06090085 (2) CITY OF CUPERTINO i�ill�,fim „�1 /'�iy�7���s��y •F�a (�( ''
BdILDING DIVISION Py;ayuYuy �,V`�L��ija[ -,y ANE0
BUILDING ADDRESS: JUST WATER HEATERS INC PERMITNO.06090085
7652 BERLAND CT
OW NEWS NAME: PERMIT ISSUE DATE
GIL BALDEMAR AND ROAN SHAIO J3400 INVESTMENT 6
JNE: SANITARY NO. CONTROL NO.
(510) 293-9901
ARCNITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
hoot LICENSED CONTRACTOR'S DECLARATION Job Description V I hereby affirm mal 1 are licensed under Provisions of Chapter 9(cemmcneln{
with null to.mde(<of ccDiviaionSoftM Business tib Profeasium Code,sad mylk0
n,scREPLACE 50 GAL GAS WATER HEATER
✓a Z License Class Lk.0
pppo Dale Contractor
1 ARCHITECTS DECLARATION
i 1 understand my plans shall M used as public records
IyU
Licensed Professional
ly OWNER-BUILDER DECLARATION
I hereby.(Seas o that 11. exempt froman me Conoars Co :Any c taw for tiro
c g O following,boson.(Section 7fD1.5,Bum^^.s and improve.
destoes Code:Any oily of roomy
f$0 which requires a pnmo to elms dej alter.Improve,deoaMh,ri e a3ir any ttrumum $1060
-zy parker to its iasuedinumAsequim pMvisllicam for such Conaenoitmfiomse Law(Chapter
C atm M is licensed purwanl la the provirions of Me Conuacwrs Lkan.x law(CMptea 9 Sq.Ft. Floor Area Valuation
(canmencing what Section 7000)of Division Scar me Butlness and Prormbuts Code)tar
— mat he is eabopt therefrom and to basis for die alleged exemption.My violation of
Section 7071.5 by arty applicant for a permit subjttu du applicant to a civil penalty of ET Occupancy Type
not mom than five hundred dollen($500).
0 1,u owner of the property,or my employer with wage u their ern wmpeasation,
will do the work and the wumum is not intended or offered for We(See 1025,Business Required Inspections
and Professions Code:The Conuemor's Llceme Law des ran to ns
ot apply an owner of q P
property who builds or i mproves lhemon.and who does such work Mmadf or through his
own employees,provided demsuch improvements Me not InteM<d proffered foraale.IL
however,me building or Improvement ts mid within one year of completion,de aurer-
builder will have the burden of proving Mark did not build or improve for puapose of
ole.).
0 1,u Manor of de Properly.am exclusively contracting with licensed mntranon to
coostmet me project(Sec,7044,Business and Profmslam Cade:)7be Coouactots U-
nease taw docs not apply to an owner of property who builds or impmm manors,sod,
who contracts for such projects with a rnnoacbr(s)th a rand pursuant he the Co mmemrs
License law.
O l am exempt under Sec B A P C Ire this reason
Owner Dam
WORKER'S COMPENSATION DECLARATION
40 1 hereby affirm under penalty of perjury ran,of the following declarations:
sa I have and will maintain eCertificate of C e Labor self-insure for Warkeh ce op Me
ration, r provided for mi Section 5700 of the labor Code,for me performance of me
wart for which this permit is issued.
0 I have and will m inuin Workers Compensation Imuran¢,as required by Section
3700.f dm Labor Code,for the perfmmarce of de weak for which this Permit it W-&
My Workers Campecumiao Innes.carrier and Policy number tie:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE '
(Tho Sudors need notion completed irms Permit is return hundred dollars(SIM)
or].a.) '
1 certify Not in the performance of the wants fm which this permit is;issued,1 atoll not
employ any perms In any manner m as In became subject to tM Worten'Compensation
Laws of califamia.Date
Applicant
NOTICE TO APPLICANT:IL a0er coming this Certificate of Exemption,you should
became subject be me workers Compensation provisions of me tabor Cede,you most
.,O foMwith comply with such proisnm m
vthis permit shall he dcemW naked.
Z 0 CONSTRUCTION LENDING AGENCY
[—, I hereby affirm mu thou is a construction lending agency for the performance of
a
the work for which this Permit Is issued(Sec.5097,Civ.C.)
14Q Undoes Name
]M Lenders Addreas
U Q I comfy that I have road this appll.mmh and state,that the above informaliun is
L4 H cone,l agree to comply with all city and county an inamxr and state laws misting to
0 U building convection,and hereby authorize representatives of this city to enter upon the
W ahoy -mcntioned property for inspection purposes.
W (Wt.)agate to save.indemnify and hasp harmless the City of Cupertino against
rA liabilities.judgments,casts and expenses which may in any way we=against mid City
U Z in consequence of the granfing of this permit.
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplionV7meameor Dam �,pe of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant m future building uccuparttalore"Modic huudom material
m defined by the Cupertino Municipal Code,Chapter 9.11.and the Health and Safety
Cade.Seems 15531(a)? All roofs shall be inspected prior to any roofing material being installed.
Oyes ON.
Will dto applicant or future building occupant urn equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Moil hvaNnm air conumi enu as&find by tM Bay Arta Air Quality Management all new materials for inspection.
District?
Oyes ONu
I hem read the Msudousma¢riaH requirements underCMpter6.95of theCilifm.
M.Health A Safmy Code,Sections 25505,15555 and 25534.1 understand dot ifthe building
does not cartendy have a tenant,that it is my responsibility to notify the occupant or the
requirements which must he mel prior In,Issuance of a Certificate or Occupancy. Signature Of Applicant Date
Ou nerorWummixedagent Dam All roof coverings to be Class "B"or better
CITY OF CUPERTINO
om 2 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36225037 . 00
DATE ISSUED. . . . . . . : 09/13/2006
RECEIPT # . . . . . . . . . : 36018
REFERENCE ID # . . . : 06090085
SITE ADDRESS . . . . . : 7652 BERLAND CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : GIL BALDEMAR AND ROAN SHAIO J
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5079
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
---------- ----- -------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BPWHEATER PER HEATER 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 84 . 02 0 . 00 84 . 02 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ - -----------------
OTHER 168 . 04 MASTERCARD
TOTAL RECEIPT 168 . 04
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
Community Development
aAt 10300 Torre Avenue
Cupertino CA 95014
~" Telephone(408)777-3228
CITY OF Fax(408)777-3333
SCUPEkTINO
Building Department
JOB ADDRESS: PERMIT#
7652 Berland Ct.
OWNER'S NAME: Gil Baldemar PHONE# 408-828-8122
GENERAL CONTRACTOR: Just Water FAX# 510-783-6360
Heaters
I am not using any subcontractors: � Q C4 -� 09/12/06_
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
��s�t2 4 �OwtC�Q•e�cRw.� 09/12/06
10/28/03
r ou r W ?✓
•
City of Cupertino Building Permit Application
E-Mail
jobsite Address: 7652 Berland Ct. Date: 09-12-06
Owner's Name:---Gil , Baldemar
Phone No.(408)828-8122
APN#: 362-25-037 Project Valuation: $ 916.00
Building Permit Info: Bldg---_ Elect—___ Plumb___(__ 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:3400 Investment Blvd. E-mail: permitdept®sbcglobal.net
City,State and Zip: Hayward,CA. 94545
State Contractor's License# 591329 Exp. Date: 3/31/08
Worker's Camp#: C44510091 Carrier:ACE Exp. Date: 4/l/07
Credit Card Information
Credit Card #: 5474-6390-0047-8660
Name on Card: Just Water Heaters Inc.
Expiration Date: 06/08
Visa MasterCard
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