03060054 CITY OF CUPERTINO ,;�p�vz
BUILDING DIVISION PERMIT CONTRACTORaINFORMA'�ION•�� .
BUILDING ADDRESS: PERMIT NO.
a
JUST WATER HEATERS INC 03060054
NA Wy PERMIT ISSUE DATE
1764 NATIONAL AVE 06/06/2003
(510) 293-9901 SANITARY NO. CONTROL NO.
ARCHITEC)ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
3066 LICENSED CONTRACTOR'S DECLARATION
S� I hominy affirm that I am licensed and r provisions of Chapter 9(commencing Job Description
with Sector 70110)ofDMmm 3 of Ne Business ands Profusions Codo,and my licenm is
mmatmre,m effect no���®
amnm elms Lieu REPLACE WATER HEATER
DmrContractortlW
DeContractor �0
W ARCHITEC`rSDECLARATION (50 GALLON GAS)
1 understand my plans shall he used as public records
Licensed Professional JUN 12 2003
OWNER-BUILDER DECLARATION
Y I hereby affirms,that I em exempt(rens the Conmcmr's License law for the
00 followingreason,(Section703L5.BusinessandpmfeuionsCode:AnycityOfcounty BUILDING
$ which require a permit to conerm mrt
mot slur,improve,dcmalim. repair my ucm
�S^ pnorin its issuance,also requires the applicant forsuch permil to rile ulgned sunemeon
2 G that he i[licentodpursuant to the provisions OfftCummins's UccouLaw(Chapter 9 Sq.Ft.Floor Area Valuation
$ (commencing with Section 7")of Division 3 of the Business and Professions Code)or
Net he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars(5500}
❑I,mowor of de pmprny,mmy employees with waguuNe'v ale conpensston, 36204034 . 00
will do the wok.and the rfmctme is not intended mroamcd fmsak(See 7W.nudrcu
and Professions Code:The Communes License Law does net apply to an owner of Required Inspections
property who builds or lmprovesthecon,and who doessuch work himselfor through his 502 — FINAL PLUMBING ENERGY
own employees,provided'hat such improvements are nolinknded oroBemd for We.if. SO6 — GAS TEST
however,the building or improvement is mid within one year of mmledon,Ne owner-
builder .will have the burden of proving that he did not Wild or improv for purpose of 507 - FINAL PLUMBING
nlrJ.
❑I,as manner of the property,am uelusively contracting with licensed contractor[to
customer the project(Sec.7044,Business ads Professions Code:)The Contraeuri Li.
cents Law does not apply to an ema of property who builds or improves Norton,and
who contracts for such projects with a comractoKU licensed puuuanuo the Contnetor'a
License law.
0 1 am ucmpt under Sec. .B&P C for this mum
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby afford under faulty of pinjory one of the following declNliml[:
1 have and will maintain a Carioca¢ofCm amt In self-insure Ter Worker'sCurn sm-
anion,as provided for by SeNon 3700 of the labor Code,for the perfmmenu of the
work for which Nis permit is iuurA.
r-11 Nm and will maintain Worker's Compensation Insurance,u required by Section
3700 of dm labor Cods.for the performance of Ne work for which this permit is Issued.
My Worker's Compenution Insunax urine and Policy number am:
Carver. Polity No.:
CERTIFICATE OF EXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(Thts section need not hecomplcred If the permll Is for one hundred dollar($100)
or Ices.)
1 certify Nat in the performance of the work for which this Permit is Issued,I Gull no
employ anypemmn in any manner an as to become subject to dee Wormem'Compensation
IJwa of California.Date
Applicant
NOTICE TO APPLICANT:If,armr making this Certificate of Emmption,you should
become subject N the Worker's Compensation previsions of the labor Code,you most
OZ forthwith comply with such provisimm in this permit shall he deemed revoked,
z O CONSTRUCTION LENDING AGENCY
gsi iherthycrrm Nn there It.construction ionl.Ch,C{arty for the performance of
uJ the work for which this permit u issued(Sm.]097,Civ.CJ ✓�
GQ lender's Name
=z Lender's Add. -
V Q I certify Our 1 have read this application and sum Bre the shove Information is
W !'. correct.1 agree m comply with all city and county ordinance[and state laws relating to
C)CrJ^ building construction,and hereby authorim mpresenutives of this city to enter upon the
W above-mentioned pmpeny for inspection purposes.
G (We)agree to sive,indemnify and keep homeless the City of Cupertino against
fA liabilities,judgments.costs and eapensm which may in my my accrue against said City
U77 in consequences of the granting of this permit
•7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of AppliceDene
HAZARDOUS
US MATERIALS DISCLOSURE Type of Roof
Will the Cupertino
forum building Occupant Chaptstoreorhurdleh Health and
ss Mfirmd by One Cupertino Municipal Code.Chapter 9.12.and the Nu1N and Safey
ICcumCode,Saxon 25532(x)7 All roofs shall he inspected prior to any roofing material being installed.
❑Yu ❑Nm
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
full hamplous air contaminants ss defined by the Bey Ansa Air Quality Management all new materials for inspection.
atr
Oyer ❑Nu
I have mW Ne harardmis materials mquimments under Chapter6.95ofNeCelifor-
is Hulto es Satnty Code.Sa9mr 25505,25533 and 25534.1 uMcntatds ftlithe building
oes not uniformly haw a unm6 Nat it u my remonsibllity m notify ftoccupmt of ane
quimmenm which most be met poor w imam fur a Cartincate of occupancy. Signature Of Applicant Date
sir mthmizod agent Date All roof coverings to be Class."B"or better
b3
o6d ° S
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 7998 Woodlark Way Date: 6-6-03
Owner's Name:---Bradley,Jack
Phone No.(408)446-4391
APN#: 362-04-034 Project Valuation: 5 1,079.00
Building Permit Info: Bldg----------- Elect----------- Plumb------X----- Mech-----------
Job Description
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-mall: 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
Name on Card: Just Water Heaters Inc. Z �d /
Expiration Date: 9/O5
Visa MasterCard X 6
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