Loading...
03050145 (2) CITY OF CUPERTINO *.rrt � k' " BUILDING DIVISION pE]uVjIZ i COIyTRAGTURATNF'®RMA�IQN:= BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT N003050145 -A PARSE T)R OWNER'S NAME: 1764 NATIONAL AVE. : , "B"To n9/2003 PIVEY RUTH H TRUSTEE NE, (510) 293-9901 SANTTARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 woZ, LICENSED CONTRACTOR'S DECLARATION Job Description I hereby an.that 1 am IiaMed under provirions of Chapur 9(mmmsneing p withS 6on7")of Divialon3oftite r�--arb BugProfession Codo,andmylicenseis n3 bmnto.lneeffaL REPLACE WATER HEATER ,,EZLicense ClassLie.N Dam Contractor (4 0 GALLON GAS) FINALED ARCHITECT'S DECLARATION �y Iundcruendmyplana shall be used as public me.,& JUN 2003 56 �o Licensed Pmfessumill OWNER—BUILDER DECLARATION I I hereby affirm that I em exempt from the Como mous License law for the E A 00 following reamn.(Section 7031.5,Business and Professiot.Code:Any city or county BUILDING which requires a permus it consuua,allot structureimprove,demulish,or repair any structure shy poor In its issuance,also requires the applicant for such permit in Me a signediuumun that be is licensed puts umun the provisions of the Contractor's Uanse Law(Chapter 9 Sq.Ft. Floor Area Valuation y $ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $600 '� .. Out he u exempt therefrom and the basis for the alleged exemption.Any violation of Section 703f.5 by any applicant for a permit mbjems the applicant to a civil penalty of APN Number Occupancy Type nm more thse Bit,hundred dollars($500). 01,u owner of the property,or my employers with wages a their sets eompet.nlon, 35926017 . 00 will do the work,and the structure is not intended or offered for rale(See.7044,Business RE.(I,,,r�I�,qD� and Professions Code:The Contractor's Li,.Law does not apply be an owner of 502 - FINAL -FDft i NU c 4MRGY property who buildsur Improv Neeson,and whodms suchwwkhimsel(orthmugh his own employes,pmvided that such improvements are not inundm oroffered Russia,If. 506 — GAS TEST however,the building or improvement is sold within one year of comptedan.the sunter- Wilderwill ban one Wooden of proving thin hedid not build inImprovefor purysseof 507 - FINAL PLUMBING sale.). 0 I.as owner of the property am exclusively contracting wish licensed contracrea to construct the project(Sec.7044,Business and Profession Code:)The ConuacmYa LL cents Law does not apply on an owner of properly who Wilds or improv themon,and who contracts for such projects with a conVYtors)licensed pursuant to IW Crematories License Law. O lamesemptuneer Sec. ,B&PCfmthisreusn Owner Dau WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the fallowing decimations: 1 haw and will maintain a Canificausf Consent to selyimure for Worker's Compere 1• upon,as provided for by Section 3700 of the Iabm Code.for the perfonnanm of the woh for which this permit is issued. 0 I have and will maintain Workers Compensation Insuranm,as required by Section 3700 of the LAW,Code.for the Performance of the work for which this permit is issued. My Worker's Compensation Insurance tinier and Polity number are: Cartier. Policy No.: _ CERTIFICATE OF FXEMP ION FROM WORKERS' COMPENSATION INSURANCE (Ihb section recd not W completed if tad permit Is foranchunemd dolhos Ol00) or leas.) I certify that in the performance of the work for which this pored,is issued.I shall not employ any person in any manner in as in become subject to the Workers'Compenmdem Laws of California.Dau Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should become subjecty it Wortpo monsorateis permit"I Nelabor Code,you mull .J O fmNwisheoecx on be soeho's Co mor that Pprovisionsoc and mad revoked. ?rA CONSTRUCTION LENDING AGENCY [r I WsebyaRrm that Neu iso commztion lending agency our the perkins cof the work for which this permit is issued(Sm. Co.C.) Q Lender's Name z Lender's Add. U O I cenify that I haw read this application and state that the move ofonnNon is It,E-' cooecL 1 agree to comply with all city and county mountain;and sou laws notions of 0U building comwetion.and hereby authsdn representatives of this city to tour upon the {27 aWw-mentioned Property for inspemlan Purposea (We)agree in save,indemnify and keep harmless the City of Cupmina!gait.( „y rrAA Ilabllitin,judgmene,cosu and expenses which may in any way accrue again mid City U r-+ APPLICANTANin D thisof the Staining of permit. WILL COMPLY WITH ALL NON-POINT Issued by:9 Date SOURCE REGULATIONS. Re-roofs HAZARDOUS SignSignatureof ApplicaDate HAZARDOUOU S MATg mic rpa DISCLOSURE Type of Roof Willy the Cicant orertino future Municipal Code.Chaptnoaar handle Health and as defined by the Cupertino Municipal Cade.Chapter 9.@,roti the HeaIN and Safety ode,Set 25533(¢)? All roofs shall be inspected prior to any roofing material being installed. ❑Yue I-]No Will the applicant or future Wilding occupant use equipment or devimS which If a roof is installed without first obtaining an inspection,I agree to remove It harardnm air mro m nmol as defined by Nc Bq Area Air Quality Manag¢num all new materials for inspection. District? 0Yrs 0N I have read the th ardnus reuriels requiremsnta under Chapter 6.95ofths Cxlifnn me HmIth&Safety Codc,ScNoes 25315,25533 and 25534,1 un l aund thin ifft Wilding Docs not currently haw a tenon.that it is my responslhility in entry dte occupant of the roquimmenu which mug be met prior W issuance of a Ccnifcau of Occupancy. Signature Of Applicant Date DwnerorauNna,<daSent Date All roof coverings to be Class"B"or better City of Cupertino Building Permit Application E-Mail jobsite Address: 7467 De La Farge Dr. Date: 5- 29-03 Owner's Name:---Spivey, Ruth Phone No.(408)253-2746 APN#: 359-26-017 Project Valuation: $ 600.00 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: 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/l/04 Credit Card Information Credit Card #: 5474-6390-0026-5679 p� Name on Card: Just Water Heaters Inc. 42, �9Q Expiration Date: 9/05 `8 Visa MasterCard ® (� Comments