05110121 CITY OF CUPERTINO R^' "—ZCTC." °b' "
BUILDING DIVISION PERMIT ,;;COINTRACTQ,RINI'D.,RMATZO;N.a
BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT No.05110121
OWNER'S NAME: PERMIT ISSUE DATE
3400 INVESTMENT R=
NE: SANITARY NO. CONTROL NO.
(510) 293-9901
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
'BLDG ELECT PLUMB MECH
0 0 0 0
i
0, LICENSED CONTRACTOR'S DECLARATION
eC 1 Comby alarm Ma,I am no:nxa under proviions of Chair.9(wmmencin{ lob Description
L� Mu Scction]tllMl)of Division 30flhe Busineuand Professore Coia.aM mylkenscu
+ d in full fame and endo REPLACE WATER HEATER
License CTuss Lic.g
e o Dow Contractor 50 GAL GAS
ARCHITECT'S DECLARATION
MW u I undersand my plans shall be used W public records
Licensed professional
OWNER-BUR.DER DECLARATION
F 1 hereby afrimn Nat I.c crept from the Contractors Ummac law for Me
p O rollowing muco.(Section 70313,Busintts and Indications Code:My City or county
m ff which require a permit to construct.altar,improve,demolish,or occur any structure
.i< priorui ins issuance.aim mquims lM applicant for such permit on file a signed suemcni
s Ma he u licensed Ivoaam to tW provisions of the comraewrs atom Taw(Chapct9 Sq.Ft. Floor Area ValU3tlOt$$5$
Ed l-S mommcncingwith Sccdon]000)of DivWon3ofl Budncuand Pmfmions Codc)or
2 W,Zinn comp,thuefmm and the buss far the alleged pd.My violation of
Section 7031.5 by m0 appOcanl for a permit mbjecu me applkan,to a civil penalty of 'APN Number Occupancy Type
no,roam man five handled dollars(M). 37525029 . 0 0
❑Lu owner ofms!peatruc or myemplaycn withwagu (See
m44.Bummus
will tlomewark,Cocme shaumacwt,Licenseandedd aw doeod s 1 apply.to shtwo ,or Re uired Ins ections
and property
wh on Cade Th camsaemrs and
who law aces tot apply lf r t rough of q P
am
mpeny wyces,provided
v impales mermn,and who me not intend,h wvk hinuelredthrough dela
ho ver.th Wiping or matsuch impm id wit ale not roc vmeerdd far sale comer.
harder.the ave M g or impmvemen u told within and 3'u of completion.me
builder win love mu burden of proving seas he did and build or improve far purpose of
ala.). •'
❑Las awrcr of me Sec.70property.,B uclusi elyand conuazti ns wind )The
enact es U.muvua t to not apply
]006.Business and rty,who Wilds
Code)pr ver M nara lyd
cause law aou not apply m m owner rousolmny)who and p or improves u Norton,and
who contracts Laces for such pvjecu wind amnlracrmrts)lianzd purwam to the Contractors
License law. \
❑lam uempt under See ,B@PCfor this moon
13711E
nv Dau
WORKER'S COMPENSATION DECLARATION
1 hemby aRum under porosity of perjury arc of the following declarations:
1 ham and will maintain a Cardmate of Covent m self insure fm Workers eampeo-
an,u provided for by Section 3]00 of the Labor Code,for me pec imersnce of me
rt for which leis permit is issued.
1 have and will maintain Wader's Compensation Insurance,u lectured by Section
me labor Code,far me perfamsumc of me wart far which this permit u Issued.
Workers Compduaion Iwran¢artier and Policy number mc,
rtier. Policy Na.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu scesan need not M completed Kine permit is format hundred do0an(SIM)
or I..)
I c reify that in the performance of the wort,for which this permit is issocd.I dull not
employ any Nunn in any mmterm u to become object to Me WorkerCompensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.after making this CeNficau,of Exemption,you should
become subject to the Warker's Compensation provision of me labor Cad,you muss
.Jz forthwith comply wish such provisiav or mu permit shall W deemed mwked.
Z O CONSTRUCTION LENDING AGENCY
walk
firm dPemcm is din a
F hereby { gemy,for the performance of
CYi me work fur which this Permit u lasaed(Su:.J09],Civ.CJ /-) _-
0..Q Lenders Name
z Undoes Md.
L)C I colify that I have and this application and sum this the above infmntion u
LL P contact.1 agree to comply with all city and county aNinances and sum Ivws mlating to
C U building convection,and hereby mthomc representatives ofthu city mentor upon lW
W show-menudgm property for inspection purposes.
gy (We)agree to save,indemnify and keep harmless Ilse City of Cupertino against
h in consequence
judgments.Me ora ad eaperuu which tory in any way aecme against said City
C)z APPLICANTcUNDERSTANDS ANof this D WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
HAZARDOUS
Signmurt of ApplicaDam
HAZARDOUDOU S ith,acATSDISCLOSURE Type of Roof
Will IW applicant oOr n
Wilding occupant pore ar handle harudoudSaflmaterial
az defined by I25 Cupenitm Municipal Code.Chapter 9.1x.dna me Health and Sa(cty
rode, 0Y.xss3x(a)] All roofs shall be inspected prior to any roofing material being installed.
❑Yu ON.
If a roof is installed without first obtainingan inspection,I agree to remove
Will us applicant infmule building Occupant billBare equipment or denims which P g
mitic'? ovairconumiwnsudefixdbytWBayAm.Ail Quality Management all new materials for inspection.
Distrix?
❑Ya ❑Nu
1 have mad the baraNrws makedals mquimmcnu under Chap er 6.95 of the Califor-
niaHealth&Safety Carte.Saran]5M5.x5531 ani x5534.1 undersand mm if me Wilding
data not currently have a tenant.that it is my msponsihility to noul'y the occupant of the
requimmmis which most be met prior to issuance of a cutirteme or Occupancy. Signature of Applicant Date
Gwaer ar authmdmd agent D,m. All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
_6 t TelepCupertino CA a95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�CUPEkTINO
Building Department
JOB ADDRESS: PERMIT#
18660 Runo Ct. 0 y/-0 /�)-/
OWNER'S NAME: PHONE# 408-248-2814
GENERAL CONTRACTOR: Just Water FAX # 510-783-6360
Heaters
I am not using any subcontractors: D- tQ.m- 9/22/05
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
9/22/05
10/28/03