06050066 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRACTQR�INFORMATION _
t'"
BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT"0.06050066
10540 STOKES AV
OWNER'S NAME: PERMIT ISSUE DATE
ITO YOSHIAKI AND JOY K TRU TEE3400 INVESTMENT BLVD 05/09/9006
Tr E:
SANITARY N0, CONTROL NO.
(510) 293-9901
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
IO0 LICENSED CONTRACIOWS DECLARATION I0b Description
%wF 1 beach,affirm Nat I am licensed under proomm
visions of Chapter 9(commencing
BZW with Section 7000)of Division J ofthe Business and Profcssime Cade,and my license is
.,H in full foxc and effect REPLACE 40 GALLON GAS WATER HEATER
License Clus L'e.N
h„
DOW COmtrxmf
ARCHITECTS DECLARATION
I s< 1 understand my plans shall W used as public records
o Licensed Professional
5 OWNER-BUILDER DECLARATION
<E 1 Wreby a11Brm Nat I am exempt from Ne Contractor's License Law for the, a
L1 O following reason.(Section]03 L5,Business and Profciom ssCalc:My city or county
<m which mquifes a Permit m conduce,,alcor.improve,demolish,nr ropor any suuctvm $104
°_< priormis issuance.also requires led applicant for such pcnnitm fleasigaJ sutemcm
that he is licensed pontoons o the provisions of Ne Camncwrs Liccnx Law(Chaptor9 Sq.Ft.Floor Area Valuation
(commenting with Section Division Jnf the Business Professions Code)or
R�
i that he is esrmpt thmefrom and gm basis for the alleged csempuon.Any violation of
Section 703:.5 by a"applicant for a Permit subjects the applicant to a civil Penalty of r ccupaney Type
not mart dun few hundred dmllms(5500}
Las owner .and
propene,m my emploY.es with wage as Neer(Sec.
campewsimer
will gothcwo.and the sheet.xswr'sLt.dooReredfarside t"ply in a4,Buor of Required Inspections
and ProfWlous Code:The Camuaeton,Licence{ave does mart apply lf an owner is q p
own eny who Wilrsmimpraws h improvements
vedwho ar ensue tended imulf err through his
awn employees,provided Net such improwmoca ax not Intended oroaereg for saler
however.the Wilding or improvement u sett within arc year of completion.the ower!-
builder will new the burden of proving that he did not build or improve for purpose of t
salt.). �
❑1,as owner of IW Propcuy,am exclusively canuxting with licensed convaams to
comoun thc project(Sec.TONG,Business and Professions Code:)The Coouscsars U. '
ccuse Law does not apply to an owner of property who Wilds or improves Merton,and.
who contacts for such projects with aconsuaor(s)licensed pueswnt to the Contractor's
License law.
❑lamesempturder See .B&PCferthis.
Owner Dam v '/
WORKERS COMPENSATION DECLARATION U
1 hereby arum under pevlty of perjury ax of the fallowing datsntiaus:
1 haveand will monuin a Certifimm of Conxm m self-inxm fm WedmisCanpen-
sation,as provided far by Section 3700 of the Labor Code.for the Performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's ante of atimn Insure which
h oid por d by Sccunn
]TOOha a Labor Code,for Ne Performance oldest wart for which this ured b s issued. '
My Worker's Compensation I....oeier and Polity numbef are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Indirection acd not be completed iflh pmmit is future hundred dollars;($:00) r
or leu)
1 certify that in Nc Performance of IW work fa which this permit is blamed.I shot Out
employ any person in any mmncrx as In become subject to the Workers Compensation
Laws of California Dam
Applicant
NOTICE TO APPLICANT:IL after making this Cerif roc of Exemption,you should
became subject to the water's Compensation provisions Of the labor Code,you must
.JO forthwith comply with such provisions o Bair permit than be dmmcd rewkcd.
'Z "'" CONSTRUCTION LENDING AGENCY
r
[-+ Incteby which rte Nu then ssued( ec.30 lending agency for Use perfunnance of
ai the work fur which this permit u issued(Sec.703],Civ.CJ
a lender's Nam.
7 z Lender's Add.
[)Q 1 unify that 1 haw mad this application and sale that the above informadun is
W f^ cancel.1 agree to comply with all city and county ordinances and sure laws relating In
QO Wilding convection.and hereby authoore upmacnutiwe of this city to enter upon Inc
pro
ion
yabove-o.j.dged ds.c st for irsa .$purpowhich ms.
(We)agree to saw,indemnify and kip harmless the City of Cupenino against
fA incoisquenc of she
es penxsmit. may in any way acetas agonst trig City
C)z A APPLICANT
of the granting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Signature o(AppliaHK ARmm Re-roofs
r Da
HAZARDDOUS MATERIALSDISCLOSUREo SURE Type of Roof
Will,,hes,Cupentor future WiloCge.Chaptnaroaand hmlth and
u defined by the Cupertino Municipal Code.Chapter 9.11,and th.Health anJ safety
Code,Section 8571(x)?
❑Yes ON. All roofs shall be inspected prior to any roofing material being installed.
'41 Will Nc applicant or fumes Willing Occupant sax cyuipment or dcvims which If a roof is installed without first obtaining an inspection,I agree to remove
shallhavardnus air conuminanu as defncd by the Bay Aro Air Quality Management all new materials for inspection.
District? P
❑Yes 0 N
1 have rod the hvmdoua materials mquixm res under Chapter 6.95 ofdre Calilm-
Ole Health&Safety Cade.Secoous 850.5,15573 and 85]4.1 undersand this if the Wilding
does not currently haw It IenanL that it Is my reepantibility m MIRY the occupant of dm
requirements which rause,demel prior as resar.e of.Canon,or Ocmpancy. Signature Of Applicant Date
Owner araallori.daghm Dam All roof coverings to be Class"B"or better
CITY OF CUPERTINO
•m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32648005 . 00
DATE ISSUED. . . . . . . : 05/09/2006
RECEIPT # . . . . . . . . . : 34307
REFERENCE ID # . . . : 06050066
SITE ADDRESS . . . . . : 10540 STOKES AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ITO YOSHIAKI AND JOY K TRUSTEE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1235
RECEIVED FROM . . . . : JUST WATER HEATERS
CONTRACTOR . . . . . . . : GILROY, JOHN LIC # 15128
COMPANY . . . . . . . . . . : JUST WATER HEATERS INC
ADDRESS . . . . . . . . . . : 3400 INVESTMENT BLVD
CITY/STATE/ZIP . . . : HAYWARD, CA 94545
TELEPHONE . . . . . . . . : (510) 293-9901
�EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ------ ---- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 1 . 00 34 .86 0 . 00 34 . 86 0 . 00
BPWHEATER PER HEATER 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 84 . 02 0 . 00 84 . 02 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 84 . 02 MASTERCARD
TOTAL RECEIPT 84 . 02
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
DLap500L9(-0
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 10540 Stokes Ave. Date: 05-04-06
Owner's Name:---Yoshiaki Ito
Phone No.(408)446-9534
APN#: 326-48-005 Project Valuation: $104.00
Building Permit Info: Bldg Elect Plumb____X_ Mech
Job Description
Replace 40 gallon 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 Ucense# 591329 Exp. Date: 3131/04
Worker's Comp#: 1626288-02 Caller:State Compensation Insurance Fund Exp. Date: 4/11/03
Credit Card Information
Credit Card #: 5474-6390-0047-8660
Name on Card: just Water Heaters Inc.
Expiration Date: V' OLo) pE
Visa MasterCard
Comments
I �
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
SCUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
10540 Stokes Ave.
OWNER'S NAME:Yoshiaki Ito PHONE # 408-446-9534
GENERAL CONTRACTOR: Just Water FAX # 510-783-6360
Heaters
I am not using any subcontractors: �'�¢ a^ Q�� -� 05/05/06_
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
05/04/06
10/28/03
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
• Owner/Contractor Signature Date
•
10/28/03