03080082 (2) CITY OF CUPEWFINO
nm1.D1Nc Drv1s1oNPERMIT CONTRACTOR INFORMATION
Bu V-DING ADDRESS: JUST WATER HEATERS INC PERMITN003080082
11 TDONEGAI OR
r OWNER'S NAME: 1764 NATIONAL AVE PERMITISSUUEDATE
PETER T.UT
2'1
ONE: (510) 293-9901 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG 0 ELECT PLUMB MECH
0 0 0
10 o LICENSED CONTRACTOR's DECLARATION ]p1J DCSCII II O}L.
Emp 1 hereby afOrm that 1 am licensed under provisions of Chapter 9(commencing p F
iRM with SectionlOW)of Division 3ofthc Bufinews and Professions Code,and mylianicia '
<❑i in ON tome and affCCt. REPLACE WATER HEATER HALE®
j Egm Luansc Class Lk.if
it: Dow—Contractor (50 GALLON GAS)
ARCHITECTS DECLARATION OCT 2 3 2003
f U I mokoni nd my plans 0.1 W used a public records
e�� Licensed Poor..ii nal RR
3 f la
OWNER-BUILDER DECLARATION BUILDING
< 1 hereby arm that I am exempt from Ne Contractor's License Law for the
a O following reason.(Section 71131.5;Business and Professions Coda:Any city or county
3$ which requires a Permit to construct,iter,improve,demolish,or repair any structure
Her as its hameme,.lsu requires the applicant formch familia Ill.a sigacdsutemem
ESO that he is licensed pursuant to previsions of the Contracwh License Law(Chapter 9 Sq.Ft, Floor Area Valua[i 3711 '
es- (commencing with Section 7MQ)of Division J of the Business and Professions Cook)or
$ that he is exempt therefrom and the bub for the alleged exemption.Any violation of �.tmwm
Section 7031.5 by any applicant for.permit subjects the applicant to a civil penalty of 36161`vr4YAd&cr0 O Occupancy Type
.at mom not five hundred dollars 55003. -
1,u owner of the property,or my cmployces with wages as their sole compensation,
will do the work,and the,structure is not intended or offered for sale(Sec.7044,Business p�
and Professions Co&The Conroctorb License Law does not apply to an owner of 5 02 - FINAL Re,uirt ddlNpections
property who builds or improves thercon,and who does such work himrelfor through his G ENERGY
own employees,provided that such improvements are not intended or offered for sale.If, 506 — GAS TEST
however,the building or improvement is sold within one your of completion,the owner.
builder will have the burden of proving that be did not Wild or Improve for purpose of 507 - FINAL PLUMBING
salt.).
O h as owner of the property,am exclusively contracting with licensed contractors to
commuct the project(Sec.7014.Business and Professions Cade:)The Canuactor's Li-
cense Law it=not pply to an owner of property who Wilds or improm human,and,
who contracts for such projects with a Centncwr(a)licensed pursuant to the Contractors
License Law.
I am exempt under Sec. B k P C far this moon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Pef of perjury ore of the following Eedw ations:
I haw and will maintain a Cenifcate of Consent to self-insme for Worker's Compcm .,
nation,an provided for by Section 37013 of the Labor Code,fm the performance of the
work for which Nis permit is issued.
❑1 have and will maintain Wet Compensation Insurance,as required by Section
J700 of the labor Code,for the performance of the work for which this pernit is issued.
My Workers Compensation Insurance caner and Policy numher am:
Cortin: Policy No.; _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(7Tu faction recd not W complexed EtW(omit is(mane hundred dollars(SIM)
car Wss.)
1 certify that in the polls m un o of the work for which this Permit is issued,1 shall not
employ any person in any manner so as w Weome subjecuo the Workers Compensation
Laws of Califomia.Date
Applicant
NOTICE TO APPLICANT:It.at making this Certificate of Exemption,you should
become Subject to the Worker a Cam Pansf provisions of the labor Code,you must
DZ, forthwith comply with each provisions or this Permit hall W deemed revoked.
OCONSTRUCTION LENDING AGENCY (3
I hereby say.that baa its construction lending agency for the Performance of
Ye > the work fur which this permit is issued(Sec.3097.Civ.C.) -
37 Q Lender's Name / I�
z Lender's Address I /
C) I certify that I have read this application and state that the own information is
Y (✓ correct,I agree to comply with all city and county ordinances and state laws relating to
V building construction,and hereby scimitar representatives of this city to enter upon the
7+U .hove-mentioned property for inspection p uprises.
tili� (We)agree to save,indemnify and keep harmless the Ci ly of Cupertino against
rp
liabilities.judgments,costs and expcnsca which may in any way accrue against mid City
Jz in consequence of theBraming of this lsermit.
'—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicanUContractor Dsw
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle haanrdous material
as definc0 by the Cupertino Municipal Code,Chapter 9.17,and the Health and Safety
ode.scctlenzss3x')? All roofs shall be inspected prior to an roofing material beim Installed.
❑Yea ❑Na P P Y g g
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it tanneries air conmminanu as defined by the Bay Area Air Quality Management all new materials for inspection.
Wolin?
❑Yes. ON.
.Ihavemad Nebamrdnusmewrialsmquimmen¢unt rChapter6.95oftheCalifor-
niaHcalthASvfctyCo ,Scctions255f15,23533md25534.lundersWndlhatlfthe Wilding
does nm cortically base a tenant,thvl it is my maponsihility w nntil'y Ne occuP.nl of Ne
mquircmcnts which must W met prom issuance of a Ccrdficaw or occupancy. Signature of Applicant Date
Owner or authanmd agent Date
All roof coverings to be Class "B" or better
City of Cupertino Building Permit Application
E-Mail
jobsite Address: 7531 Donegal Dr. Date: 8-15-03
Owner's Name:---Lui, Peter
Phone No.(408)829-9550
APN#: 366-16-062 Project Valuation: $ 711.00
Building Permit Info: Bldg---------- Elect_-_---_- Plumb------X----- Mech_____-----_
Job Description
Replace 50 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# 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 0—
Name on Card: just Water Heaters Inc.
Expiration Date: 9/05 [ j
Visa MasterCard ® v
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