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