08050237 (2) CITY OF CUPERTINO
BUILD114C DIVISION PERMIT CONTRAaG.wT�L.O��R INI�OItMATION .
PERMIT NO
Buatil�q,wld"lAYW00D DR JUST WATER HEATERS INC 08050237
OWNER'SCNA�ME: ti PERMIT ISSUE DATE
HOM HARRY D AND ALICE N 3400 INVESTMENT BLVD 05/29/2008
NE: (510) 293-9901 SANITARY N0, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BL=DG ELECT PLUMB MECH
(
u o o LICENSED CONTRACTOR'S DECLARATION Job Description
w C 1 hereby affirm Nal I am licensed under Provisions of Chapter 9(commencing p
Ltw{ms«tion70M)ofDi.;ean3tribeBui�andprofesaaoeeade.awmyranseis REPLC 40 GAL GAS WATER HEATER
m H in full tome and effect.
jq? Lleenm Clara Lie.
=F❑ Dam Contracts,
m ',f' ARCHTfECTS DECLARATION
U1 understand my plans shall W hand as public records
gG Licenced Proved nal
OWNER-BUILDER DECLARATION
j�f 1 hereby affirm that 1 am exempt from Wn Contractors License Law for the
C e a rallowing revon.(sauce 703 L5,Business and PreG..:ions Cade:Any city m county
which mquiru a permit to consvhn.Meer,improve.demolish.or repair any structure
5Zi prior in in mumce.Who require the applicant for such permit to rile a signed moment
g� that he is licensed pursumi to We provisions at We Contractor's LicenuLaw(Chapter 9 Sq.Ft. Floor Area Valuation
(CommcncingwiWS dun7000)mf0ivWon3ofW BusinessmdProfessionsCadc)or $1040
tha W u eurpt thmefmm and the main for IW alleged eaempdan My violation of
Section 7031.5 by any applicant for a permit subjects We applicant W a civil penalty ofNumber Occupancy not mom Nan five hundred dollars($500). 3 1631014 . 1Ype
❑I.uowrcr of Ux poperty,ar my rrplaym with wagualhev role emnprnation,
will do We were.and We sMcmre isnot intended oroRered fa Mrs(Sus.7)64,Business
Md Profasians Code:The Contravenes License Law does not apply m an owner of Required Inspections
prepenywbo WildsmimprovesNveon,aha wMdassuchworthimulf ar Wmugh his
than cmployces,provided that such improvements tae not intended ornBcmd forsale.If.
however,the Wilding or improvement is sold within one year of completion,the owner-
Wilder will have tla Wrden of proving that he did not beulci or improve for purpose of
ale.)_
El 1,as owner of the property am exclusively contnning with liansed Contractors in
cmnsamct We Mica(Sec.7W,Business aha Profusions Code:)The Convacmr's Li- .
cena Law dos net apply to an owner of property who Wilds or Improve duchess.Nd
who comment for such pmjecu with a ConvacmKs)licensed pursuant in Was Contractors
License Law.
❑Iameaemptunder See ,B&PCforthutoacrm
Owner Dam
p1WORKER'S COMPENSATION DECLARATION
I hereby arfum under per aty of perjury ma:of We following deelartianr
have and will maintain a Ceniriam of Co..,to calf-insure for Worker's Compen-
ation,an Provided fm by Section 3700 of We Latest Code,for We performance of the
were for which Was Permit is mused.
1 have and will maintain Workeh Compmuadon Wo anus,as required by Section
3700 of We LawCode.for We performance of the wart for which WU Permit is;land. '
My Workers Compensation Insurance artier aha Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thu xction need not W complemd if do forme Is fortune hundred dollen(SIgO
or leu)
I certify boat in We pert es anee of We wort for which this permit u issued,l shall net
employ any person in my mantra,w at in become subject in We WorkersCompansation
Laws of California.Dam
Applicant NOTICE TO APPLICANT:If,after making Wu CcniOcate of Esemption,you should
Wcome subject to We Watson's Compensation previsions of the Latw Code-you most
wJz forthwith comply with such provinces;or this permit Nall x darrcd rcwkW.
Z O
r CONSTRUCTION LENDING AGENCY
[—m Iherebya(Rnn Wo Wert isaconswNnning agency forthe perfwmana of
fY.> the. wort for whicA this permit u issued(Sec.JlD7'1,Civ,G)
W Q Lenders Name
Z) z Lenders Mdrus
V O I awry 0.11 have mad this application and aam boa the above isle om iW,u
W ^ correct I agree W comply with nl city and county pNinareas ad auk laws totaling to .
Wilding construction,and hereby auWorim mprescnutiva of this city to cna n Con We
above-menuAgm Propertycosts
for inspection purpowhich CoA
H M (We)agree to ave,indemnify and Itap humlus We City of Capenina against
ave Z Ii consequence f ftcamandof this na permit Cory in any way acme against said City
(„),�[ A APPLICANT
est We RSTA gofA AND
'—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Srgnuurt of APPIaaHAZARDO pate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant m forum tpal Cgio.Chantsmm 2.handle haalsh Mmamrial
u dented Section
tla Cupertino Municipal Code,Chapter 9.13,and We Healed mtl Safety
code. Oyes 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ya ON.
Will We applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it haralloa nr conumiwcs as dained by We Bay Arta Air Quality Mm,a nas all new materials for inspection.
Duvict?
❑Yns ON.
I have toad We hvartlous mamriau mquiremcnu under Chapre,t.95 of dm Cilifor.
his Hcalih&Safety Cade,SceGons 25505.25533 am125334.1 understand Watt We Wilding
docs not currently have a Meant.Wu it u my responsibility to amity We recursion,of We
requirements which most W met prior to issuance of a CenlOaW of ovopncy. Signature of Applicant Date
Owner arauWamad agent pans All roof coverings to be Class'%W'or better
CITY OF CUPERTINO
.4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31631014 . 00
DATE ISSUED. . . . . . . : 05/29/2008
RECEIPT # . . . . . . . . . : BS000004944
REFERENCE ID # . . . : 08050237
SITE ADDRESS . . . . . : 19850 BAYWOOD DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HOM HARRY D AND ALICE N
ADDRESS . . . . . . . . . . : 19850 BAYWOOD DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2316
RECEIVED FROM . . . . : JUST WATER HEATERS
CONTRACTOR . . . . . . . : GILROY, JOHN LIC # 15128
COMPANY . . . . . . . . . . : JUST WATER HEATERS INC
ADDRESS . . . . . . . . . . : 3400 INVESTMENT BLVD
CITY/STATE/ZIP . . . : HAYWARD, CA 94545
TELEPHONE . . . . . . . . : (510) 293-9901
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- - -------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 1, 040 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1PRWHEATR UNITS 1 . 00 24 .48 0 . 00 24 . 48 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 106_. 56 ' 0 . 00 106 . 56 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 106. 56 MC
-------------7-
TOTAL RECEIPT 106 . 56
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
518 WATER HEATER
•
��05 oa 3 7
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 19850 Baywood Dr. Date: May 28, 2008
Owner's Name:---Harry Hon
Phone No (408)446-3956
APN*: 316-31-014. 00 Project Valuation .S 1040.00
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: Fax: (510)293-2022
Address:3400 Investment Blvd E-mail: .permits®Justwaterheaters.net
City,State and Zip: Hayward,CA. 94545
State Contractor's License# 591 329 Exp.Date: 3/31/08
Worker's Comp#: C45096282 Carrier: ACE Exp. Date: 4/1/09
Credit Card Information
Credit Card #:' 5474-6390-0047-8660
Name on Card: Just water Heaters Inc.
Expiration Date: 6/08
Visa MasterCard ® -
Comments
• Community Development
10300 Torre Avenue
tt C � Cupertino CA 95014
Telephone(408)777-3228
CITY Of Fax(408)777-3333
WUPEkTINO
Building Department
JOB ADDRESS: PERM#��a 3
19850 Ba ood Dr. 7
OWNER'S NAME: Harry Hon PHONE # 408-446-3956
GENERAL CONTRACTOR: JustWater Heaters FAX # 510-783-6360
I am not using any subcontractors: 05/28/08
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 i
• tx. �rz. 1 �0"` l-(AQ`sc�^^ 05/28/08 ...
Owner/Contractor Signature Date
10/28/03