03050096 CITY OFCUPERTINO
BUILDING DIVISION PERMITC®I ' 'MOR IN#T UR�$ATIO
BUILDING ADDRESS: JUST WATER HEATERS INC PFRMITNo.0370�5,0096
OWNER'S NAME: 1764 NATIONAL AVE �aMn���721/2003
NE`' (510) 293-9901 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
30o
LICENSED CONTRACTORS DECLARATION
F Jbb
1 hereby M.Nsac at 1 licensed under pmo
vishner or Chapter 9(commencing �0 �®
a tj y`j with Section 7000)of Civilian. Ne onSof Bv `
iness and ProfeWnns Cma.md my lice..is
_5�
in mc'�nlarcect tx g REPLACE WATER HEATER p fy gyp
f �_¢ centracter (S O GALLON GAS) OCT 1 3 2003
ARCHITECTS DECLARATION
1 undcomend my plans Mall he used m public records
ted Llecnted Pm(cssionsl BUILDING
OW NER-BUILDER DECLARATION
f 1 hereby affirm that 1 am exempt(rare the Committees Licence Law for the
p o (allowing moson.(Section 7031.5,Business and professions Code:Any city m county
$ which acquires a Permit In construct,alter,improve.demolish,or repair any structure
zy prior in its issuance.arm requires the applicant forsuch repoitto file a signed suument
< that he Is licensed pursuant to the previsions of the ConbacursLicense Law(Chapter 9 Sq.Ft. Floor Area Valuation
(commencing with Section 7000)°(Division 3 of the Business ad Professions Conk)of
that k of exempt therefrom and the basis for the alleged eeemption.Any violation of
Sedum 7031.E by any applicant for.permit subjects be applicant in a civil penalty of APN Number Occupancy Type
not more Nm five hundred doll.SXQ. 3 6 6 5 3 0 2 1 . 0 0
❑1,u owner of the propny,u my empleyeca with wags u their tele compensation,
will de the work,and thestmcwre is not intended"offered for We(Sec.7044,Business Required Inspections
and Professional Code:The Conhacumes License taw duo not apply to an owner or 502 — FINAL PLUMBING ENERGY
propeny who bui Idsor imprw re
etheon,a nil who dm such work himsel f m through his
own employee,provided that such Improvements ate not Intended or offered forale.if. 506 — GAS TEST
however.the building or improvement Is sold within one year of compledon,the owner.
builder will have the burden of paving that he did not build or improve for purpose at 507 - FINAL PLUMBING
ole.).
O 1.as owner of the property,am exclusively contracting with licensed cameraman,to
contract the preject(Sec.70",Business and professorate CW,:)The Cmiummes Li.
.teal law does not apply u an owner of promeny who builds or Improve thereon,and
who comuacu for sum projects whin adermreetor(t)licensed moment in the convectors
License law.
❑l am exempt under See. ,B&P C fee this reeaon
Owner Data
13C11WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declmationc
I have and will maintain•Certificate of Covera to se166uum for WorkefaCompen-
--y"
on,u providd for by Section 3700 of the Labor Coate,for the performance of the
k for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
0 of the Labor Code.for tho performmed of the woes for which this profit u ism d,
Workers Compensation Insunnce artier and Policy number art:
rier. Policy No.:
CERTIFICATE OF EKEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(lila section need notaecompleted if the permit is forom hundred dollars($1018
or less.)
1 certify that In the performance of tic wank for which this Permit is issued.I Mall not '
employ any Arson in my mmncr se u in become subject tithe Worke,ri Compenatlon
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.area,making this Cci iBate of adoption.you Mould
become subject in the Workers Compensation provisions of the Labor Code.you tun
2, forthwith comply with each Provisions or this permit Mall be deem[!mead.
yO CONSTRUCTION LENDING AGENCY
EIfor thereby which
that there issro (Sam.3nle"ding agency for the performance of V "
W the wort(ter which Nu permit u issued(Sam.7097.Civ.C.)
{g7 0 Ladcrs None ^ t
= z Landers Addmsi
U p I certify that I have mad this application and sou thss the above information Is
UA F~-' correct I agree to comply with all city and county ordiner a and sou laws felting to
DU building Corundum.adthereby whorl representatives of this city to enter upon the
Lk7 above-mentioned property for inspection pumoeea
G (We)agree a are.indemnify and keep harries,the City of Cupertino i geinsm
rA liabilita,judgments,costs and expevas which may in my way accrue against said City
U Z in consequence of be grating of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of AppliaHDate
HAZARDOUS
US MATERIALS DISCLOSURE Type of Roof
Will the,applicant or furo building occupant stem or handle Hearin
a mauritl
u defend by the Commotion Municipal Code.Chapter 9.12,md the lth an!Safety
dc,Sector 25532(87 All roofs shall be inspected prior to any roofing material being installed.
❑Yes ON.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it h,rans rinairconummu ss
indefinft by Bay Arta Air Quality Management all new materials for inspection.
strict]
"l Yes ON.
1 have rad the haamen s materials requirements under Chapter 6.95 o(the Califon
nu Health&SafctyCode,Sectors;25505,25533 and 25531.I anemometer oat if the Wilding
doss not currently he.a uan
nl that it u my responsibility he notify the occupant of the
requirements whim mon be met poor wissuanccero Ccnigcate or Occupancy.
alSignature of Applicant Date
Owner oraethorimadagent Date All roof coverings to be Class"B"or better
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 11682 Westshore Ct. Date: 5- 21-03
Owner's Name:---Slier, Karel
Phone No.(408)996-9848
APN#: 366-53-021 Project Valuation: $ 809.00
Building Permit Info: Bldg----_----- Elect----------- Plumb------X----- Mech----------
Job Descri tion
Replace 50 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 License# 591 329 Exp. Date: 3/31/04
Worker's Comp#: 1626288-03 Carrier: State Compensation Insurance Fund Exp. Date: 4/l/04
Credit Card Information
Credit Card #: 5474-6390-0026-5679 Z / ? c) 7 o 7
Name on Card: Just Water Heaters Inc. /
Expiration Date: 9/05 �O
Visa MasterCard ® D
Comments