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06030010 (2) CITY OF CUPERTINO BUILDING DlvlsloN PERMIT QR IN OR9'A.T 9,44 r,, BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT NO.06030010 21578 FLINTSHIRE ST ER'S NAME: PERMIT ISSUE DATE DAVID SEHR 3400 INVESTMENT-BLVD 03/03/2006 PRONE: SANITARY NO. CONTROL NO. (510) 293-9901 ARCHTIECTIENGINEER: BUILDING PERMIT INFO BD D PLUMB MECH l� 3oj LICENSED CONTRACTOR'S DECLARATION lobDescrit 1 ionhy affrtm Det 1 m licensed under and Professions of CMpmr 9(commencing P j- l� wfNSarcean1k1)ooDlviNon3of the Buaimu and Pro(eulans Code.and mylicenw0 �wpW7■■ LE eco infail tChms ect REPLACE 40 GAL GAS WATER H D gZ_ License Clsv Lk.Is Dau Comnamer ARCHITECTS DECLARATION JUN I undemW u and my plans shall used public mcords _ ?OOG Licensed Professional OWNER-BUILDER DECLARATION /J 1 Wraso.(Sect the 1 1. exempt from Ne Cantrsemfa License Law for the 1 a0 Which noon.Permit t 71D L0.Business and Pinfons,dens Code:Any city ar en my Curs / $ W for I its I.a a permit re cram ft elan improve,h remit t ri nasi,any+roams 1 —�� miormiu lensed p,almrc W es tieapions Of for such remit LOOrile a M Lmdmmmem < (commencing �tWuslieemed pummnl mthc ofDivision rthe ConowmseLIeensemlOns Cpter9 Sq.Ft. Floor Area u 1 $ (eons a Is exempt with Section]and of Division 3 the id dgBusinessaxe end Proon.Any vi latIC)ion of Nat W is ammpt Nemrrom and the bol+for Ne aildged exemption.Any Wohlfart of Section 7031.5 by any applicant for a permit ubjects the applicant to s civil penalty of er Occupancy Type not roam Uun five hundmd dollars ISS00). _ ❑1,a awou of Um pmpmy,m my mploym WIthvmges u dek wleCompe=Um, willdo the work.and the structure la notimendedaral(emd fmuk(Sec.7044.Bosircas Required Inspections and Professions Cade:The Co t rwtor'.License LAW does seat apply m nse an Came,of q P property who builds or im prow themmn.sed who dae+uch wart himself or through his Own employee,provided thatwch improvementsm notinumbul uoaered for We,It. however,Ne Wilding or Improvement Is mid widen mu year of completion.the owner, Wilder MB have the burden of proving that W did rot Wild or improve fu purpose of u1cJ. ❑1,as Owner of the property,am exclusively contracting with licensed Contemn w comtruct the project(Sec,7010,Bear.and PmRasia m Cade)The Contractor'.U- cemeLaw does mus Imply manownsrofproperty who Wit or fmPMOU lhmeem.mJ, who convects for such projects with a Comrac7Ogs)licensed pursuant to UU L'entracro(s License Law. ❑1 am exempt under Su. .B k P C fonhis moon —Dam- IF WORKERS COMPENSATION DECLARATION I hereby strips under pecaRy of perjury one of tie following dalmtiom: ❑I have and will maintain•CeriOue orconsentmselGlnsm ran Warkef+Cmpcn. otion,as Provided ran by Section 3700 of the Lair Code.for the perrmmeee of de work for Which Nu pcmh is iuued. ❑1 have and will maintain WorWfs Compensation Inmmnce,as required by Section 370D of the labor Cade,for the performuee of Ota Werk for which this permit It iuued. My Worker's CompensWan Ineuranee carrier and Policy number m: Carrier. Policy No.: CERTIFICATE OF EXFMP ION FROM WORKERS COMPENSATION INSURANCE (Thtswetim need not W mmplemd Btie permit B foram hurldmddollns(SIOO) or less.) 1 certify that In the perfines.of the work for which this permit is Issued.Ishan not employ Lawsoanypornia, any manner wmlm become subject U¢Warken'CampenuUon ^^✓ _Q Laws of Cailrasoninm Applicant NOTICE TO APPLICANT:If,afar making Ude CeniOum of Exemption,you should / W come subjee7 of the WoheYs Compensation provisions ar Ne IaWr Code,yen mvu OZ rordowith comply with such provisions or this Permit me]the deemed mated. Z O CONSTRUCTION LENDING AGENCY V Hr 1Wmhy•Ohm Net Nem iso converser..Ismiugamncy fo,de perfmmaneeuf Ci> the work for which thus permit is issued(Sec.3(197,Civ.C.) W Q I eft es Name z Lender's Add. U 0 I certify that 1 have mad Ws application and sou that the give information ie U. emm0.1 agme to comply with all city and County ordinances and sou laws mhting m 0 Wilding convection,and Wmby sutborlm¢pruenutives of Nis city to comp upon the W shove-mentitrned property for Inspection purposes (We)agree to save.indemnify and keep hapmleu the City or Cupertino against In liabilities,judgment,coats and expenses which may in my my wane against said City V 4 In APPLICANTeof the solutul Of UNDERSTANDS AIND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signature of AppliHtAZARDDOUS MATERIALS DISCLOSURE Dam Type of Roof Will Me appliam Or tuts Wilding oceupammun,mb&Wlc handout maw" u detrmd by the Cupertino Municipal Cade.Chapur 9.13,and the Health and Safety 110.Section 355370)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes E]No Will the applicant Or future building occupant use equipment or dcvim w3rich If a roof is installed without first obtaining an inspection,I agree to remove emit hats dnus air Contaminants as armed by the Bay Ansa Air Quality Muugcmcm all new materials for inspection. Diiaicl7 ❑Ye ❑Nu Is 11vc mad the Iteral ios,mamueb mquimmenu order Chap sir 6.95 of Ue Califor. .i.NalNa SofctyCode.Swtim25305,25333am125531.IwWcro sed Neirde Wilding does trot Cumntly he.a mnane met It i+my msponsihility to family the occupant of Ne requirements which must W met prior to Issuance or a cermficam of occupancy. Signature Of Applicant Date ' Owner or anharn"agent Date All roof coverings to be Class"B"or better • ocv�3oo� o City of Cupertino Building Permit Application E-Mail Jobslte Address: 21578 Fllntshire St. Date: 12-29-05 Owner's Name:---David Sehr Phone No.(408)253-7874 APN# 356-20-026 Project Valuation: S 731.00 Building Permit Info: Bldg Elect Plumb x Mech Job Description Replace 40 gal gas water heater. Contractor Information Company: Just Water Heaters Inc. Phone: (510)293-2012 • Contact Name: Dulce Fax: (510)783-6360 Address:3400 Investment Blvd. E-mail: permltdept®sbcglobal.net City,State and Zip: Hayward,CA. 94545 State Contractor's License# 591329 Exp.Date: 3/31/06 Worker's Comp#: 1626288-05 Carrier:State Compensation Insurance Fund Exp.Date: 411/06 Credit Card Information Credit Card #: 5474-6390-0047-8660 Name on Card: Just Water Heaters Inc. ,�i 3 �)3 Expiration Date: 06/08 t Visa MasterCard Comments Community Development 10300 Torre Avenue Cupertino CA 95014 � &YO Telephone(408)777-3228 M TINO Fax(408)777-3333 Building Department JOB ADDRESS: PERMIT # 21578 Flintshire St. 0Loos CO k OWNER'S NAME Janice Sehr PHONE # 408-253-7874 GENERAL CONTRACTOR: Just Water FAX # 510-783-6360 Heaters I am not using any subcontractors: � c� � 03/01/06_ Signature Date Please check applicable subcontractors and complete the following information: 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 1 03/01/06 10/28/03 CITY OF CUPERTINO I 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw COPY # 3 Sec.: Twp: Rng: Sub: Elk: Lot: APN . . . . . : . . : 35620026.00 DATE ISSUED. . . . . . . : 03/03/2006 RECEIPT #. . . . . . . . . : 33433 REFERENCE ID # - - - : 06030010 SITE ADDRESS . . . . . : 21578 FLINTSHIRE ST SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER. . . . . . . . . . . . . : DAVID SEHR ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , RECEIVED FROM . . . . : JUST WATER HEATERS CONTRACTOR . . . . . . . : GILROY, JOHN LIC'# -15128 COMPANY - JUST WATER HEATERS INC ADDRESS 3400 INVESTMENT BLVD CITY/STATE/ZIP . . . : HAYWARD, CA 94545 • TELEPHONE . . . . . . . . : (510)293-9901 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL __________ _____________ __________ __________ __________ __________ __________ BENERGY PERMIT FEE 1.00 34 .86 0.00 34.86 0.00 BPWHEATER PER HEATER 1.00 10.79 0.00 10.79 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 ------7--- ---------- ---------- ---------- TOTAL PERMIT 84.02 0.00 84 .02 - 0:00 METHOD OF PAYMENT AMOUNT NUMBER _________________ ------------ __-__--___________ OTHER 84 .02 MASTERCARD TOTAL RECEIPT 84.02 VOICE ID DESCRIPTION VOICE ID DESCRIPTION _____ ---------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING