03050015 CITY OF CUPERTINO
BUILDING DIVISION PERMIT C�NTRACTORINFURMe1TI01
BUILDINGADDRESS: JUST WATER HEATERS INC PF ""03050015
L976 W HILL IN
r OWNER'S NAME: r 1764 NATIONAL AVE �R�TL�ffn5/2003
URPHY DANIEL C AND JANET R
ONE: (510) 293-9901 SANITARY NO. CONTROL NO.
ARCHITEC ,ENGINEER: BUILDING PERMIT INFO
BLDG ELECT D O PLUMB MECHO
goo LICENSED CONTRACTOR'S DECLARATION lob DescriptiollQQ^�
sYe m I hereby,firm that l am licensed under provisions of Chapter 9(commencing '"'
<Z with Section 7UW)nfDivI.Ian 3 cruse Busincoa,nd Profession.Code.andmylicenscis N���®
In fuu(one end.B110. REPLACE WATER HEATER
j 0 Z Licenx Clas, La.0
= p o,m cSDECr
1- (40 GALLON GAS) MAY 1 5 2003
yq ARCHITECT'S DECLARATION
Y 22 1 undcnund my plans Mail he used As public retards
6
;o
LicantsedPmfci ssonel BUILDING
OWNER-BUILDER DECLARATION
i<
@ 1 hereby salon Nat I am exempt from We Cantaaara License Law for the
D C following moon.(Section 70313,Business and Profession,Code:Any city or county
$ which requires a permit to convect,tlten improve.demolish,lir total,Any soucm.
oo prior In its issuance,also requires the applicant for such permit to Ne a signed statement Valuation
£�£Z< Npursuant at he is licensed pursuano We provisions of Ne Contractor's Licca.Law(Chapter 9 Sq.Ft. Floor Area
K�m (commencing with Section 7W0)of Division 7 ofthe Business and Professions Code)or
9 that he Is exempt them(mm and Ne basis for the alleged exemption,Any violation of $763
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of APN Number Occupancy Type
not mart Nan five hundred dollars 45001.
❑ 1.. awn orNepap>r,«myemplaye wiNwaga.,Nei„am ampmauon. 36227019 . 00
will do the work,and themom.is nmimmmaded oroflood for sate(Sm.moa.Baia.•• Required Inspections
and Professional Cade:The Corns ctors License Law doer not apply m an owner or 305 — FRAME 9 P
property who builds orimprows themen,and whodousuch wrk himself orlhrough his
own employee,provided Natsuch improvements are nolimendW orortemd(wals.If. 307 - INSULATION
however,the building or improvement is veld within one you ofcompledon.the owner-
builder will hove We burden of proving that he did not build or narrow for puse rpoe( 601 — ROOF TEAR OFF
ale.). 602 — ROOF PLYWOOD NAIL
❑ I.as owner of the property,am exclusively contracting with licensed conamarsa 603 — ROOF BATTENS
construct the project(Sec.70th,Business and Professions Code:)The Cenlnctara Li
eemeLawdoesnotapplytoanmonerofpropmywhoWildsorimprovestheeon.and, 604 — ROOF IN—PROGRESS
who convects for such progm with a eenusumr(s)licensed pursuant in the Communes
Lkense Low.
❑I am exempt under Sm Bk P C for this rtsson
137M
wner Date
{ WORKER'S COMPENSATION DECLARATION
l` I bomb,Mr.m under penalty of perjury ane of Ne fallowing&,].admu:
Ihave And will maintain ection 3700 of Consent Cache.for for Wmkebce of the
tion, r provided for mi Sector 3]00 of We labor Code,for Ne performance of the
wails for which this permit is issued. ,
1 hove and will maintain Workers Compensation Inset me,c.As required by Section
of Ne labor Code,for the performance of tae wok for which Nis permit is issued.
y Workers Compensation Insurance canna and Policy number ate:
rtier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mil,sectlun need not M completed lithe permit Is forum hundred dollars(SIM)
or less)
1 cenify Out in the performance of We work for which this permit is issued.)shall not
employ any person in any nam,An As W baceme subject in We Worker'Compewdan
Laws of califoonic Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should
become subject in the Worker's Compensation provision,of Ne labor Crede,you must
�Z forthwith comply with such provisions or this permit hall be deemed revoked.
OCONSTRUCTION LENDING AGENCY
'E~ thereby salthi thn More isaed(Sec.3W7,lending agency l'm the performmce of V
0: Le wok for which thla permit is issued(Sec.7097,Civ.C.)
fol z Lenders Name
7 Z Lenders Aadtoss
U O 1 citify that l have maid ha stateu ut
d this application aNthe show Infomatia u
Is.!+ mrem I agme in comply with all city and county ordinances and ante laws refining an
C) building construction.and hereby authodm repreenutives of this city to enter upon the
W ahovnmentiuned property for Inspection purposes
gy (We)agree in ave,indemnify and keep humioss the City of Cupertino against
liabilities,judgments,casts and expense which may in any way scene against aid City
U Z In consequence of We ganging of this Permit.
rv•i APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signuurtof AppliaDam
HAZARDOUS
US MATERIALS DISCLOSURE Type of Roof
Will the a Cupar or filum building k.Chapter
roto orand We Healdoa material
As10wncr
dcOned by the Cupertino Municipal Cock.Chap¢,9.13,and 0te HcJN and Safety
We Sation 35E32ta)? All roofs shall be inspected nor to an roofing material beim Installed.
❑Yas ON.
P P Y g g
Will the applicant or future building occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
il havardous air contaminants ss dcGned by We Bay Am,Air Quality Management all new materials for inspection.
strict?
❑Yes C]No
I have read We baardrms materials requirements under Chapter 6.95 of We Collier.
x health h Safety Cade,Sown 75505,35577 and 25531.1 undcoWW Wa if Ne building
es not currently haw a inane War it a my napoaihility m Autry We=owl of the
quirements which must to me,poor anisaecofacenirawofOccupancy. Signature of Applicant Date
or authorized agent Data All roof coverings to be Class "B" or better
City of Cupertino Buildi ng Permit Application
E-Mail
jobsite Address: 7676 West HIII Lane Date: 5-02-03
Owner's Name:---Murphy, Dan
Phone No.(408)257-1933
APN#: 362-27-019 Project Valuation: 4 763.00
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: permlts@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
Name on Card: Just Water Heaters Inc. 2i/ 7
Expiration Date: 9/05
Visa MasterCard X
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