03040038 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT ,CON�RAC,aTQRIN�+QRMAT_ION �¢
BUILDING ADDRESS: PERMIT NO.
2074 VALLCO FASHION PARK JUST WATER HEATERS INC 03040038
s OWNER'S NAME: HRMIT195UEDATE
BENIHANA RESTARUANT 1764 NATIONAL AVE 04/07/2003
NE: SANITARY NO, CONTROL NO.
(510) 293-9901
ARCHITEC rENGINEER: BUILDING PERMIT INPD
BLDG ELECT PLUMB MECH
0 0 0 0
�Oo LICENSED CONTRACTOR'S DECLARATION Job Description
1 kmby affirm dI am limned under proviYoru op of Chapter 9(commencing
Z with Section 7")ofOlrlsion Sof time Business and Profcuiom Cade,and my license Is
n< C /� C
infullfohns ellen. FIN Y• LED
5'�i ucenmClssa �'g REPLACE WATER HEATER
Dole Contractor (100 GALLON GAS) APR ], rJ ZOOS
e Q
ARCHITECTS DECLARATION
Y Jy Iundcrnend my phnaakllkuacdupuMlc rtcards
38 Licensed PmfcssianH
OWNER-BUILDER DECLARATION BUILDING
�0 E I hereby alarm that 11. exempt from time Canons Co e:LicenseAny c law for to
ypC which followingmason.
permit(Sectit 7construct.sineuandroc.de oli Co dc:Any chy ormunty
ure
$ which requ(v•pmmh re resthnor,imrrove,demolish,t ri repair any nrumum
F Yy' thatpriorhe iBi mitedpalwntin Me provisions
applicant for achrermhto Bleasigned mwment
�p (commencing wit
pursuant mthc of Division 3 of Me Business
law(Chapter Sq.Ft. Floor Area Valuation
xp Met he Is turem it emberson and M basis or th al Business end on.An ions Crust)of
T�
Met he b esempt Nemfrom and Ne buts for Ne alleged exemption.Any vlolNun of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number 6241ey Type
not mom Nen five handout dollMa($500).
❑1.u owner ofthepmpeny,many employees with wgu uNebaolecompenation, -i1r?nn6q no
wllldo Ne work,end the mmctum B wt Imtmded moffemd for We(See.70N,Business
and Pooresslaru Cade:The Comnntort Liceme Law docs not apply in a owner of Required Inspections
property who WllJs orlmprov tiwrere.and whodmuuch workMmmlrorthmughhls 301 - ROUGH PLUMBING
own employees,provided to such improvements am not Intended mortared forsele.if,
however.the building or Improvement is sold within ham year orcompledlon,the owner- 303 — ROUGH MECHANICAL
sal)er.111haw lkburden ofproving that be did Out Wild orImprove far purpose of 304 - ROUGH ELECTRICAL
01.as owner of to property am excluaively contracting wit licensed contractors to 505 - FINAL ELECTRICAL
contract to pmjm(Sec.7044.BW neo and Postmortem Cade:)The Conoactor's Li. 507 — FINAL PLUMBING
come law dean not apply b on owner of property who Wilds or Improv Morton,and.
who contracts for such projects with a eomratoHO licenad pursuant to to Contractofa 508 - FINAL MECHANICAL
License Law,
0 I em emorpt under Sec. .B&P C fat this mason
Owner Dole
WORKER'S COMPENSATION DECLARATION
_ 1 hereby affect under Penalty of perjury ham of the follmving declinations:
_1931110,
hew and will maintain.CmditmmofC.ne.t t self-Wum fm Workmen Cnmpen.
Ion,u pro idrA fm by Section 3700 of Me Labor Code,fm the performance of the
woh for which this permit is lamed.
❑1 have and will main am Workse,Compensation Insurance,a required by Schon
3700 of the labor Codc,for the performance of the work for which Mia permit is Issued.
My Worker's Compensation]more a carder and Policy number am:
Cartier. Paltry No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This suction nand not be monphind if tbe permh Is fm ort hundred dollar(SIM)
nr less.)
1 costly that in the performance of the work for which this permit is boom.I shell not
employ any person In any mummer an a in le cumesubject to Mk WmkeW CompcmMon
Laws of California.Gam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Examine,you should '
bemme sublem to the Worker's Compensation previsions of Ne labor Cedc.you mum
.J O fur kwhM comply with such provisions m Nis permld shall be deemed revoked.
,zea 0 CONSTRUCTION LENDING AGENCY
f•+o-+ Ihemhy affirm that Nem Isa mmdmctlon lending agency for the Performance of
a the work fur which ibis perm1M is land(Sm.3097,Civ.Q
WM Lender's Name n (i
�z Lender's Address
V Q I certify that 1 have reed this pplication and ante that Mac above Information Is -
tl. F correct.I agree to comply with all city and county onfl aceund auk lawn mining to
0 building construction,and hereby athodm representatives of this city to enter upon Me
W above-mentioned property for inspection purposes.
G WO)agree to ave,indemnify and keep harmlea the City of Cupertino against
00 liabilities.judgments,cots and notation which may In any way ammo gains,mid City -
U 7 In consequence of the gnnOng of this permit
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:344_12�koDate
SOURCE REGULATIONS.
Re-roofs
SiLnuum of ApPli<adConDam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or forum Wilding occupant mom o.handle Health
material
a rlo,Sed by 25 32(,07Cupsarda.Municipal Code,Chapter 9.1x.and tk HcdN and Safety
Carlo,season zss3x(.)7 - All roofs shall be inspected prior to any roofing material being installed.
❑Yu ❑Na
Will tc appbcmd m future building Occupant use equipment m devises which If a roof is installed without first obtaining an inspection,I agree to remove
It hauardwa air mnwninama an derined by the Bay Am Air Quality Mamgemem all new materials for inspection.
Witt?
❑Yes ON.
1 hove mad the Weardoua materiels requirements under Chapter 6.95 of the Cable,
nla Health A SafctyCak.Scetiom 25505,25533 ad 25534.1 understand thin if Ne Wilding
data not currently hem a bnmt,Nat It is my respondMllty,to notify Mac occurred M the
requirements which mum W met prior to issuance or a Certiacam of Occupaey. Signature of Applicant Date
Owner serm hodmd spent Date All roof coverings to be Class"B°or better
a 3
City of Cupertino Building Permit Application
E-Mail
jobsite Address: 2074 Vallco Fashion Park Date: 4-7-03
Owner's Name:---Benihana Restaurant
Phone No.(408)253-1221
APN#: 316-20-063 Project Val7Plumb
--$3.,636. 1,
Building Permit Info: Bldg___________ Elect__ ____ _____ Mech___________
Job Descri ti
Replace 100 gallon gas water heater.
Contractor Information
Company: just Water Heaters Inc. Phone: (510)293-2012
i1 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# 591 329 Exp. Date: 3/31/04
Worker's Comp#: 1626288-02 Carrier: State Compensation Insurance Fund Exp. Date: 4/1/03
Credit Card Information
Credit Card #: 5474-6390-0026-5679
Name on Card: Just Water Heaters Inc. 'f-
Expiration Date: 9/05 ��
Visa MasterCard
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