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08020121 CITY OF CUPERTINO BUILDING DIVISION PERMIT BUILI21NGAppJtES$�_ITED PL JUST WATER HEATERS INC PERMIT08020121 jjVElR'SUNUA`vE1: U1V PERMIT ISSUE DATE WOOD KATHIE A 3400 INVESTMENT BLVD 02/20/2008 PHONE: SANITARY N0, CONTROL NO. (510) 293-9901 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH uoo LICENSED CONTRACTOR'S DECLARATION rd 0 with krcby affirm that I em liecnsed under provisions of Chapter 9(commencing Job Description U ction7")afDivision SafdwBottom and ProfeuiumsCade,and myliceneci- REPLC 40 GAL GAS WTR HTR a p 01 in full taus and effect. �? License Class Lie.Is S h Dato Contractor ARCHITECTSDECLARATION i I t ndenund my plans that]be used a public retards JyU o Licensed Pret ameal OWNER-BUILDER DECLARATION E 0 f I hereby a(Sect on 1 am exempt from the Cowes Co License Law for mW E02 O O fallowing moan.res;a Permit t 703 onstru t.amps and Pradow.de oli Cade:Any city or county S5Ir which requsune,also requires construct.alter.impmsu dch emolish,fire sig anytatmure ement Z�, Methet in slcense pursuant Inde the applicant for COntratur to rile ga (Chapter g F< Met licensed pursuant to the provisions of thew Business Uccnse Law(C ode)or Sq.F[.Floor Area $895 Valuation yt� Me,heintlagwiN eraftn70W)MDiv¢iofr of Neaged quad Pmfessinvll.d,a Of 3 Nn io u attempt Nemfmm and the bub far does alleged soman to Any it penalty of Section 70L.5 by my red dont fora permit subjects the applicant to a civil pentlty of Number Occupancy e newt mom Nen to.hundred dalton(Baro). 32653 015 � P Y TYP - 1,aawnoroftbepmWay.mmymoplayceawithwguuNeirmkeomp melon, willdothewmrk and Neswctuseunot intended fir Dossed fmsale(Sec.70W,Burinexa Required Inspections and Professions Code:The Contractor'se ns License Law dues not apply k an owner of - Q p property who Wildsorimp rms tharcon,and whodoessuch work himulforNrough his Own employes,provided that such improvements are not immmded aro@end Iwale IL howewr,the building orimprovement is sold within ane year of cumpkdon.Ne Manor. Wilder will have the burden of proving that k did not hulk at improve for purpose of ❑1,as owner of the property am exclusively contracting with licensed contractors w convect Ou project(Sec.7044,Business and Professions Code:)Tk Cocuumba's U. cense law does not apply in an mvewr of property who Wilds or improves thewon,and, who contracts for such projects with a annummor(s)licensed pursuant to the Com ucones Lkeom Law. ❑Iarnexemptunder See ,B&PCforthisomme Dau WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury new of the fallowing declensions: ❑IhamandwillmainWn•CeWRauofConsenttowir-insumfor Work sCumpen. salon,u provided for by Section 3900 of the Labor Code,fm the performance of the work for which this permit is Wood. ❑1 have and will maintain Worker's Compensation Insanes,as;inquired by Section 3700 of the Labor Code,for Ne perfmmance of the work furwhkh Nu permit is issued. My Workees Compensation Insurance camor and Policy number are: Cartier. Polity No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ClLusectlon=ad MAW completed if tic permit is furan hundred dollars(SIM) mit .) 1 mrdly that in the performance of Ne work for which this permit is issued.l shall oat employ any person in any mannerm as b became subject to NC Workcri ComPenation Laws of Califamia.Dam Applicant NOTICE TO APPLICANT:If,after making this Certinum of Esemption,you should become subject to the Wohaes Compcuktion provisions of Om Labor Code,you must Oforthwith comply with such pmvisiom or this permit Mall k dcemed revoked. . ,'Z.t`-r CONSTRUCTION LENDING AGENCY •�-r Ihereh affirm that there la a commuminn lending a F r e Ixney for the perrarm.ewe of lYia�.r the work for which this permit Is issued(Sea 7097,Civ.CJ W Q Lenders None CL,Z) Z Leaders Add. U Q I certify that I lave mod this application and sam Out Nc above information is Ly P correct.I agree m comply with all city and county ormnanes and sok laws misting to 0U building comectiun.and hereby authodm¢pwanadves ofthia city to enur open the L17 above-mentioned property for inspection purposes G (We)agree to sew,indemnify and keep mordes the City of Cupertino against r r/1 liabilities,Judgments,casts and expensa which may in any way a come agsiat mid City U r,�7 In consequence of the gaming of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signuurt of AppRraHAZAI )OU Data HAZARDOUS MATERIALS DISCLOSURE Type Of Roof Will theapplicantfir Futurebuildingo e.Chapter or handle Health and dented io the Cupertino Municipal Code.Chaptor 9.11,roti the Health and Safety e, zss3z(a)7 0y. ❑No All roofs shall be inspected prior to any roofing material being installed. �Ya Will the applicant or future Wilding=open,use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit haardnus air caaaminams as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes C]No I haw mad the haardmm materials requirements under Chapter 6.95 or the Califon na Health&Safety Cade,Smiiom255U5.25533wd25534.1mdc dthuifthe Wilding dam not currently haw a wont,Met It a my McNuibility to notify Ne azupant of Ito requirements which monk mem prior a iuuumc of a Certificate ofSignature Of Applicant Date Owner or amhodzcd ager Dam' ' All roof coverings to be Class "B"or better pg 0, 0►a1 City of Cupertino Building Permit Application E-Mail Jobsite Address: 10091 united Pl. Date: February 19, 2008 Owner's Name:---Balakrishman, Karupplah Phone No (408)257-7009 APN#: 3}6-35-909^ ,3Zro 3a IS. OZ�5 Project Valuation .$ 895.00 Building Permit Info: Bldg___-_ Elect—_— Plumb—-JL— Mech_ Job Description Replace 40 gallon gas water heater. Contractor Information Company: Just Water Heaters Inc. Phone: (510)293-2012 • Contact Name: Fax: (510)293-2022 Address:3400 Investment Blvd E-mail: permits®Justwaterheaters.net City,State and Zip: Hayward,CA. 94545 State Contractor's License# 591329 Exp. Date: 3/31/08 Worker's Comp#: 01 DKRM11001070 Carrier: Nelos Exp. Date: 4/1/08 Credit Card Information Credit Card #: Name on Card: Just Water Heaters Inc. Expiration Date: 6/08 Visa El MasterCard Comments • CITY OF CUPERTINO 4 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32653015 . 00 DATE ISSUED. . . . . . . : 02/20/2008 RECEIPT #. . . . . . . . . : BS000003984 REFERENCE ID # . . . : 08020121 SITE ADDRESS . . . . . : 10091 UNITED PL SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : WOOD KATHIE A ADDRESS . . . . . . . . . . :10091 UNITED PL CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5723 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 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 895. 00 0.50 0. 00 0.50 0. 00 1PPERMITFE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00 1PRWHEATR UNITS 1. 00 24 .48 0. 00 24 .48 0. 00 1TRAVDOC FLAT RATE 1. 00 40 .79 0. 00 . 40.79 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 106 .56 0 . 00 106 .56 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 213 .12 MC . --------------- . TOTAL RECEIPT 213 .12 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- --------------------------- ---=---- ---------------------------- 518 WATER HEATER • Community Development 10300 Torre Avenue � �:.'� Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: PERMIT # 10091 United P1. 0 g 0 a b I d, OWNER'S NAME: Balakrishman, karuppiah PHONE # 408-257-7009 GENERAL CONTRACTOR: JustWater Heaters FAX # 510-783-6360 j 2-'8 lam not using any subcontractors: �-ic' RakL� 02/19/08 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 l 5 1 ZS Roofing Septic Tank Sheet Metal Sheet Rock • T('il�e v ata, 02/19/08 Owner/Contractor Signature Date 10/28/03