03090080 a CITY OF CUPERTINO �« F +
BUILDING DIVISION PERMIT ° CONTRACTQR INFOYtMATION �.
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•' BUILDINGADDRESS: JUST WATER HEATERS INC PERMITNO.03090080
OWNER'S NAME: 1764 NATIONAL AVE PERMrr L$ue DATE
INE:
(510) 293-9901 SANITARY NO. CONTROL NO.
ARCHITECTIE14GINEER: BUILDING PERMIT INFO
BLDG ELELT PLUMB MFCH
0 0 0 0
+oij LICENSED CONTRACnderpDECLARATION Job Description
I hereby affirm that 1 am limed under and
Professions
ofChapterCode. 9(Commencing p
ii wi 7000) Divixian7of Ute Business and Prufcssinnx Code.and my license is
r<d License
ane Classdcflect.
ig? u.natclA, ase.» REPLACE WATER HEATER
Dart.Contractor (80 GALLON ELECTRIC)
£ ARCHITECTS DECLARATION
4 W V I understand my Pimm shall W teed as P ildie accords
e Licenud Professional
OWNER-BUILDER DECLARATION
MI hereby alTi m Nat 1 am exempt from Ne Com.cmrs License Law for the
00 following...a.(Settle.7051.5,Business and Profcasiuns Cade:Any city or county
S$f which requires a Permit to construct,alar,improve,demolish,or repair any structure
-2< prior to its issuance.also requires the applicant for such Permit in file a signed statement
ss
that he is licensed pursuant in the provisions of Oc Contractor's License aw(Chapter9 Sq.Ft. Floor Area ValuatiYp2643
LI-0 (commencing with Section?000)of Division 3 of the Business and Prafessions Cnk)or
Nal ha u exempt dtcrefrom anal the basis for the alleged exemption.Any violation of
Section 7071.5 by any applicant for a Permit subjects tha applicant o a civil Penalty of 3�$ffi B7m�G�r 0 OCCU Type
not arm Nan five hundred dollars(1500). - -' _ paDC Y --- -
0 1,o Owner of the property,Or my employees with wagon their sole compensation, Ir r't 1 'w
will do the work,and NeswOura is not imm.ded oroffsred forsale(Sec.7W.Bminass .�
and Professions Cade:The Clmoscmr'a Lt..law daex nota I to an Owner of n Re ulred'In��sppe�cttCVER'
property who builds m improver thereon,and who doessuch work himselfor through his 0 ..�,I��IAL �PLUMBINL;IY
awnemployees.pmvlded that uch improvements art not intended oroRered for=Is.If. _ �. E
however,the building or improvement Is sold within one year of completion,Ne Owner.
builder will have the burden of proving that he Nd not Wild at improve for purpose of rj — A LU
sale.), 'yt1y❑j\\ ��
❑1,as owner of the property,am exclusively contracting with licensed contractors to U .—
constmci the ra jker(Sec.7014,Business and Professions Code:)The Contractor's Li.
cease law does not apply to an owner of property who builds or improves Umreon,and,
who contracts forsuch projects with a conuator(s)licensed pursuant in the Containers `
License Law.
❑I am exempt under Sea ,B&P C forthis moon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hcrchy affirm under penalty of perjury oro of the following declarations:
I have and will
an
&CCnificoa of Coastal o Alf-insure for Worker"C.I.A.
c/ cation,As pmvided for by Section 2700 of the labor Code,fm the porfoamance of are
.,it for which this permit is issued.
❑1 have and will maimain Worker)ComrcmNan huurance,as required by Section
5700 of the labor Code,for Ne pe Tia....of the Work far which this permit it issued.
My Worker's Compensation loan...carrier and Policy number Are:
Carrier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Calls section need not bo completed if rhe permit is fora ne hundred dollars($IN))
or less.)
1 cenify that in the perhomanec of Ne work for which this Permit is issued.l shall not
employ any person in any manner so as m become subject to WDracts Compensation n
Laws of California.Dem /Y V
Applicant R ✓`
NOTICE comelu j APPLICANT:If,after making thio Certificate of Exemption,oc you should
7� Eccomehcomp to the WorkeroComPmVr this previsions of the Labor edevoke you must
forthwith comply with such provisions or this Permit botl.mcd revoked.
Z y CONSTRUCTION LENDING AGENCY
1 hereby Arm that there its conauamion lending agency for the Perfurman.of
0: V7 Ne.,it far which this permit is issued(sec.5097.Civ.C.)
Landers Name
Z Lsndcrs AdOcki
..2 0 1.nify Nat 1 have read Nis application and use Nat the above information is
y F correct.I&goes to comply with all city and county onlim ues and state laws relating to
V building construction,and hereby suthmim representatives or this city to cora upon the
Ya ahove.mcntioned property for inspection purposes.
ti (Ws)agree to on,indemnify and keep harmless the City of Cupertino against
N hohilkoS,judgments,costs and Carcases which may In any way 9CCNC against said City
.-)Z in Consequence of the granting of this Permit.
•'^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Signature of ApplicentlConData Re-roofs
HAZARDOURDOU S MATERIALS DISCLOSURE Type of Roof
Will the applicant or foam building eat nom or handle h eldaamaterial
As tlefined by the Cupeninn Municipal Cade,,Chapter 9.13,and Ne HeaIN and Safety
Cale,S❑nYoen 255520? 0 N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment ordericas which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
Varier
❑Yes ❑Nu
1 have real Ne ha.aNas mauai dS requirements under Chapter 6.95 of Ne Califor.
nim HealthB SafetyCode,Sections,35505.25577 anal 5554.1 umk.a.d dtst if lM Wilding
dots cot lionady have a anent,On it u my responsibility a m ifY the..11%of the
requirements which must lc met pdortu icauanceofa CcrdOca:of Occupancy. Signature of Applicant Date
Owner tar authorized actor Data All roof coverings to be Class "B" or better
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 22901 Stonebridge Date: 9-10-03
Owner's Name:---Bingham, Ronald
Phone No.(408)375-7382
APN#: 342-13-050 Project Valuation: S 1,643.00
Building Permit Info: Bldg----------- Elect----------- Plumb------X----- Mech-----------
Job Description
Replace 80 gallon electric 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: 3/31/04
Worker's Comp#: 1626288-03 Carrier: State Compensation Insurance Fund Exp. Date: 4/1/04
Credit Card Information
Credit Card #: 5474-6390-0026-5679 �( 2-3 1 o
Name on Card: just Water Heaters Inc.
Expiration Date: 9/05
Visa MasterCard X
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