ihhi wl(km13acntmcilending Cor she percarmemu of
� Ne work for which Nu permit Is issued(Sec,3097,CivC.)
, `J
a Q Lenders Name
O z Lenders Mdm..
U O I certify that I have mad this application and tum that the Above information is
Ifr F eomct I Area at comply with all city and county ordinances and sou laws relating in
O U Wilding conduction.And hereby o(horim representatives of this city at emu upon the
LLl
above-mentioned properly for inspection purposes.
(We)agree on save,indemnify and keep humlesa the City of Cupertino Against
wa rAlabdides.judgmmu,co,and expenses which may In my my same galnsl old City
i
U n eonmguenCo of thus'reading or this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplianuConuanor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fuUuo building=opal store or handle huardous material
As deroul by the CupeNna Municipal Code.Chapter 9.13.and the Health and Safety
Code,Sado.25531(.)1 All roofs shall be inspected prior to any roofing material being installed.
❑Yee C]No
Will the applicant or future Wilding occupant use equlpmmt as devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hanonn Air conuminnu ss defined by the Bay Area Air Quality Management all new materials for inspection.
Didicl7
❑Yes No
Itsave and the hvngmsmateriaismquimmcnu undcrChapmr6.95 of the Califor.
nu Hulth&SafmyCo .Seg.25505.25533and25534.1mdcraftlfdn Wilding
dam mm currently love a tenant,Nat it u my responsibility An notify the oaupanm of No
requirements which muck met prior At issuance of a Certificate of Occupancy. Signature Of Applicant Date
All roof coverings to be Class "B"or better
Owner or authorimd agent Dom
Community Development
10300 Torre Avenue
IN �' Cupertino CA 95014
CIT 0 Telephone(408)777-3228
Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRESS: PERMIT # G
20304 Pacifica Dr. OS-° Z o 0 /
OWNER'S NAME: Gendler, Inns PHONE # 408-257-8727
GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360
I am not using any subcontractors: � CQ � ^�� 2/11/05
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 11
• �� � ��"` t 2/11/05
Owner/Contractor Signature Date
10/28/03
2
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 20304 Pacifica Dr. Date: 2-11-05
Owner's Name:---Gendler, Inna
Phone No.(408)257-8727
APN#: 369-44-003 Project Valuation: S 818.00
Building Permit Info: Bldg—---- Elect___--_ PI u m b____X----- Mech-_--_-_-
Job Description
Replace 50 gal elect. 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 Zlp: 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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