04020012 (2) 11 CI'T'Y OF CUPER'f[NO "aV A v
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION p(
RU ILDINGADDRFSS: JUST WATER HEATERS INC PERMIT" 04O2OO12
95 DR EDE DR
OW NEWS NAME: PERMIT ISSUE DATE
ONE: SANITARY NO. CONTROL NO.
InDate
CHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELELT PLUMB MECH
0 0 0 0
uLICENSED CONFRACTOR'S DECLARATION
t I hereby arum that 1 am licensed under provisions of Chapter 9(commencing Sob Description
? h Section 7000)of Division 3 ofthc Business and Profcssiuns Cmki.md my license is
^ ull force and effect. 1=9 p�
� ct cess Lk.a REPLACE WATER HEATER e LED
Contractor (5 0 GALLON L
££ ARCHITECTS DECLARATION
I understand my plans shall be used as public records
FEB 2 3 2004
3 C G Licensed Professional
sg OWNER-BUILDER DECLARATION Ift��g1� �1
S I hereby affirm that I am exempt from the Contractor's License Law for the `�kY�p ®I1tl�
p 0 following mason.(Section 70315.Business and Professions Code:Any city or county L
.,m� which requires a Permit to construct,alter,improve,demolish,or repair any structure
Prior to its borance.arm requires the applicant for such permit to File a signed statement
that he is licensed pursuant 1.thcpmvmamns of the Com ahaa License Las,(Chaper 9 Sq. Ft. Floor Area Valuatioy 980
yF� (commencing with Section 7")of Division 3 of the Business and Professions Ccoe)or
i Nal he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of APN Number Occupancy Type
not more than Five hundred dollars(S5W). P Y YP
I,as owner of the popery,or my employees with wages as their sol.compensation. 35925020 . 00
will Jo Ne work and Ne swaum is not intended or offered for sale(See,7094,Business
and Prefessions Code:The Contractor's License Law does not apply to an owner of Required Inspections
properly who builds or improves thereon,and who doessuch.,it himself orthrough his
Own employers,provided that such improvements arc not intended or offered for sale.If,
however.Oc building or improvement is sold within one year of mmpledon,thc owner-
builder will base dm burden of proving Nal he did not Wild Or improve for purpose of
sale I
❑1.as owner of the pmpsrty,am exclusively contracting with licensed convenors to
Conswct the project(Sec.7094.Business and Professions Code)The Contractor's Li.
conic Law does mol apply to an owner of property who Wilds or impm na daemon.and
who contracts for such projects with a contncora)licensed pursuant to the Contractor's
License law.
❑ 1 am exempt under Sec. .B&P C for this reason
Owner Da¢
WORKER'S COMPENSATION DECLARATION
I hereby grim under penalty of perjury one of the following declarations:
1 have and will maintain a Certificate or Consent to.elbinm
se for Worker's Comte
pem.At provided for by Section 37W of the Labor Code.for We pdrrmm sec or the
73700
h for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as required by SsCIiOn
of the labor Code,for the performance of the work for which Nis perssmit is iued.
y Worker's Compenatin Insurance canis,and Policy number art:
rtier. Polity No.: _
CERTIFICATE OF EXIEMMON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is(mond hundred dollars($100)
or less)
I certify that in the performance of Ne work for which this permit Is issued.l shall nut
employ any pdmpn in any manner o u o become Subject10 the Workeri Comp.nsation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject be the Worker's Compensation provisions of the labor Code.you mud
.J ,Z forthwith Comply with such provisions or this Permit hall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
I— I herebyaffirm Oat them isacd(Sec.3097.lending
s. agency forthe Performance of �.
x the work fur which this permit is issued(Sat.309],Civ.C.) ✓\�
CUj LQ Under's Name
= z Lender's Address
V C) I certify Nal l have read this application and sum that the above information is
E' coned.1 agree 19 comply with all city and county ordinances and state laws relating to
0 V Wilding comorction.and hereby aur cans,«prcspntatixs of Nis city to enter upon the
G alcove mentioned popdny for inspection purikaes
(We)agree to save,indemnify and keep harmless the City of Cupeniem against
liabilities,judgments.Costs and caldrons which may in any way accord against mid City .
or due granting of
his permit.
U z APPLICANTcUNDERSTANDS IAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicarDam
HAZARDOUS
US MATERIALSt sure or URE Type of Roof
Willthe yft Cui,enjimMt Of ure niipal ode.Chapter 9.
said handl
HcardousmSafety ,
al
as defined io the 32(a),na Municipal Code.CM1apmr 9.11.and tW HcaIN and Safety
GOJc, 0Yoc525512(ap ONO All roofs shall be inspected prior to any roofing material being installed.Will the applicant or future building Occupant mic equipment or devices which .If a roof is installed without first obtaining an inspection,I agree to remove
it hamodaus air contaminants as dc0ned by has Bay Area Air Quality Management all new materials for inspection.
won?
(:1 Yea ONO
I have mad the hanardous materials requirements under Chapter 6.95 of the Califor-
riaHim lib tbSafetyCode,Seadom 25505.25533 and 25534.1 undemmnd that ifdm Wilding
docs Dal cunenlly have a mnaat.Nat it is my responamilily to no61,rhe comic nt of the
bouiremcnta which must be met prior to iaeatoe of a CColficam of Occupancy. Signature of Applicant Date
Owner or atuhott,ed agent Dale All roof coverings to be Class "B" or better
r.
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 7595 Defoe Dr. Date: 1-15-04
Owner's Name:---Hsu, Steven
Phone No.(408)253-4266
APN#: 359-25-020 Project Valuation: S 980.00
Building Permit Info: Bldg----------- Elect----------- Plumb------X----- Mech--------_-
Job Description
Replace 50 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 �'/ 3 Q I
Name on Card: just Water Heaters Inc. `/
Expiration Date: 9/05
Visa MasterCard X
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