04020029 (2) CITY OF CUPERTINO . a.�aa=mgv 5 d °" "
4 BUILDING DIVISION PERMIT K CrO,NTRACTQRINI+ORMA.TIONs.
BUILDING ADDRESS: JUST WATER HEATERS INC PERMITNo.04020029
OWNER'S NAME: FERMITLSSUEDATE
PIYU L
JNE: SANITARY 0 OLNO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u0Z
LICENSEDCON(RACI'OR'SOECLARATION Job Description
dC I hominy affirm that I am licensed under previsions M Chapter 9(commencing
tJ with Section TOM)of Division Sof Ne Business and Professions Code.and my license is
_G v, in full force and effect.
�v,z �C11,�c,ns, LK,, REPLACE WATER HEATER �®
"�ca Dam contractor (40 GALLON "V� •OEM
J ARCHITI=S DECLARATION
I understand my plans ab8 he used as public meow MAY 2 4 2004
�yU
Clf Licensed Pmfcamonal
3 OWNER-BUILDER DECLARATION
+� I hereby a1Erm that 1 am exempt from On Com arim's License Law for the RRww
i a o following mason.(Section 7031.5,Business and Profosiuns COdc:Any city or county 10 p��®�pg�
K m which inquires a permit hs construct.eller,improve.demolish.Or repair any dructum susOO tllJ �tl
prior to its issuance.also inquires the applicant for such permit to Glc a sigocd statement
that he is licensed pursuant to the provision of ft Contestant[Jecrese,Law(Chapter 9 Sq.FC Floor Area Valuatio�872
QFC (commencing with Section TIDO)of Division 3 of the Business and Profanions Coda)or
i that he is exempt thoofrom and due basis for the alleged exemption.Any violation of
Sestion]W1.5 by us,appliesumfor a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom Nan five hundred dol Ws(SSW).
❑I,a sewn.,none propene.m my empmycea wise w.gea a thw mm emmpemsstimn. 32345048 . 00
will do Ne work,and the swctum is not intended m onered formic(Soo.1U44,Business
and Professions Code:The Contractor's License Law dos not apply in an owner of Required Inspections
property who buildsor improves thfeon,and who does such work himself or through his
own employers.pmvided that such improvements am not intended oroRert l forsale If.
however,the building or improvement is sold within one year of eumpletion.Ne owner.
builder will hae the burden of proving Nat he did not build or improve for puryo d,of
sale.).
I,ex owner of dm property.am exclusively contracting with licensed counselors to
convect the project(Sec.1064.Business and Professions Code:)The COmrsclor's Li
come law does not apply to an owner of properly who builds or improves themon.and
who contracts for such projects with a eunuaetor(s)licensed pursuant in the Comnactora
License law.
CD I am exempt under See. ,B&PC for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affrm under penally of perjury one of the following dedarstio e
1 have and will maintain a Certificate,of Consent to self-insum for Washer's Com,m-
sation,as provided for by Section 31W of the labor Code,for the performance of the
wssu
work for which this permit is named.
1 have and will maintain Worker's Compensation Insurance,as mquiied by Section
31W m
of the Ube,Code,for the perfmmce of Ne work for which this Forest is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Cartier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(lots section need not becomplcard if the Permit is for one hundred dollars(SIM)
if,less)
1 eeNfy that in the Performance or the work for which this permit is issued,1 shall not
employ any person in any misinform as to become subject 0 the Workers'Compensation
Laws of Califnmia.Out
Applicant
NOTICE TO APPLICANT:If,after making this Candlish,of Exemption.you should
become subject On the Worker's Compensation previsions of the labor Code.you most
.J O forthwith comply with such provisions orthis Permit shall the deemed sawked.
Z CONSTRUCTION LFNDINGAGENCY
[-+ 1 hrehy chthi that there is a construction(See. 0 lending agency Ins the performance of _
rL the work for which this permit is issued(See.3097,Civ.C.)
to A
Lenders Name
IY Lendeexls Address
U Q I certify that I ban read this application and mute Net Ne above infomntlon is
F correct I agree to comply with all city and county ordinances and suite laws relating to
0 Wilding convection,and hereby authorize nePresentsives Of this city to enter upon the
r I47 aMve-mentioned property for Inspection pur(pYi
(We)agree to save,indemnify and keep harmless the City of Cupertino against
FNliabilities.judgmcn..Cos.and"Fcnsex which may in any way acenc against said City
U Z, in consequence of the granting of this pOmmit.
r. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signawm of Applica - Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum Wilding e,Chat stem or handle hatooJous
add
as defined by the Cupertino Municipal Code.Chapter 9.13,and Ne Health arid Safety
Aillilliceme.Scction35533(a)?
❑ All roofs shall be inspected prior to any roofing material being installed.
Yes ❑No
Will the applicant or future building occupant time equipment or dcvios which If a roof is installed without first obtaining an inspection,I agree to remove
h haraA m air contaminants a defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes 0 N
1 have rtaHhe haaNm.materials mqunements under Chapter 6.95 of du Califor-
niaHalth&Safe,,Code,Sections 8585.15533 and 25534.1 undersand Naif the building
dors not currently ham a tenant that it u my removability to nomy the mceupant of the
mgnimmntsWhich must be me(Our toissmanceof.cenirmaleofOccupancy. Signature of Applicant Date
Owner or egcm Dale All roof coverings to be Class "B"or better
.` c"
City of Cupertino Building Permit Application
E-Mail
jobsite Address: 20578 Cedarbrook Ter. Date: 1-22-04
Owner's Name:---Lin Piyu
Phone No.(408)996-1381
APN#: 323-45-048 Project Valuation: S 872.00
Building Permit Info: Bldg---------- Elect----------- Plumb------X----- Mech_
Job Description
Replace 40 gallon water heater
Contractor Information
Company: just Water Heaters Inc. Phone: (510)293-2012
Contact Name: Dulce 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: 3/31/04
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
Visa MasterCard
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