04090098 CITY OF CUPERTINO I �-r gky�*gy�*�,k �� �t'� 't'��f
BUILDING DIVISION PERMIT 4�1\'lifts AbRAINFO^"" 'b' ' ,Al
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BUILDING ADDRESS: JUST WATER HEATERS INC PERMITNOb4090098
ER
a OWN 'SNA01W31 PERMIT ISSUE DATE
r
ONE: SANITARY OLNO.
RCHDECTYENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Z Q
�oo LICENSED CONTRACTOR'S DECLARATION
1 Mmby affirm that 1 am)leaved under provisions of Chapter 9(commencing Job Description
with Section 7000)ofUivision Sof Jan Business end Professions Cods,and my license is
m full force ane elfecL
imz DammClass Lic.0 r REPLACE WATER HEATER
'-� ARCHITECTS DECLARATION 4 O GAL GAS)
I understand my plans shall M used As public records
use Licensed Professional .
OWNER-BUILDER DECLARATION
I hereby affirm Nal 1 am exempt from Mc Contractor's LI«nm Lew for the
O O following moon.(Section 703 1.5,Business and Professions Code:Any city or musty
$IL which mgdma a Permit to muuuct.alcor.improve,demolish,ar minor any structs
F prior m its isswnce,aim rtquir«The applicant for such permit to rile a signed statement
ice "IMIrlicensWpursuant todmprovisiowofMeContractor
'rLhmnulaw(Chaplv9 Sq.Ft. Floor Area Valuatiq�944
(commencing with Section 700D)of Division 3 of the Business and parasolCsde)ur
a.. Nat he I.Attempt Overman and the bash for On alleged exemption Any=of
Section 7031.5 by any Applicant far a permit mbjmM the Applicant to civil penalty of APN Number Occupancy Type
not mom this R.hundred dollars($500).
01,uawnerofthepmperty.«anyeanployces with m ilwas Nehromearelenaation, 36227011 . 00
will do Newon,and Mnrwermaractnmenamse La does Apply
70 N,Biurets '
and Professions code:Than canuxcmre a«non law doer not m,n owner of Required Inspections
property who builds«improves timreon,end who d«s tach work himmf or through his
own
employees,provided thatsuchimpro.an usnindoroeeed If.
enor,Me Wilding or Improvement Lr mid within amyearofcompletion,Me Owner.
build=will Ove the burden of proving Mu Im did not build or Improv:for purpose of
sale.).
❑I,As owner of Me property,Am exclusively contracting with licensed mntrecm s as
construct the project(Sec.7044.Business and professions Code:)The Commcmr'e Li.
cense[sew does sol apply m m owns of property who or improve ManComm.crel
whocontractsLace for such projects with a conu«mrtO II«nu0 pursuant m Me ContnctaM1
License Taw.
❑I em exempt undo 5«. .B @ P C for this sawn
Owner Data
WORKERS COMPENSATION DECLARATION
I hereby&Man anther penalty of perjury arc of the following declaruiome
1 have and will andnWn a CcrtIE«m Of Contain selblwuan for WorkersCOanpen-
wtion,As provided for by Section 37M of the Labor Code.far W parfmmame of the
work for which this permit is issued.
❑1 have and will maintain Wart Compewation Imuran«,As required by Section
3700 of Me Labor Cars.f«Me performance of Ne work for which this permit is issued.
My Workers Compemadon Insurance terrier and Policy number ere:
Carrier. Policy No.:
CERTIFICATE OF EKEMPnON FROM WORKERS'
COMPENSATION INSURANCE
(Thawed.need notImmosplemd If Ile permit uforme hundred dollen($]W)
sneer.)
I certify that in the performance of the work for which MIA permit is issued.I shill nut
employ any parmn in my manncrm as to became subject to the Workers•Compensation �J
Laws ser California.Dem
ApplicaOTICnt
N
NOTICE TO APPLICANT;If,After Compensation
this Certificate of of Exemption,o dyou should
become subject y it Workers Coanpewhis permit
of the labor Coded you muss
��J.. faMwiN comply with such pmvhinas or this permlshall Md«teed revoked.
„Z,rO CONSTRUCTION LENDING AGENCY
[.. I hereby&M.Wt Nem Ise mnumctinn Inion;agency for Mo per(oranen«of
a> the work for which this paranh is Wood(Seed 3097,Ci,C.)
W O Landers wee
=z Lender,Addmn
V Q 1 certify Mat I have mad this pplication and sum Met Mc aha.Information Is
{i.,^-' coect.L ages as comply with W city and county ordinances And sum lawn relining to
C)SV' building mmwcbm.and hereby maoriu mpeenuuvxa of this city to enw upon Me
W alrow-mentioned propmy for inspection purywet
(We)agree to and.indemnify and keep number;the City of Cupertino against
zy Ilabilidu.judgmenuM,coats ahexperuea which may In my way+mrm against add City
V^' APPLICANTin mousqeUNDERSTANDS AOf Me uffliOfnND WILL COMPLY WITH ALL NON-POINT Issued by: Date -
SOURCEREGULATIONS.
Re-roofs
HAZARDOUS
Signuum ofAppliuDam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII Mc applicant or rumor building e.Chap face or ad t e Health
sd Saeid
asde0wd by the Cupertino Municipal Code.G+pter 9.11.ant Mm HcdN anti Safety
Code,Zman 25532(.13,7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes ONO
Will the applicant or lmue building occupant tau equipment or devices which If a roof is installed without first Obtaining an inspection,I agree to remove
7�1�nmr
mit havardow air em uminanu w JeGncd by the Bay Area Air Quality Management all new materials for inspection.
isuict7
❑Yon ON.
I have mad Ma hwandaus material equiemenu under Chopmr6.95 of Mc Califon
.H«IN&Safety Cw 25
u
ade,Seeda505.75533 anJ25534.I underrinn l Ihuifft building
oret currently ben a moat.Men it is my a mstrAmility m nodry the Occupant or Ne
ulemcuS which muss M mel prior m issuance of a Cemncate ser Ocmpmcy. Signature Of Applicant Date
or Authorbad agent Data I All roof coverings to be Class nBn Or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
�_. Telephone(408)777-3228
CITY 0, Fax(408)777-3333
,CUPERTINO
Building Department
JOB ADDRESS: PERMIT #
7647 S uirewood Way D <�o 0 v
OWNER'S NAME: Poole, Margaret PHONE #408-257-2613
GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360
I am not using any subcontractors: DJACD- � � 9/15/04
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
• -"� �4 � 9/15/04
Owner/Contractor Signature Date
10/28/03
City of Cupertino Building Permit Application
E-Mail
Jobslte Address: 7647 Squlrewood Way Date: 9-15-04
Owner's Name:---Poole, Margaret
Phone No.(408)257-2613
APN#: 362-27-011 Project Valuation: S 944.00 -
Building Permit Info: Bldg-_____ Elect____- Plumb----—X_—__ Mech-_______-__
Job Description
Replace 40 gal gas 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# 591329 Exp. Date: 3/31/06
Worker's Comp#: 1626288-04 Carrier:State Compensation Insurance Fund Exp. Date: 4/1/05
Credit Card Information
Credit Card #: 5474-6390-0026-5679 �7
Name on Card: just Water Heaters Inc.
Expiration Date: 9/05 1 0
Visa E] MasterCard
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