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CITY OF CUPERTINO
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CONTRACTOR INFORMATION
BUILDING DIVISION PERMIT
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BUILDING ADDRFss:
104"1 PENNTNOTON IN
JUST WATER HEATERS INC
PERMIT N006010003
OWNER'S NAME:
PERMIT MUM DATE
ANN HUANG
3400 INVESTMENT
01/02/2006
NE:
SANITARY NO. CONTROL NO.
(510)293-9901
ARCHITECT/ GINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Pte., OO O
LICENSED CONTRACTOR'S DECLARATION
I Worry that 1 Itcerved orcbaper 9 (commencing
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Job Description �a ,
affirm am under province.,
usinand Professions Code, Code, andm license is
with SecGonl"d.fDivision 30f Ne Bns
,d, t[§
Ind'
in fullromp and Effect.REPLACE
WATER HEATER All-
t '
Licenense class Lie.
Dow -
Dam Connector-
50 GAL GAS
DECLARATION
ARCHITECTS DECLARATION
P1oavd
1 undcrsunJ my plans shall he usul u public Excnrda
` u
Licensed Professional
OWNER -BUILDER DECLARATION
.
DING
I hcuhy.(firm that 1 exempt License law for the
the Gerimal
i $�— V
�r�,l
]rn t,5, B. senfrom
mMUa. (Section 1. and P(UfCWUM Code My clly ar nty
Co
rahich
t-lv�,
wllleh re t tel eaR,WCL alter, ImpmM, ouuum
dict. are any tWCWm
iiGulnl n e. also h prowit t a sig
prior us its issuance, nu requites the applicant for such permit m Ole a sigud summcm
(coma is to the the Co Li prix Law Chapterrew)or
Sq. Ft. Floor Area
Valuati 4398
ming with of Divionaf
Business Cnic)
wing with Serafro
Of Division 3 of the Business end proceson.
Of
Ont he u exempt therefrom and 0e baso for the Jlcgcd eumption. Any violation of
thea Z ,and Any
Sartori 7031.5 by any applicant for a permit subject the applicant to a civil penalty of
Baro hundred dolmrs(S500).
APN Number
Occupancy
P cy Type
WE Mom then
36204030.00
❑ h as owner ofthe Property. crmyemployees with wages u such sole compntrea ,
willda the work, end the swesum is not Munadcd or offend Entente (See 7060, Business
and Professions Code: The Conuamor's Lt. Law does riot apply M an owner of
Required Inspections
opcny
prw ha buil de m ire proves thereon, and who does auch work himself or though his
Own employ=. provided Out such improvements are not intended or offered for sale. IL
however, the building or improvement is sold within one year of compleien. Ne owner-
bullder, will have Ne buNa. Of proving wt or did not Wild or impose far purpn,c of
este.).
❑ 1, a owner of the property, am exclusively contacting with limned contractors to
cora met the pmjmt (Sec. 906., Business, and Professions Cade:) The Contactori U.
cerin Law does not apply m an ownv Of property what milds or improves Demon, and,
who contracts for such projects with a eontrutoKa) licensed pursuent re Ne Con (man's
License Law.
1 am exempt under Sec , B g, P C for this masan
Owner Date
-
WORKER'S COMPENSATION DECLARATION
1 herby affirm under pemlty Of perjury oro of the following dplMauon:
1 hem and will maintain aCenificaw of Ca aunt m self -Insure fm Wmeres Compen.
on, as provided for by Section 3900 of the labor Code. for the pertarmnce of the
k for which this permit is issumi.
13'1.1rQ
1 have and will maintain Workers Comprosation Insurance, as requited by Section
or the labor Code, for du performance of we work far which this permit u issued.
Worker's Compenation I... caniv and Policy number ameer.
Polity No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Dissection, teed not ba completed if the permit is Intone hundred dollars (SIM)
or lOa.)
I modify that in fee performance of the work for which this permit is issued, I shall nm
employ any Name in any manner sou m become subject o the Workers Compensation
Laws of California. Dam
Applicant
eau of Exemption, you should
NOTICE TO subject
became W Has APPLICANT-. If, alum making this
the Worker's or Ne Labor Code,
provisions; you most
comp y provisions or this provision
forthwith comply with such provisions or this permit shall be deemed revoked.
teed
f `I
CONSTRUCTION LENDING AGENCY
1 hereby off rte Nat there is a conswction lending agency for the factionalism of
Ne work for which this permit is issued (Sec. 3097, Civ, C.)
L gimmes Narm
,
Lender: Address
I cenify Nat I have mad this application and nam Nn the above infonnniun u
cortttL I agree to comply with all city and county ordinances and sum laws Existing to
building pwmction, and hemby l uthoeu reprer nuthrut of this city of enter upon the
ahovcmcmioncdproperty for inspection a
(We) ague to cave, indemnify and keep harmless 0e City of Cupertino against
which
coati and expenses which may in any way attme agnntaid City
mm
inscion,
m conuquenee of the granting of this permit
of Me
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Sngnewre ofAppbcaOtor Data
HAZARDOUS
OUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant of for= building attupant some or handle ha nodous exaueal
defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
de. Section 25532(a)?❑Yea ❑Na
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or forum building attupam sou cyuipmcm or acvitts which
If a roof is installed without first obtainin an ins ection, I agree to remove
g pit
hanodous air conmmmants as defined by the Bay Area Air Quality Management
all new materials for inspection.
tin?
Ittimments
❑Yes ❑NU
1 have mad ae Woodaus materials requirements under Chapter 6.95 or the Califo-
Health& Safety Cade, Somfo n25505. M533 and 25536.1 un�rpand aw if lie Wilding
cs lel cEumml, he. a Intent, that it u my msponibility M notify the Upan, ter de
which mon be mel poor to issuance of a Ccnifcate of Occupancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
owner at anthoeaea epenl D,m
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Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
10
Fax (408) 777-3333
Building Department
JOB ADDRESS:
T
PERMIT
1043 Pennington
o o " o
OWNER'S NAME:Ann Huang
PHONE # 408-725-0581
GENERAL CONTRACTOR: Just Water
FAX # 510-783-6360
Heaters
I am not using any subcontractors
12/21/05
Signature Date
Please check applicable subcontractors and complete the following information:
U2r� � 12/21/05
10/28/03
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
U2r� � 12/21/05
10/28/03
t
•
C
E -Mail
of Cupertino Buildinq Permit
Jobslte Address: 1043 Pennington
Owner's Name: ---Ann Huang
Phone No.(408)725-0581
APN# 362-04-030
Building Permit Info: Bldg ---
Date: 12-21-05
Project Valuation: S
ect___—_ Plum
Job Description
Replace 50 gal gas water heater.
Contractor Information
o_0�° //or 0�!3
lication
1,398
Company: Just Water Heaters Inc. Phone: (510)293-2012
Contact Name: Dulce Fax: (510)783-6360
Address: 3400 Investment Blvd. E-mail: permltdept@sbcglobal.net
City, State and Zip: Hayward, CA. 94545
State Contractor's License* 591329 Exp. Date: 3/31/06
Worker's Comp#: 1626288-05 Carrier: State Compensation Insurance Fund Exp. Date: 4/1/06
Credit Card Information
Credit Card #: 5474-6390-0047-8660
Name on Card: just Water Heaters Inc.
Expiration Date: 06/08
Visa ❑
MasterCard
Comments
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