04020023 CITY OF CUPERTWO ��" err ate" '
BUILDING DIVISION PERMIT �1'�4J^ �g` jk", �`�;"'j '9 �O
,r A,:
BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT NO.04020023
n44c; RAN ETERNANID0 AIT
OWNER'S NAME:
PERMIT ISSUE DAIS
t
NE:MAI SANITARY OL NO.
BUILDING PERMIT INFO
ARCHITECIENGiNEER: BLDG ELECT PLUMB MECH
40 Z, LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing P
' with Student 70(g4)ofDivision 3o(the BusincaeandProfessors,Code.andmylicense is �1..aa pp��
inmRmtceanderract. REPLACE WATER HEATER r'�Y�I��®
j Z License Close Lic.M
E g o Date Cortacmr (7 5 GALLON )
�e QQ my ARCHITECTS DECLARATION q �y
y 2< 1 understand my Plans shall W used As Public records FEB 2 S ZOO4
DyU
3 too t; Liecmcd Professional
5
OWNER-BUILDER DECLARATION BUILDING
I hereby reaso eRhm on 11. exempt from Ne Cantns Ccx License Law for the
p O following meson.(Section ID3 Construct,5, abor, and P s.dcar ll Code:Any city nr county
$(v which its i Tea a permit tat p.i.tialter.improve,demrdkh,or mesh any structure
Tai the,,inhe itsiensedp rte mqo the tbe i,burant mrsuch permit Lic.n.i U.(Chapter
< (commeacing wit partner, Division
nl thehe uxmr'and Proflaw(Chodo,ry Sq.Ft.Floor Area Valua[ion439
z (commas wrote it Meanness
and the basis f r ofthealleged
Business exemption.
Any vi Code)of '7�
$ Bothe Is exempt therefrom and the beer far be alleged cxmpvon.Any violation of
Sermon 7031.5 five
anyWr applicant for a permit Subjects the applicant to a civil penalty of APN Number Occupancy Type
Am more Nen fiw hundred dollars(5500).
❑Las ovreraftheproperty,omyemployce with wagmss thchsulecompense0on, 35712050 . 00
will do the work and theaswmure is not intended oroflered foraale(Sec,7044,Busineal Required Inspections
and Profeailom Code:The Contractor's License Law dean not apply to an e owner of q P
property who bullde or improve Maroon.and who does such work himself or through his
awn employees,provided Nat such improvements are not Intended or offered for sale.if,'
however,Ne building or improvement is held within one year of completion,Ne owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property.am exclusively contacting with licerecd contractors to
construct Ne po jest(Sec.7044,Business and Professions Code:)The Convector's Li.
cense law does not apply A,an owner of property who Wilde or Improve thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the CO^trantors
License Law.
❑1 Am exempt under See. .B @ P C for this moon
Owner DAM
Adik WORKERS COMPENSATION DECLARATION
I hereby eRmt under pernity of perjury one of Ne following dalarations:
1 haw^rad will maintain eCertiOmM of Consent to self-imam far WminesCompen-
setion,an provided for by Section 3000 of Ne labor Code.for Ne performance of the
work for which thin permit is issued.
I have and will maintain Worker's Compensation Insurance,an required by Section
3700 of the labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number Am:
Canner: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS' ,
COMPENSATION INSURANCE
(TMs section need not W completed if the Permit is for one hundred dollars 1$100)
or)aBE.)
I certify Nat in the perfonnence of to wok for which this permit is issued.l shall not
employ any person in any manners as to become subject to the Workers Compensadon
Laws of California.Deed
Applicant /)
NOTICE TO APPLICANT,If.after compensation
Nis CcniMsof of Ube,
you should
become subject y it Worker's Coo s or this craft Aes Is ted labor Code,you moat
,J O forthwith comply with such provisions or this Permit dull be dcemcd rewkad. �--
r� CONSTRUCTION LENDING AGENCY
'T+ I hereby aRnm Nat Nem la a construction lending agency for Ne perfurmanee of
�i 7 the work to,which thr permit is Wood(Sec.3037.Co.C.)
Is7 Q Lender's Name '
z Lender's Add..
U t] I certify that 1 hew mod this applia,io.and Also,that the shove information is
D. (~ comet.1 agree to comply with all city and county ordinances and state laws alatng to
O building construction,and hereby auNorin mprese^utive or this city to enter upon the
a above-mentioned property for inspection purposes
(We)agree to save.indemnify and keep homeless the City of Cupertino against
nF.t V) liabilitie,judgments,antis and expemea which may in any way seem against said City
C)z APPLICANTeUNDEof the RSTANDSthis
AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApPlicanUCanDem
HAZARDOUS MATERIALS DISCLOSURE - Type Of ROOF
ed Noapplicant ar(muco Wildinge.Chapter 9.12.
handle hawadour
As defined by the Cupertino Municipal Code,Chapxr 9.12.and IW NcilN and Se(cty
Code,Scc❑uoYm ONO n 255320)? All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
lt hazardous air contaminants As defined by to Bay Are^Air Quality Management all new materials for inspection.
71c'
istrict?
❑Yes 0N
I hove mad the mucadous mmchda mquiremenu under Chapter 6.95 of the Calilm
SaftyCode,Sectors 25505,25533 and 25534.1 utormand Nmilthe building
as not CMwAdy haw a Mmnt that it is my responsibility to Ma ly tbe occupant of the
quirement%which mustOnmetpriortoissuanceoraCtnVmMofOccupancy. Signature of Applicant Date
wner or authcrixcd agent Date All roof coverings to be Class nBn or better
b
City of Cupertino Building Permit Application
E-Mail
jobsiteAddress: 10445 San Fernando Date: 1-22-04
Owner's Name:---Lua, Maisie
Phone No.(408)973-1 93 5
APN#: ?-r7 / 2 �jJ U Project Valuation: S 1,439.00
Building Permit Info: Bldg---------- Elect---------- Plumb__--X----- Mech_--__
Job Description
Replace 75 gallon 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/l/04
Credit Card Information
Credit Card #: 5474-6390-0026-5679 2 /
Name on Card: Just Water Heaters Inc. /
Expiration Date: 9/05
Visa MasterCard ® �(
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