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05050132 (2) CITY OF CUPERTINO 0. maki'n<»s BUILDING DIVISION PERMIT i:CONTRACTOR�INFURMATIQN aa�hi- BUILDING ADDRESS: JUST WATER HEATERS INC PERMfr"005050132 A71 R7TT,Tm OWNER'S NAME: PERMIT ISSUE DATE AML ONE: SANITARY N0. CONTROL N0, (510) 293-9901 ARCHITECPENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH _oo LICENSED CONIRACTOR'S DECLARATION OO O O mC I hereby affirm the I am limood under provisions of Chapter 9(commencing Job Desert � iW with Section 7")of Division 3 ofdu Business and Profnde essioCo ,and my license is ^ NALED may in full force and effect. sy? LicenseClas Lle.a REPLACE WATER HEATER 12, 'J`i Dam Contractor (5 0 GAL GAS) 7 l8- 7005 ARCHITECTS DECLARATION �i ee—I 1 undersunu my pbms shell be used ispublic reminds GyU o t, Licensed Professional �� p�p ;9r® 3 OWNER-BUILDER DECLARATION rpfvl8l {I{]ti9 tlpst�q/II c c I Withy.sIct NW that I em cBusin from the Cssions Co License Law for tW O O following moon.(Section 703 L5,Business and Professions Code:Any city or county m f which requires a permit in eowruct,slur.improve.dcmoliR or repair any structure to prior in its issuance,also mi ores the applicant for such permitto file a signed suumem �0 that he is licensed pursuant be provision of die Conuactuh License Law(Chapter 9 Sq. Ft. Floor Area Valuat 060 ¢�a (commencing with Section 7")of Division 3 of the Business and Profession Ceuc)or Y� 3 that he is exempt themfrom and B¢basis for the alleged exemption.Any violation of Section 7031.5 by atry applicam for a permit subjects the applicanuo a civil penalty of APN Number Occupancy Type not mom Nan five hundred dollars(SS(K). P y YP ❑I,as owner of the property,or my employees with wages as their sole compensation, 36927026 . 00 will do be work and one structure is not intended car named fouale(Sec.TBLI,Business and Prafesslon Code:The Conuanors Lice=Law docs not apply to in owner of Required Inspections property who builds or improves fireman.and whodees such work himself or through his Own employtts,provided that such improvements are out intended or offered fertile.IL however,the building or improvement is sold within one year of eomplction,the owner- builder will tine the Wrden of proving Nal he did not Wild or improve for purpose or salcJ. Q I,as owner of the pmpcny,am exclusively contracting with licensed mntr ctom to construct the project(Sec.70a,1,Business and Professions Code:)The Contractor's Li. cents Law docs not apply in an owner of property who Wilds or improves themon,and who contracts for such pmjecm with a contractor(s)licensed pursuant to the Contractor's License Law. ❑1 am exempt under Scc. .B&P C for Nis mason Owner Dale WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: lip I haw and will maintain a Ceniricate of Consent to self-insum for WorkersCompen- sellon,as provided for by Section 3700 of the labor Code,for the performance of bm — work for which this permit is issued. ❑1 have and will maintain Wortses Compensation Insurance,as required by&cion 37W of be Labor Code.for Ne performance of the work for which this permit is issued. My Workers Compensation Insurer¢carter and Policy number am: Carrier: Policy No.: CERTIFICATE OF EX EMP TION FROM WORKERS' COMPENSATION INSURANCE (Thio section reed not he omplcuddur permit is for one hundred dollars(SIM) nr leer.) I certify that in the performance of Ne work or which Nis permit is ismed,1 shall not employ any person in any manner¢as u become subject o the Workers Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:IL after making this Cenificam of Exemption,you should became subject to the Workers Compensation provisions of Ne Labor Code.you most .JO foMwith comply with such provision Or Nis permit shall W deemed Cwted z.�. CONSTRUCTION LENDINCA ENCY agony [—� Iber which that them iavnd(See3M7,Cending agency for the Performance of Ci the work for which this permit u usucd(Sec.l09],Civ.C.) DW Q 4ndcrs Name =2 Lender's Address U p 1 certify that 1 have read this application and sum that the about information is "P emmeL I agree to comply with all city and county ordinances and sum laws relating in 0U building consuumion.and hereby amhorin rcprtsenmives or this city in enter upon the �tll .hove-mcmioned property for inspection purpose. H 6 (We)agree to save,indemnify and keep harmless Ne City of Cupertino against . pl liabilides,judgments,costs and expenses which may in any way same against said City U in consequence or Ne gaming of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. 3 Re-roofs Signature of ApvlicaH one HAZARDOUS MATERIALS DISCLOSURE Type of Roof Willy dr,Cuamor future buildingoccupantstoreorand the Health and as defined by the Cupertino Municipal COM.Chapter 9.13.and esu Health and Sa(ny code. 6 Yes en1ss32(a)? ❑No All roofs shall be inspected prior to any roofing material being installed. ❑ 70wncIf a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or forum building by ft B rex equipment of devices which g itharardnus airconumimnu as defined by tW Bay Area Air Quality Management all new materials for inspection. r trin?❑Yea ❑Ne 1 havemad Ne hannums materialsreyuiremenu under Clupurri.95ofthe Califor Hwbh&SafetyCode.section 35X)5.15533 and 25534.1 vnucrstand that done Wilding cs not coren0y have a moan Nat it u my reaponihility to nmily dte acupa t of die uirements which must W mel Our to Issuance nr a cerdneato of ampancy. Signature of Applicant Date or authnrizm agent Date All roof coverings to be Class "B"or better City of Cupertino Building Permit Application E-Mail Jobsite Address: 871 Betlin Ave. Date: 5-24-05 Owner's Name:---Watson, Blanch Phone No.(408)253-9340 APN#: 369-27-026 Project valuation: S 2,060.00 Building Permit Info: Bldg_ Elect----------- Plumb------X----- 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/l/06 Credit Card Information Credit Card #: 5474-6390-0026-5679 �S- Name on Card: just Water Heaters Inc. Expiration Date: 9/05 Visa MasterCard ® Q Comments AAA Community Development 10300 Torre Avenue Cupertino CA 95014 CITY OF Telephone(408)777-3228 11CU PEkTINO Fax(408)777-3333 Building Department JOB ADDRESS: PERMIT # 871 Betlin Ave. 0 1.3 2—. OWNER'S NAME: Watson, Blanch PHONE # 408-253-9340 GENERAL CONTRACTOR: Just Water Heaters lFAX # 510-783-6360 I am not using any subcontractors lJX �-�- �° } � 5/24/05 Signature Date Please check applicable subcontractors and complete the following information: [, J SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting o 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 5/24/05 Owner/Contractor Signature Date 10/28/03