03040009CITY OF CUPERTINO
' - 'I `SMO ` 00'"s
BUILDING DIVISION PERMIT
W0NTkAiC�.T0R MNTI MATiC1N:
%d `l*ww'X,BUILDING
ADDRESS:
PERMITNO.
21453 SHANNON CT
JUST WATER HEATERS INC
03040009
OWNER'S NAME:
PERMIT ISSUE DATE
LOGAN JESSE & VIRGINIA TRUSr
1764 NATIONAL AVE
04/01/2003
SANITARY NO. CONTROL NO.
(510)293-9901
CHITECT/FNOINEETt:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby efilrm lost 1 am licensed under provisions of Chapter 9 (commencing
I
with Section 70n)) ol'Divlsion 3ofthe Business and Profculons Code, and my license Is
In full force and effect.
License Class Lle.gREPLACE
WATER HEATER FINALE
Dam Contractor
ARCHITECTS DECLARATION
(4O GALLON)
1 understand my plans Mall be used as public records
SEP 1.5 2003
Licensed Profession,]
OWNER-BUILDER DECLARATION
1 hereby af0on Net I am exempt from the Canlraaar's Licence Law for the
following moon. (Section 703 1.5, Business and Pmfeadom Cade: Any city or county
Q� �
EW'LD
which outdoes s permit to con timet. alter, impmw, demolish. in mind, y structure
prim to IB Issuance. aISO requires the applicant for Such permit to rile a Signed statement
Nal he is licensed pursuant to the pmvidons of the Comrmtm's lJmtue Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7K]) of Division 3 of the Business and Profossions Coca) or
Net he Is exempt therefrom and Ne but, fns the alleged exemption. My Wristlet of
AIN Number
Occ y Type
Section 7031.5 by any applicant fix a permit subjects the applicant to a civil penalty of
not mom than It. hundred dollars H3M),
0 1, as ownu of the pmpwy, or my employes with wages as Neirmle compensation,
nn
Required Inspections
will do U. work, and Nc svu otim is not Intended m .ffered Inseam (Sm. 7014,Budness
and Profession, Cade: The Comntten uearue Law doss not apply to an owmr of
-
progeny whobuild, orlmpraws Nerom.and whodoeswch work hlmselfurthrough his
502 - FINAL PLUMBING ENERGY
own employee, provided Nu such Impmvemmu are, notintended mortared fors de. if.
however, Ne building or improvement lssold within one year of cemplation, On owner.
506 — GAS TEST
Weyer will have the burden at pmvingthm he did not build or improve for purpose of
507 — FINAL PLUMBING
0 1, as owner of the property. am exclusively contracting with licensed Contraction to
construct the pmject (Sea 7044, Business and Professions Code:) The Contractor', Lt.
came Law does not apply m in owner of property who builds or Improves Nemon, and
who contracts for such projeea wit a contractor(s) licensed punuanuo Ne Comorcum's
License Law.
0 l am exempt under Sea ,B At P C fns this noon
Owner Date
WORKERS COMPENSAflON DECLARATION
1 hereby afBon under penalty of perjury oro of the following declarations:
haus and will maintain a Cerd imme ofCauent to se161uum for Workmen Canpen.
on, as provided for by Section 3700 of the labor Code, for the performance of the
'
work Tor which NB permit Is Issued.
an
0 1 have d will maintain Worker', Compcnsarmn Insurance, u required by Section
7701 of the IA1Wr Cede. for the performance of the work forwhich this permit is Issued.
My Worker's Compensadon Immranee carrier and Policy number am:
Corder. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Tht, section need not be com pleted If the Football Is fm ow h undred dollars (SIM)
lir less.)
1 certify that In Ne performance of the work for which this permit B issued. I shall not
employ any poison In any manner an an in become subject to the Workcri Compensation
Laws of Califomia. Data
Applicant
NOTICE TO APPLICANT: If. after making this Certificate of Exemption. you should
become suhjcn m the Worker's Compensation provisions of the Labor Code. you must
forthwith comply with Such prevision or Nis permit shall be decreed mwked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that Nen is a construction lending agency for the Forformams of
the work for which Of. permit is Issued (Sec. 7097. Civ. C.)
Lender', Name
.
`
Lender's Address
I certify that 1 haw reed Nle application and sum that the above Inlormuiun Is
correct- 1 agree to comply with all city and county ordinances, and sate law relating in
building construction, and hereby authadn repnttnutives of Nis city in enter upon tiro
above-mentioned property for Inspection poryoma
(We) agree to new, indemnify and keep harmless the City of Cupcnim against
liabilities,judgments, costs and expenses which may In my my memo against said City
in of the flooding of tANhisD
APPLICeRN
ANTUNDERSTANDS WILL COMPLY WITH ALL NON-POINT
Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Type Of ROOF
Signature of AppllwO Dam
HAZARDOUS MATERIALS DISCLOSURE
WIII the em or future occupant smrc at handle alloan material
u definW by thea CupCupH
ertino Municipal Code. Chapter 9. 12, and the uIN and Safety
Code. Section 25532(,)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yu ON.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicem or future bullJing occupant arc eyuipmenl ar devices which
It herard11 air cmtamocina as defined by the Bay Are Air Quality Management
all new materials for inspection.
Oia7
CYea ON.
lhavemWN MnM esmsteoalsmquim=ntaundorChapw6.95of1heCalifor-
nia HuIN,4SalclyCode,Secdou25505,25555ud25534.1unM dUmif N:Wilding
doss not currently haw a mnanc tint it IS my responsibility in nodfy the occupant of she
requirements which men be mel poor to commerce of a Certificate of Occupancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner
or authorized agent Dem
CIT OF
CUPERTINO
APN. #
Building Address
CITY OF CUPERTINO
WATER HEATER
PERMIT APPLICATION FORM
o3obr3ti9
o o
Date:
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PPERMTTFEE
Nl�l tfL'�. Cil
PLUMBING
Owner's Name:
Phone #:
Contractor: d� Phone:spa -2/��' 2012 -License
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USf ev�C.e. t-% 11,rC
BUILDING
Contact: Phone:
Cupertino Business License #:
Building Permit Info:
BI dg ❑ Elect ❑ Plumb
Mech ❑
Job Description: /
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Residential Commercial ❑
Cost of Project: s ev,
Strapped 0 On Platform El Bonded El
New Location ❑ Replacement El
Qty. if
Applicable Fee ID
Fee Descrintion
Fee Grout)
BPWHEATER
Water Heater / Vent
BUILDING
PPERMTTFEE
Plumbing Permit Issuance
PLUMBING
BENERGY
Energy
BUILDING
BUSLIC
Business License
BUILDING