04040123 ` crrY or CUPERTINo
BUILDING DIVISION PERMIT CONTRA INFORMATION m
BUILDING ADDRESS: JUST WATER HEATERS\ INC PERMIT Ncb 4040123
11602 SEVEN SPRINGR nR
OWNERS NAME: PERMITISSUEDATE
Aft SCOTT CANALI 1764 NATIONAL AVE04/20/2004
ONE: SANITARY NO. CONTROL NO.
(510) 293-9901
ARCHInCT/ENGINEER: UI MITINFO
E LUMB MF.CII
0 o LICENSED CONTRACTOR'S DECLARATION O O
F 1 hereby affirm that 1 am licensed under provisions of Chopmr 9(commencing Job Description
.Z with Section of Division 3 of The Business and Professions Code.and my license is
o rdn in sen roma and erreO` REPLACE WATER HEATER OCT 2004
Z License Class Lic.N
Dam Contractor (5 0 GAL)
�d¢¢ ARCHITECTS DECLARATION BUILDING
I understand my plans shall M used as public records
g"T o^ Licensed Professional
j OWNER-BUILDER DECLARATION
<l 1 hereby affirm that I am exempt from the Contractor's License Low for the
i p o following reason.(Section 71131.5,Business and Professions Code:Any city or county
K m which requires a permit to construct,allot,impmvo,demolish,or repair any structure
LZi prior to its issuance,also requires the applicant fursuch permittu rile aligned statement
E5G that he is licensed pursuant m the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuatic$798
yH$ (commencing with Section 7Wfl)of Division 3 of the Business and Professions Code)or
y,�.. that he is exempt therefrom and The basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of ApN Number Occupancy T
not momdom5.hundreddollars(S500). P Y YPe
❑1,as owner of the property,or my employees with wages as their sole compensation, 36654016 . 00
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business
and Pmaxaions Cade:The Conuactofs License Law does not apply in an owner of Required Inspections
pmperty who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended Or offered for sale.If,
however,the building or improvement is sold within One YOU of completion,the owner
Wilder will have the burden of proving Nat he did not Wild or improve for purpose of
sale.).
❑I,as owner of the properly,am exclusively contracting with licensed contractors to
emouXt the project(See,1644,Business and Professions Code:)The Contractor',Li
cense Taw docs not apply to an owner of property who builds or improves Hereon,and
who contracts for such projects with a contraemr(s)licensed pursuant In the Conoactors
License Law.
E]I am exempt under Sec. ,B&P C for this reason
Owner mm
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations.
v I have and will maintain a Certificate of Consent to self-insure for Worker's Camper.
anion,as provided for by Section 37M of the labor Code,for Ne performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section -
3700 of fine Ubor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number art:
Cartier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This Suction need not hecomplcmd ifthe permit is for one hundred dollars($I00)
m less.)
1 candy that in the performance of the work for which this permit is issued.l shall not
employ any person in any manner ren as to become Subject o the Workers'Compomsarion
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Ceni Bute of Exemption,you should
become subject to the Worker's Com ambration provisions of the Error Code,you must
.JO forthwith comply with such provisions or this Form i t shall be deemed revoked.
CONSTRUCTION LENDINGAGENCY
I—f 4 Ihereby alarm Nat Nese is a eomswctinn lending agency or he graurnarm.of _
ai N 3097,C
e work for which this permit Is issued(Sec.3(ri],Civ.C.1
RWi Q Lender's Name
Z)z Lender's Address
V O 1 cenify that 1 have read this application and areae that the above information is
U, H correct.l agree to comply with all city and county ordinances and state laws relating to
0V building construction,and hereby autharim repmsenaatives of this city to enter upon the
ahnvcmomioned property for inspection purposes.
WO)agree to save,indemnify and keep harmless the City of Cupenino against
N liobllitieajudgmenke.costs and expenses which may in any way aconic against said City
in consequence of the granting of this permit.
UIssued b Date
"^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
SOURCE REGULATIONS. Y�
Re-roofs
HAZARDOUS
Signawrc of Applicapate
HAZARDOUDOD S MATERIALS DISCLOSURE Type of Roof
Will theepCorector future building Occupant store or handle Health and
as defined ion 25 32(a)l nn Municipal Cade,Chapter 9.12,and the Hcellh and Safety
COJC.Section 25532(,)? All roofs shall be inspected prior to an roofing material being-7 Yes El No P P Y' g g 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
tit hazardous air contain inams es defined by she Bay Area Air Quality Management - all new materials for Inspection.
sbin?
❑Yes ❑NO
1 have read the haysorous materials requircomms under Chapter 6.95 of Nc Califor
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand due IF On mi ding
does nor currently have a tenant,that is is my responsi hilly to noufy the ncupant of the
requirements which must M mer prior In issuance of a ConificatO of Occupancy, Signature of Applicant Date
Owner Or authorized agent Dare All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
UPEkTINO
Building Department
JOB ADDRESS: PERMIT # o C1L o/ 2-311602 Seven Springs Dr.
OWNER'S NAME: Mr. Canali PHONE # 408-996-0656
GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360
I am not using any subcontractors: UAce. 4/19/04
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
Owner/Contractor Signature Date
10/28/03
city of Cupertino Building Permit Application
F
il
ddress: 11602 Seven Springs Dr. Date: 4-19-04
OwnersName:---Mr.Canali
Phone No.(408)996-0656
APN#: 366-54-016 Project Valuation: S 798.00
Building Permit Info: Bldg_---_-_ Elect_—_-- Plumb----—X-_- Mech-_--_---
job Description
Replace 50 gal 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-mall: permitsojustwaterheaters.net
City,State and Zip: Hayward,CA. 94545
State Contractor's License# 591329 Exp. Date: 3/31/04
Worker's Comp#: 1626288-03 Carrier:State Compensation Insurance Fund Exp. Date: 411/04
Credit Card Information
Credit Card #: 5474-6390-0026-5679
Name on Card: Just Water Heaters Inc. 6 (�
Expiration Date: 9/05
Visa MasterCard
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