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03080073 (2) CITY OF CUPERTINO + BUILDING DIVISION PERMIT CONTR�CTORTNFURMATIQN BuI LDINGADDRESS: JUST WATER HEATERS INC PERMIT N0.03080073 • OWNER'S NAME: 176)4 NATIONAL AVE PERMIT ISSUE DATE DAVE FAHEY 2003 NE: (510) 293-9901 SANITARY N0, CONTROL NO. ARCHITECT'/ENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH 100 LICENSED CONTRACrOR'SDECLARATION JobDescri [ion I hereby affirm that 1 am licensed under previsions of Chapter 9(commencing p with Section 70at0 of Division 3 of Ne Business and Professions Code,and my license is mmnrate mulefmct. REPLACE WATER HEATER jyZ LimA.Cl.. Lic.g .eFi Deas Cumnctar (4 0 GALLON GAS) ARCHITECTS DECLARATION I u I urbcmand my plan shall M used u public recends AUG 2 •' 2009 6 l er Licensed Profcuinnal OWNER-BUILDER DECLARATION ��� i 8 1 hereby affirm that 1 am exempt from the Connectors License Law for the LDUVO no following reason.(Section 703 1.5,Business and Professions Code:Any city or county V'�A g which requires a permit to construct.alk,Imptnve,demolish.or repair any structure prior to its issuance.auurequires beapplicant foruch permit to file asignedmaumem ¢ that he is licensed pursuant to the providers,or the Commons License Law(Chapter 9 Sq.Ft. Floor Area Valuatio�711 2 9 (commencing with Section 7100)of Division 3 of do Business and Professions Coded or that he Is exempt therefrom and the huts for the alleged exemption.Any vinlation of y Section 7031.5 by am applicant for a Permit subjects the applicant m a civil penalty of 3.TAPIR Mallcr O O Occupancy Type nos mom than five hundred dollars($500). ❑ 1,is owner of the property,or my employees with wages As their sole compensation, will do the work,and the sVucture is not intended m arrered initiate(Sec.7044,Business g�� d�Isn� and Profusion Code:The Cmrux toe License law docs not apply m an owner of 502 - FINAL PL'YfESB I NCU c RGY property who builds or improves diversion,and who does such work himself or through his own employees.provided that such lmpmwmenu are not intended oroffued for.le.If, 506 — GAS TEST however.the building or improvement is sold within one year of completion.she owner bander will ban the burden of proving that he did not wild or improve for purpose of 507 — FINAL PLUMBING is) ❑I,As owner of the property.am eaclusively convecting with licensed enormous an construct see project(Sec.70d4,Business and Profession Cade:)The Contractors LF cense law docs not apply to an owner of property who builds or improves themon,and who contracts for such projects with a conuaclor(s)licensed pursuant u the Curvature , License Law. ❑I Am exempt under Sec. B@PC for this recon Owner Data ' WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 130711 have and will maintain a Canificate of Consent to se161mu a for Worker's Compere on,.provided for by Section 3700 of be labor Code.for the performance of she k for which this permit is issued. hive and will maintain Worker's Compensation Insurance.ss rcquircd by Soction 0 of Ne labor Code,for the performance of the work for which this Permit is issued. Workers Compensation Insurance carrier and Policy number am: iee Policy Na.: CERTIFICATE OF MEM MON FROM WORKERS' COMPENSATION INSURANCE - (Thu action recd not be completed if Ilse Permit U for one hundred dollars D100) or less.) I certify that in the performencA of the work for which this permit Is issued,I shall not employ any Person in any manners As m become subject o the Workers'Compensation Laws of California.Data Applicant NOTICE TO APPLICANT:IL after making this Centficato or Exemption,you shmuW become subject to the Workers Compensation provisions of the tabor Code,you mut Oforthwith comply with such provisions or Nis Permit shall W deemed revoked, ti.yN. CONSvRVCn ONLENDINGAGENCY I hereby sift that have its Q comSec3lending agency for We Iserfamana of 1i work for which this permit is issued(Sec..30097,Civ.C.) Lenders Name 7 Z Lender's AOdrass J p 1 certify that I haw read Nis application entl sate that da.soon information is E+ correct.I agree To comply with all city and county ordinances and nam Tawe relating to 7 U building convection.and hcmby suthrriu representatives of this city to Amur upon the G w avo-msntioned propertyrp for inspection puoses. (We)agme to Mi,indemnify and keep humle.the City of Cupertino against Iimlli8ea.judgmcou.CNIA and Asturias which may in anyway aceme,against said City U z Aconsequence of the granting of I LICANT UNDERSTANDS WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signature of ApplicanVCrnData HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the eppenl or future building occupant none handle allous maudal ss Cu defined by Bre Cupertino Municipal Code,Chapter 9.11,. He and Use Health and Safety ale.Section 15331(x)? All roofs shall be inspected prior to any roofing material being installed. ❑Yas C3 No Will the applicant or roue building occupantom equipmanl or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hatArdous air concrnimru.defined by the Bay Arta Air Quality Management all new materials for inspection. trict7 ❑Yes ❑Nu I have mW the harArdlms materials requirements under Chapter6.95 of dte Califon ria H.1th&Safmy Codc,Scctiuu 355(15,15533 and25534.1 undcrrand that if du wilding does not currently haw a arrant,that it u my responsibility m Willy the courses of Use requirements which must W met prior In issuance or a Ccnfficate of Occupancy. ,Signature Of Applicant Date Owner or.mhonxed agent Data All roof coverings to be Class"B" or better c> City of Cupertino Building Permit Application E-Mail Jobsite Address: 10903 Canyon Vista Dr. Date: 8-12-03 Owner's Name:-= Fahey, Dave Phone No.(408)255-2666 APN#: 356-28-007 Project Valuation: S 711.00 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: Dulce Fax: (510)293-2022 Address: 1 764 National Ave. E-mail: permitsOjustwaterheaters.net City,State and Zip: Hayward, CA. 94545 State Contractor's License# 591329 Exp. Date: 3/31/04 Worker's Comp#: 1626288-03 Carrier: State Compensation Insurance Fund Exp. Date: 4/1/04 Credit Card Information Credit Card #: 5474-6390-0026-5679 Name on Card: just Water Heaters Inc. Expiration Date: 9/05 6k 61 Visa MasterCard X Comments