00110072 (2) CITY
I euDiCIVSONO
niNDIINPERMIT CONTRACTOR INFORMATION:
BUILDING AjDfII;!3O BUBB RD JUST WATER HEATERS I 1EMITNO:,601. 10072
owNFaR's NS`�1M ATE
SINGI_EY - , 1764 NATIONAL AVE APPLICATION lli4 /?_000
ZONE. - (51.0) 293-9901 .. SANITARY NO, COWS OI.NO:
G O p ARC(IITEC717ENGINE HU BUILDING PERMIT INTO
kC BLDG ELECT PLUMB MECH i
z S N= l herrn all emEhat a CONTRACTOR'S I nDECLARATION i 9(ennnnencin Job Description -
F_C� wimsacporeandefDiisn,m3onneuawme.aandProre,man,c e,andmyheenw` REPLACE, 40 GALLON GAS WATER HEATER
is In pallSec force add,n D'
0 Linens¢Claws Lic.k
�ppp..5 Dam - Contractor
F a LLO�n ARCHITECT'S DECLARATION
g 1 underslnnJ my plans shall M anal as public recants
p O License)Pnsfeasionul
°' OWNER-BUILDER DECLARATION
w'4_'u, I hereby affirm that I um exempt from the Contractor's License Law for the ,
t:3 following reason.(Section 7831.5,Business and Professions Code:Any city or county
f O which requires a permit to constrict,alter,improve,demolish sampan any structure
tpy � prior to its issuance.also requires the applicant for such permit to rile a signed statement
— thin be is licensed putsnanttothe pnwt, n.of theComracto(wLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation
men
(comcing with Section 7W))of Division 3 of the Business and Professions Code) 5664
or don he is exempt therefrom and the basis for the alleged exemption.Any satiation - -
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
of not more than ise handrail dollars a500B. APN Number Occupancy Type '
❑F,as awnerof the property.oran,employees with wager ase meirsme compensation, 36^¢05042. 00 .. ..
will do the work.and the-structure is not intended or offered for awe(sec.7(141, Required Inspections
1. Bnsimess and Professiuns Code:The Commctor'x License Law does not apply to an q p
ownerofpnipeny Who builds or imp nwe,theater,and who does such work himself 502: — FINAL PLUMBING ENERGY
or through his own emi provided that such imprwemems are not intended or -
offered for sale,IL however the building or improvement is sold within one year of 506 — GAS, TEST
completion.the oume>builde,will base the burden of proving that he did oat build car I
improvemrparpoacor,ale.), 507 — F•INAL PLUMBING
❑1,as owner of the property,um exclusively cataract ng with licensed contractors us' -
coromet the project(Sec.70,14,Boniness and Profossfor,Code:)The Comenuor s
License Law tlses not apply it,an owner of pmpeny who builds car improve,thereon,
and who contracts for such projects with u contmnnr(s) licensed pursuunl to the -
Contractor's License Luo.
❑lam exempt under Sea .B&P C for this reason
Oona Dam
WORKER'S COMPENSATION DECLARATION
t hereby affirm under penalty of perjury one of the following dealamfions: '
o1 I have and will maintain a Cenitirme of Consent In nlGimum for Worker's
Compensation, as provided for by Section 37W of the "We Code, far the
perfo rmocc of the work fanwhich this permit is ivaed. ,
❑1 base and will nommumn Worker's Compenntion]as umnec,as required by Section ,
37110 of the Labor Cade,for the performance of the work lire which this permit Is
issued.My Worker's Cmupensation Insurance currier and Policy number ore:
Cartier: Policy No.:
CERTIFICATION OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section aced not be cmmplemd if the permit is for one hundred dollars
($IOIB or lava) .r s
1 cenirythat.in the offorram ct,of the work for which this permit is issued,I
shall not employ any person any manner so as to become subject to the Worker.' -
Compensation Laws of California.Date
AppLcart
_ NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you.should -
Z become subject to the Workers Conipensutimr provisions of the Labor Code,you most -
ZQ, Q 6mM1with cmnply with such provisions car this permit shall M deem¢)revoked
F E CONS'TRUC`TION I-ENDING AGENCY -
I hereby ofirii that there is a construction leading agency for the performance,
W of the wart for which this permit is owned(Sec.3197,Co.C)
L Q lender's Name
Lender's Address ,
C.7 Q I certify that 1 boor read this application and amu that the above information is
fzr E. crrea.I agree to comply with all city and..my ordinances and same law,relating '
Q U 18 Wilding conslmetian.and hereby mahorlee representhtive,of this city cat enter upon
W the inose-nord mw0 pmpcny for inspection purposes.
y Os (We)a,.in;nave,indemnify and keep hamdess the City of Cupertino agoras
rn liabilities,judgmems cosh and expenses wthch may in any way accrue a,mano said
C.7 z
City in consequence of the granting of this permit. .
r"r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS,
Y'
Signature of ApplicantlConamur Dam Re-roofs
HA%ARUOUS MATERIALS DISCLOSURE
Wll the upplicam or future Wilding accupant store or haMFe houadmn material Type of Roof �as defined by the Cupcnino ManicipM Cale,Chapter 9.13,and the Health end Safety '
Cade,Section 25532m)? -
ore, oNo All roofs shall be inspected prior to any roofing material being installed.
Will the pImam or future building occupant aro eyinpren,or device,which If a roof is installed without first obtaining an inspection, I agree to remove
emit hnmNeus air conmminams us defined by the Bay Area Air Quality Management
,,via? all new materials for inspection. Applicant understands and will comply with
0 Yes ` 11No all non-point source•regulations. -
I Woe read the Woroxi m mmcnd,regtirements under Chapter 6.95 of the
California Health&SJely Qde.Sections 25505,25533 and 25534,1 understand that
if the Wilding docs not curently have a tenant.that it is any responsibility to nearly the '
occupant of the requirement,which must W met prior to issuance of a Cenilicala of
Occupancy.
Signature of Applicant Date
Owner or nothoriacd agent - Data All roof coverings to be Class `B"or better
OFFICE .
e
City of Cupertino Building Permit Aeplication
E-Mail
Jobsite Address: 111 50 Bubb Rd.
Owner's Name:---Singley Sam
Phone No.(408)252-6945
APN#: 362-05-042 ------------ Project Valuation: $664.68----------
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: 1764 National Ave. E-mail: permits@justwaterheaters.net
City,State and Zip: Hayward,CA. 94545
State Contractor's License# 591329 Exp. Date: 3/31/02
Worker's Comp#: 03KR0001018 Carrier: Clarendon Exp. Date: 4/1/01
Credit Card Information
Credit Card #: 5474-6331 -7168-6326
Name on Card: Just Water Heaters Inc.
Expiration Date: 9/02
Visa MasterCard Lft
Comments
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•
CITY OF CUPERTINO
• 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: nancyc
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:36205042.00
DATE ISSUED.. .....: 11/14/2000
RECEIPT #. . . . . ....: 14004
REFERENCE ID # ...: 00110072
SITE ADDRESS . . ... : 11150 BUBB RD
SUBDIVISION . . . .. . .
CITY . . . . . . . . . .... : CUPERTINO
IMPACT AREA . ......
OWNER SAM SINGLEY
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4957
RECEIVED FROM ....: MAIL-IN
CONTRACTOR .......: GILROY, JOHN LIC # 15128
COMPANY ..........: JUST WATER HEATERS INC
ADDRESS ..........: 1764 NATIONAL AVE
CITY/STATE/ZIP ...: WAYWARD, CA 94545
TELEPHONE ........: (510)293-9901
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REE NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPWHEATER PER HEATER 1.00 9.99 0.00 9.99 0.00
PPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
PERMIT 45.51 0.00 45.51 0.00
METHOD OF PAYMENT AMOUNT NUMBER
---- ------------ ----- ---
OTHER 45.51 MASTERCARD
TOTAL RECEIPT 45 51
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
•__••_ -----------=`----------__ •_______ -------
___--------------
'___
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•