05080026 (2) CITY OF CUPERTINO �
BUILDING DIVISION PERMIT CONTRACT,ORhINFORMATION "i
-:� . . .,,
BUILDING ADDRESS: JU .
ST WATER HEATERS INC PERMITHo.05080026
22054 BAXLEY CT
OWNER'S NAME: PERMIT ISSUE DATE
ATILARA MERTOL 3400 INVESTMENT BLVD 08/03/2005
ONE: I SANITARY NO. CONTROL NO.
(510) 293-9901
ARCHITECrIENGINEER: I BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
10 C LICENSED CONTRACTOR'S DECLARATION = O O O
til❑ 1 lenity afrom Nat I am licensed under provisions of Chapter 9(commencing Job Description'
fiU with Section 70111)of Division 3 of to Business arW propulsions Code,and my license is �f- 1 O ®
4U! in full force and effect. REPLACE WATER HEATER B �Il tV }i
License Class LK.Is 50 GAL GAS
a F,q Dale Cormier.,
£ ARCHITECTS DECLARATION
a< I understand my plans shall h used w public records d •J 200[
nose J
s LL Licensed Professional f,1,
cg o 3 Oat I am exempt B nn Oc CoATION IfLfL.,1ll\' �jj DIN tltf
A<x 1 hereby Affirm Nal 1 em exempt(rum th Contrecmh License Law for IW LaJyS llpra9V/1J�e WI�t
p o following reason.(Section 7031.5,Business and Professions Code:Any city ser county VVV
m E� which Maim.a Permit to construct,eller,improve,dermumb.m Mimi,any swemre
_Z< pnor hrits issuance.alsonquires the applicant fur such MrmitmflcasigncJ su¢ment
£ thatheisliccnwdpumanLmthepmvisiouoftheContractorsLiccnselaw(Chapm,9 Sq. Ft. Floor Area Valuat 71100
yrs (cmmmencingwith Section7")MDivkion3ofthe Businessand Pmfessiom C< )or
i 3 that he is exempt threfrom and the basis for the alleged eaemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of ffNNNpprr��ber Occupancy Type
not mom than five hundred dollars(5500). 3 5 6 0 6 U L 9 . 00
0 1,as owner of the property,or my employees with wages As their sole compensation,
will do the work and th aructuM is not intended ormRcmd forsale(Sec.7064,Business
And Pmfusims Code:The Courommr's License Law docs not apply to an owtle,of Required Inspections
property who Wildsmrimprona thereon.and whodoes suchworkhimself orthrough his
awn employees,provided Nat such Improvements are not intended oroRerW(or sok.If,
however.the building or improvement is sold within one year of compledon.the owner. ,
builder will have the burden of proving that h did not build or improve fm purpose of
sale.).
❑1,as owner of the propeny,am exclusively contracting with licensed contractors to
consumer the project(Sec.7014.Busirecs and Profusions Code:)The Contactors Li-
cense law does not apply to an owner of property who Wilds or improve themon,and
who contacts for such projects with a contracror(s)licensed pursuant to the Contractors
License Law.
O lam exempt under Sec. ,B&P C for this mason
Owner Dat
7037WWORKER'S COMPENSATION DECLARATION
1 hereby Arpin under penalty of perjury One of the following declaration:
1 have and will maintain a Coruk.m of Cmnsenl to self-inti.for Worker's Compen-
'
on,ss provided for by Section 3700 of the Labor Code,for Ne performance of the
rk for which this permit is issued.
I have and will maintain Worker's Cormaggadon Insurance,u required by section
of Ne labor Code,for IW pcofarmance of the work for which this permit is issued.
WmMe.Cmmpensation Insurance carfcr and Policy nmber are:
rtier: Policy No.:
CERTIFICATE OF EXEMMON FROM WORKERS'
COMPENSATION INSURANCE
[This xcdon oud not he completed lith fermi,is for one hundred dollars($100)
or less.)
1 cenify that in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner sou An banns.mbjecuo the Worked Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Eacmption.you should
become Subject in the Worker's COMIKMSA ton previsions of the Labor Code,you must
0 z forthwith comply with such provisions or this permit shall W dcsmed revoked.
Z O
71CONSTRUCTION LENDING AGENCY
F .. Ihenb affirm that Nene is a construction lending c o`
Y a S ap my for Nc Performance ser V
C work for which this permit is issued see,309'!,Civ.CJ
Le m
f31 z Linda's Na .
�,z lender's Address —�
U O I century the 1 have read this application and Suitt that the above information is
it, f-' corm.I agrce to comply with all city and county on inances and sum laws relading to
OLJ building construction,and hereby authorise mucamemives of this city to enter upon the
Ualive-mentioned property for inspection purposes
y (We)agree to save,indemnify and keep harmltas the City of Cup otim,agmina
F[n liabilities,judgments.coo and expense which may in any way see=against said City
U in consequence of the grants ng of this permit.
^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature or ApplicaDale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant mfuture building Occupant store or
uodJcc, by the Cupertino
handleh aalmammal
fSedtiMunicipal Code.Chapter 9.11,an0Bih Health and Safety
'
❑Yo 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 hazardous air contaminants as dcfmcd by dm Bay Area Air Quality Management all new materials for inspection.
arin9
❑Tcs 0 N
1 ban mad the hamardous materials mquirements underChpmr6.95 Oldie Califor-
nia Health&Safety Cade.Seeuons15505.25533 and 15534.1 umlmslaNd Ih ttif Irk Wilding
dos not currently have a Mount,that it is my responsibility m omily the eccupanl of the
reyaiMmcnts which mug h met prior to issuance of a cerdfitate or Occapamry. Signature of Applicant Date
Owner orapthonaedagent Dart All roof coverings to be Class"B"or better
Cv
Community Development
�� 10300 Torre Avenue
V' Cupertino CA 95014
Telephone(408)777-3228
� CITY OF Fax(408)777-3333
UPEkTINO
Building Depart me t
JOB ADDRESS: PERMIT # 1 /
22054 BaxleyCt.. 0-(-D � [-l]
OWNER'S NAME: Mertol, Atilara PHONE # 408-255-8380
GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360
I am not using any subcontractors: ) -d fo1 7/01/05
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing Just Water Heaters 591329
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
�L�Qce 4-i 7/01/05
Owner/Contractor Signature Date
10/28/03
City of Cupertino Building Permit Application
E-Mail
jobsite Address: 22054 Baxley Ct. Date: 7-01-05
Owner's Name:---Mertol,Atilara
Phone No.(408)255-8380
APN#: 356-06-029 Project Valuation: $ 1100.00
Building Permit Info: Bldg_-------_ Elect----------- Plumb----—7t----- Mech
Job Description
Replace 50 gal gas water heater.
Contractor Information
Company: just Water Heaters Inc. Phone: (510)293-2012
Contact Name: Dulce Fax: (510)783-6360
Address: 3400 Investment Blvd. E-mail: permitdept@sbcglobal.net
City, State and Zip: Hayward, CA. 94545
State Contractor's License# 591 329 Exp. Date: 3/31/06
Worker's Comp#: 1626288-05 Carrier: State Compensation Insurance Fund .Exp. Date: 4/1/06
Credit Card Information
Credit Card #: 5474-6390-0047-8660 q
Name on Card: just Water Heaters Inc. /
Expiration Date: 06/08
Visa MasterCard
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