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CITY Or CUPER'1'iN0
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BUILDING DIVISION PERMIT
CONTRACTnR INTORMACION
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BUILDING ADDRESS:
JUST WATER HEATERS INC
PERMIT NOO 3100061
OWNER'S NAME:
1764 NATIONAL AVE
PERMITISSUEDATE
NE'
(510) 293-9901
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB M[CH
12:1
LICENSED CONTRACTOR'S DECLARATION
I hereby afofm That 1 am licensed under provisions or Chapter Y (commencing
that pr comy
Job Description
P
with SectionIher70(g))ir
Division Om Business a Professions Code,and licenseis
in OU Tome and affect
License Class Lic.N
REPLACE WATER HEATER
Dam cmumsu r
(4 0 GALLON GAS)
ARCHITECTS DECLARATION
I understand my planss shall shall be used as public recnNa
'
Licensed Professional
OW HER -BUILDER DECLARATION
1 hereby atTrm that I em exempt from the Contractors License Law far the
following reason. (Section 7031.9. Business and Professions Code: Any city or county
which requires a permit to construct. alter, improve, demolish, or repair any structure
prior b) its issuance, also moires the applicant for such Permiuo rile a signed statement
that he is licensed pursuant to the provisions of t1be Contracter's License Uw (Chapter 9
Sq. Ft. Floor Area ValuatiO$807
(commencing with Section 70W) of Division J of the Business and Professions Cole) or
that he Is exempt therefrom and the huis for the alleged exemption. Any viomdon of
Section 7031,5 by any applicant for a permit subjects the applicant to a civil penalty of
32&ID $Jile80O
Occupancy Type
not more than Eva hundred dollars(SSW).
--
❑ I, u owner of the pmpeny, or my employees with wages ss their able compensation,
will do Ne work, and the sweture is not intended or offered for sale (Sec. 7044, Business
Code: The be
License law does out apply lf as owner
.itinfiPoywhobuilds
end Pity
i.suchwork
necton,
R d hS�e ��❑
c
who bas improves thacmh
,improves and whorl himselfora is
his
502 - FINAL PlffoA I NG E'MRGY
own employees, provided that such impmvemeru are not intended of offered for sale. If,
506 — GAS 'TEST
however, the building or improvement is sold within one year of completion, me owner.
builder will have the burden of proving mar he did not build or Improve for parlance of
507 - FINAL PLUMBING
sale.l.
❑ 1, as owner of the propeny, em exclusively contracting with licensed contractors to
construct the pmjcd (Sec. 7044, Business and Professions Code:) The Contractor's Li.
tens. Law does nor apply m an aa. of,,.,Hy who Wilds or improsea thereon, and.
who contracts for such projects with a concoctor(s)licensed posy and to the Contrera
License Law.
❑ 1 am exempt under Site , B & P C for this reason
Owner Due
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of Perjury one of the following decluations:
1 have and will maintain a Ccnificate of Consent to self-insum for Winter's C=Nn.
union, u provided for by Section 3700 of the Inbar Code, for the Performance of she
-
workfor which this Permit isissued.
❑ 1 have and will maintain Worker's Compensation Insurance, u required by Section
3700 of the labor Code, for the Performance Of the work furwhich this permit is issued.
My Workers Compensation Insurance eamicr and Policy number am:
Carrier. Policy Na,: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
.
(TMs section need not M completed If the permit Is far one hundred dollars (Slip)
nr IcssJ
I certify mat in the performance of the ..,it for which this padres, is issued,) shall nut
-
employ any pefean in any manner sa as to become subject to the Workers' Compensation
Laws of California. Data
Applicant
NOTICE TO APPLICANT: I[ after making this Ceniftcam of Esemprion, you should
become subject to the Workers Compensation provisions of me labor Code, YOU must
forthwith comply with such provisions of this Normal shall be deemed revoked,
CONSTRUCTION LENDING AGENCY
I hor hy agency or the perfurmanceof
thalmcre isaed(Secm3W7,
C
which
0. work for which this permit is issued (Sec. JOY], Civ. CJ
h.
Lender'Name
Landcr's Address
1 cenify that I have rod this application and some that ma above information is
'
correct. 1 agree to comply with all city and county ordinances and sole laws relating to
building construction, and hereby antistatic mpreum mives of this city Its enter upon the
ahovc-mentioned property for inspection purposes.
(We) agree to uve, indemnify and keep harmless the Ci ly Of Cupertino against
liabilities,judgments. costs and expcnecs which may in any way accrue against said City
in consequence of the granting of This parm it.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Type of Roof
Signature of ApplinData
HAZARDOUS
HAZARDODO US MATERIALS DISCLOSURE
Will the applicant or (Muni building occupant start o handle material
dc.Sed the Cupertino Municipal Codc. Cheper 9.13. and rhe Ncalmh and Safcmy
Health an
io
e. s -I eazssup)1All
❑tea ❑Na
roofs shall be ins ected rior to an roofin material beim Installed.
P P Y g gWill
If a roof is installed without first obtaining an inspection, I agree to remove
the applicant or future building occupant ase equlpmcnl or device, which
it havardous air contaminants as defined by me Bay Area Air Duality Management
all new materials for inspection.
rie'Q
1�qtommcms
Yes ❑Nu
I have mad the huallousmaterials requimrrcnts anda,Chapter 6.95 ofthe CalifonHealth&
SafetyCode. Sections 7550s.25577 and 35574.1 undmond that ifme Wilding
s nm currently have a mount, that it is my responsibility m nfy the Occupant of mo
which must the met prior to issuance or a Certificate m Oceupercy.
Signature of Applicant Date
All roof coverings to be Class "B” or better
Owner or authomcd agent D„e
t
•
C
E -Mail
of Cupertino Building Permit
Jobsite Address: 10110 Penninsula Ave.
Owner's Name: --- Rovetti, Doreen
Phone No.(408)863-0177
APN#: 326-24-028
Building Permit Info: Bldg ----------
Date: 10-8-03
Project Valuation: $ 807.00
--------- Plumb ---- —X-----
Job Description
Replace 40 gallon gas water heater.
Contractor Information
Company: just Water Heaters Inc.
Contact Name: Dulce
Address: 1764 National Ave.
City, State and Zip: Hayward, CA. 94545
03. 0L0c/,,/
ication
Phone: (510)293-2012
Fax: (510)293-2022
E-mail: permits@justwaterheaters.net
Mech--- ------
State Contractor's License # 591329
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. 3 / 26
Expiration Date: 9/05 g 6/
Visa ❑ MasterCard X
Comments