04060198 (2) clTv OF cuPEaT Ireo CONTRACTOR'INFORM ATION;
BUILDING DIVISION PERMIT .k _,�., ,•,
BUILDINGADDRESS: JUST WATER HEATERS INC "104 060198
20677 CRA
OWNER'S NAME: PERMIT ISSUE DATE
RON KUMAR 1764 NA
NE: SANITARY NO. CONTROL NO.
(510) 293-9901
nRCHDECf/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
o LICENSED CONTRACTOR'S DECLARATION Job Deseri
WU C 1 hescby affirm that 1 am licensed under ons of Chapter 9(commencing ' N LE
D
wide Stefan 7")of Division 3ofdc Businusand Professions Code.and my license is
pin in full forcamd effect. REPLACE WATER HEATER
jqi u=nmaas Lic.M (50 GAL)
n^p Date Cunlsanor
ARCHITECTS DECLARATION SEP d 9 2004
as-a 1 understand my plans shall he used u public«cordo
JaU
Licensed Pmfeso...I II r1 f L� II q
a'Og OWNER-BUILDER DECLARATION
o BU
II �I' trY),II
.�<Y 1 hereby affirm deal I em exempt from Ne Convenor's IJecnu LOU,for the U V 111' \\VI'
z a O following meson.(Sects n 7031.5.Business and Profesxinns Code:Any city a,county
K m f which require,a permit to commeo,eller,improve,demon h.nr repair any swcmre
Id
—'^ prior On its issuance.also acquires the applicant for such permit to file a signed staement
that he is licensed purmenuo the previsions of Ne Common's Liana Law(Chapter 9 Sq. Ft. Floor Area Valuati,q000
�H$ (commencing with Section 700(d of Division Sof the Business and Professions Cole)or
_
that he is exempt therefrom and dm bale for the alleged cmmpton.Any violation of
Section 7031.5 by arty ap,li.,(a,.permit subjects the applicant m.civil penalty of APN Number Occupancy Type
not more Nan five hundred dark.(S50W.
0 1,m owmr of the pmperty,m my employe wide wage u deeir sole compensation. 35915018 . 00
will do the work,and the sw=um is not mu ndcd or offered formle(Sec.7064,Business
and Profossions Cade:The Convmtoh License law does not apply to an Owner of Required Inspections
property who Wilds or improv thereon,and who does such work himself or through his
own employees.Provided that such imprev.mems meant intended.,offc.d for sales If.
however.the building or improvement is old within am year of completion,Ne oonc-
builder will ban the Wrdcn of proving that he did not build or improve for purpose of
salt.).
0 h as owner of the property,am exclusively contracting with licensed compactors in
consumer the project(Sec.7044,Business and Professions Code:)The Contractor's Li.
come Law does not apply in an owner of progeny who hilts or improv daemon,and.
who contracts for such pmjccu with a contractogs)beamed pursuant in the Contractors
License law.
Q l am exempt under See. ,B A,P C for this reason'
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury am of the following declarations:
LI have and will maintain a Certificate of Consent to self-insumfor Worker's Camper.
ation,as provided far by Section 3700 of the labor Coda far the performance of the
work for which this permit is issued
rl 1 ban and will maintain Worker's Compensation Imuran=,as acquired by Section
3700 of the labor Codc.for the performance.(the wok for which this pencil is issued.
My Workers Compensation Insurance carrier and Policy number am:
Carrier. Polity No.: >
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sectio need not tecompleted if uhe permit is fm one hundred dallua(SIM)
v less.)
I earrify that in the performance or dm work for which this Permit k issued.I shall not
employ any parson in any manncrsn as to become subject o the Workers'Compensmion
Laws of California.Da¢
Applicant
NOTICE TO APPLICANT:If,after making this Cenificre or Exemption,you should
become subject to the Worked Compchtsation provisions of the Labor Code,you muss
.J z, forthwith comply with such provisions or this permiuhall h d=mcd revoked.
OCONSTRUCTIONn.isacLENDINGAOENCY
(-. kfarw d➢thi thaltMrtisacommc.3M.lending agcmy fm dm performana of
a the work fur which this permit is issued(Sec.3041,Civ.C.) `I
Q. Lendch Nam.
7 z lenders Address
U 0 1 certify Nat I have read this applicidiem and sum Nat the above information is
U.F cone¢I agree to comply with all city and county ordinances and alone laws larding to
Or, building construction,and hereby authorie repreunlotiv of this city in enter upon the
r Cil above-menanncd property for inspection purposes.
(We)agree to ave,indemnify and keep harmless the City of Cupertino against
Fw fa/1 liabilitia,judgmenu.costs and e.,.which may in any way...0 against said city
U Z his Permit.
APPCANTUNDERSTANDS eNof the granting of tAND
L WILL COMPLY WITH ALL NOWPOINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
HA2AR
Signature of ApplicaHA2ARacmr Data
DOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or furore building ,Ch., smrc or handle h.ird .mamritl
a defined by the Cupertino MuniciW I Code.LTapmr 9.11,antl the HcaIN and Safety
Code.Seaton 25532(a)? All roofs shall be inspected prior to an roofing material being Oyes ❑Na P P Y g g installed.
Will me applicant or future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
_mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
t]Ycs ON.
I have mad thc Weemous mamlmis requirement,under Chapter 6.95.(0e Califor-
mallealthS Safely Codc.Sections 15505,25533 am125534.1 undersand that ifthe Wilding
docs not cart,have a mnam that it k my mspomihility an redly the occupant or the ~"
requirements which most h met prior wcouan=or a ccmficam at Occupancy. Signature of Applicant Date )„
Owm,doaudern.degent Dae All roof coverings to be Class "B"or better' -
Community Development
10300 Torre Avenue
A Cupertino CA 95014
Telephone(408)777-3228
� CITY OF Fax(408) 777-3333
UPEkTINO
Building De artment
JOB ADDRESS: PERMIT# 0 6 (� �y
20677 CraigCt.. 0
OWNER'S NAME: Kumar, Ron PHONE # 408-257-1154
GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360
I am not using any subcontractors: 0-au- 6/16/04
Signature Date
Please check applicable subcontractors and complete the following information:
07 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
0--d-fo +-(o`+aku-c� 6/16/04
Owner/Contractor Signature Date
10/28/03
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 20677 Craig Ct. Date: 6-16-04
Owner's Name:---Kumar, Ron
Phone No.(408)257-1154
APN#: 359-15-018 Project Valuation: S 1,000.00
Building Permit Info: Bldg----------- Elect----------- Plumb------X----- Mech-----------
Job Description
Replace 50 gal water heater
Contractor Information
Company: Just Water Heaters Inc. Phone: (510)293-2012
AContact 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# 591 329 Exp. Date: 3/31/04
Worker's Comp#: 1626288-03 Carrier: State Compensation Insurance Fund Exp. Date: 4/l/04
Credit Card Information
Credit Card #: 5474-6390-0026-5679
Name on Card: Just Water Heaters Inc.
Expiration Date: 9/05
Visa MasterCard X
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