04020011CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
AtONTRA.CTORINFORMA"I'IQN
BUILDING ADoaess:
119,9 Vc)PKqj4TT?P.
JUST WATER HEATERS INC
PERMITND04020011
OWNER'S NAME:
PERMIT ISSUE DATE
ONE:
SANITARY NO. CONTROL NO.
(510)293-9901
CHITELTIENGINEER:
BUILDING PERMIT INFO
lUccuse
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
I hereby that I em under pmvisions of Chapter 9 (commencing
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Job Description �'S/,
phScaion]U))nf
0)'if Division3of the Business end Prufcssienx Cnde,antl myliccnse is
fthe Bu
�y�mllf....darro.t
Class Lic. x
REPLACE WATER HEATER^( G A
DaN TSDECr
ARCHITECTS DECLARATION
(40 GALLON ) 1r
1 undramatic my plans shall he used as public records
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041
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Licensed Pmfesamnal
OWNER-BUILDER DECLARATION
I hereby arfirm that 1 am exempt from the Contractor's License Law fur the
�e
following mason. (Section ]Ud 1.5, Business and Professions Code. Any city or county
which requires a permit to construct, altar, improve, demolish, or repair any structure
! prior to in issuance, also niquinx the applicant for such Permit u file a signed ammment
: that he is licensed pursuant tothc provisions efthe Contractor's License Law (Chapter 9
Sq. Ft. Floor Area Valuatic$805'
(m now.6ng with Section ]UID) of Division 3 of the Business and Profusions Cnde) Lir
I that he is exempt themfrom and the basis for the alleged exemption. Any vinlatmn of
Section 901 by any applicant for a p.rmalt objects the applicant o a civil penalty of
net mom man five hundred d.11... ($5W).
APN Number
Occupancy
p y Type
❑I, u owner or the property, or my employees with wages u their sole compensation,
36208006.00
will do the work and Ne swctum is not intended meffemd forsale (Sec. 7(144, Business
and Professions Code: The CCO=L.ea License law does not apply to an owner of
Required Inspections
progeny who builds or improves thereon, and who doessuch work himself or through his
own employees, provided that such improvements are not intended orolfered for sale. If
however. me building or improvement is sold within one year ofcompletion, the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sal..).
❑ 1, as owner of the property, am exclusively convecting with licensed contractors to
construct the pmject (Sec. 7044, Business and Professions Code:) The Contractors Li-
Came Taw does not apply to an owner of property who builds or improves memon, and
who contracts for such pmject, with a c.nmctor(s) licensed pursuant to the Contractors
License Law.
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❑lemexemptunderSeu. ,B&PC for his mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby aRum under penalty of perjury one orthe following declarations:
1 have and will maintain a Certificate ofCamcnt toself-insum far Workers Compcn-
sation, as provided for by Section 3700 or the Lebo, Code, for tho perminnare. of the
work for which his permit iseem.d.
01 have and will maintain Worker's Compensation Insurance, as required by Section
3710 of the Labor Code, for the performanec of the work for which his prom it is issued.
My Workers Compensation Insurance, caner and Policy number arc:
Cartier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thlsmction it not he completed if the permit is fnrmre hundred dollars (311x))
_
or less.)
1 cenify that in the performance of the work for which this permit Is issued, I shall not
employ any person in any manner se as to become subject to the Workcn' Compensation
Laws of California. Data
Applicant
NOTICE TO APPLICANT: If. after making this Cenificate of Exemption, you should
'
become subject to the Workers Compers.1mn pmvisions of the Labor Code. you most
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forthwitheomplywithsuehpmvisions or this permit shall be deemed invoked.
CONSTRUCTION LENDING AGENCY
1 herby aRthi that there is lending agency for the
s ued sed (Soctinn performance of
dm work for which this permit is iss(Sec. 3097, Civ, C.)
Lender's Name
Lender's Add..
1 certify that I have read this application and shoe that he above information is
correct. l agree to comply with all city and county ordinances and state laws relating to
building commacoion, and hereby authorize repressnmiver of his city to enter upon the
shov.-mentioned for inspection purposes
(We) agree to rave, indemnify and keep harmless he City of Cupertino against
judPragments, coca and expenses which they in any way seethe against said City
liabilities,quence
of goo
inconsequence of me granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONPOINT
Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Date,
Signature of AppliceHAZARDOUS
MATERIALS DISCLOSURE
Type of Roof
Will the applicant Lir future building uccupanumm or handle hasirdoua material
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as 'armed by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
❑Yin ON.
All roofs shall be inspected prior to any roofing material being installed.
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 ha'rardnus air conmminants as dcfned by the Bay Area Air Quality Management
all new materials for inspection.
istrico?
❑Yes 0N
I have mad the havardous materials requirements under Chapter 6.95 of the Califo>
nix Hulh& Safciy Cndc, Secdou 25505,25533 aed2.5534.1 and re=d hg if dg Wilding
docs not comartly ham a renano that it is my responsibility In notify the Occupant of the
roquiremams which must he met prier to issuance ora Ccoin"Ie of Occupancy
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner Lir authorized agent Data
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•
C
E -Mail
of Cupertino Buildina Permit
Jobsite Address: 1122 Yorkshire PI.
Owner's Name: ---Price, Debbie
Phone No.(408)996-2872
APN#: 362-08-006
Building Permit Info: Bldg -----------
Date: 1-15-04
Project Valuation: $ 805.00
ect----------- Plumb ------ X_____
Job Description
Replace 40 gallon water heater
Contractor Information
0
U�2 Uo r//
ication
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 # 591329 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
Name on Card: dust Water Heaters Inc.
Expiration Date: 9/05
Visa MasterCard
Comments