06060147 (2) CITY OF CUPERTINO .+ sem„ -ffiw,' '- '$�♦' `'//�y''y ,,
BUILDING DIVISION PERT .. OF. TRe�C�TUII�Tk`U^-
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BUIL0TIO ADDRESS: JUST WATER HEATERS INC PERMRN0.06060147
20680
R'S NAME: PERMIT ISSUE DATE
SHIRLEY WANG 3400 INVEST
8h AE: SANITARY NO. CONTROL NO.
(510) 293-9901
ARCHITEL r1ENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
0 0 0 0
i0o LICENSED CONTRACTOR'S DECLARATION Job Description
4 1 hereby affirm thin am licensed under provisions of Chapter 9(commencing
with Section 1010))of Division 3afthe Business and Professions Code.and my Iicemed is
a�� inmRmmeandeffect. REPLACE 40 GAL GAS WATER HEATER
jaZ Licmuc Class Lm.a
F p Dau Comromer
ARCHITECTS DECLARATION
f0
I understand my plans shall he used as public Secures
s G Licensee Professional
`+7 OWNER-wrap,fraud DECLARATION
2 o S 1 herthy.affiremSec that 11. vempt from dm Contractors LIAnyc Law for the
0 o following reason.(ration]Ombra Business and Rofde oli Cade:Any city m county
$ar which its Usa•m,also
to en es this alar.improve,demolish,i m repair atmewro $1200
_Z j, prim W its isswneg rnuant volumes the of forsuch ConamarmR miamed file a signed(uumem
<
thin he is with
punuamt Wtha provisions of dm eBuinWraldmnsetaw )Cade)9 Sq,Ft. Floor Area Valuation
5E Thant a is
(commencing pt thmt Ven and of auris f r of the 4 egad ess xam and Pmfibon.Any
Cade)of
x $ Nu io V ev.5b thero(mm and On burs it bj alleged are Rent SO Any l Imet(on Of T
Section 7031.5 five
any hundred
fora permit aubjew the applicant W a civil pcoahy of Occupancy •TPR
not mom Than five hundred dallan($500).
0 Lies Owner of the property,army employees with wage a Neo solecompensadon,
will de the work.and de suuctam is natmmoi aranered r.sam(Sm.1014,Basines, Required Inspections
and Profehov Cade:The Contractors License law does set apply W an Owner of q P
property who builds or im prow thereon,and who does ash wale himsel f ar through Ala
own employcea,provided that such improvements see net intended"Offered formda.a, ^.
have.,Ne buildintorimprovement is Said within one year ofcompletion.the owner- f
builder wig have the burden of proving that he did mat build a Improve for purpose of
Safe.).
0 1,as owner of the property,am vclushmly contracting with licensed conuamors he
contract Ne project(Sec.]ON,Bvmm and hons Cade:)Theves v Wh
Ll-
comes raw cora not apply b an owner of property rty wce builds or improves thereon,and,
who contracts for such pojecls with•ronWr(
traca)licensed Formula,in Ne Colonnades
.Law.
m
❑lavempt under See .B&PCfar this recon
73070r Dau /_L+
WORKER'S COMPENSATION DECLARATION
1 hereby Affirm under penalty o(peduq see of Ne following declarations: /
0
s and will maintain.Corsican of Consent W self-InsertfarWarier,C.Pee-
.u Provided for by Section 3700 of Ne tabor Cade.for the performance of the
for.bleb Nis permit is issued
ave and will maintain Workers Compensation Ivunnce,u required by Section
ofNe labor Code.fa Ne perfarmanet ofNe work far which Nu permit u iaucdorker,Compereatian Insurance carrier and Poliry number art:
r. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This meds need notbeeompkud ifthe permit is forane hu etrdda0an($TOM
or leas)
I cenify Nat in the per(ormaae of She work fa which this permit Is ISaued,I shall net
employ any person in any mmar an as m become subject W lbs Workear Compensation
Laws of Calif ends.Date
Applicuot
NOTICE TO APPLICANT:If.afar making OU CeniOaW of Exemidem,you should
becmnubjaN
e, t Om Whc
ora Compensation provisions of she Code.you man
.J 0 forthwith comply with such p ndsons or This permit,hnl be dcemed invoked.
z t•' CONSTRUCTION LENDING AGENCY
[r 4 I hemby a n.O.,Nem is a c...trachea lending.genry far the arfurmance Of
CG> are work fur which this permh is issued(Sec.3591.Cih,C.)
W Q lender's Name
z Under.Address
U Q 1 minify that I have mad this application and sum that Ne above infarme0un 6
LL(~ cancra I agree W comply with all city and county cNivaes and sou laws relating W
0U
building construction,and hereby auNarim mpmscnmivv of Nis City to enter upon the
W above-mentioned property for inspection purposes
(We)agree to Save.indemnify and kap handles the City of Collation against
rHi 5,1 Iiabilificsjudgme es,cosn and expenses which may in anyway amus against said Cry
U,'Z in consequence of the grmOng of Ni,permit,
"•' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:S Date
SOURCE REGULATIONS.
Re-roofs
SlgtWumofYvpplignUCodmacrar Dare
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
NMI]the applicantor future building accupwasrom or handle huaadoes material
1M.wict?fined by On Cupertino Municipal Code.Chapter 9.12.urn the Health and Safety
Section 25532(a)1 All roofs shall be inspected prior to any roofing material being installed.
❑Yea C]No
Will the applicant ser future building aceopant sea equipment or drdol,whichIf a roof is installed without first obtaining an inspection,I agree to remove
hvaNnus air conuminamu u dclined by the Bay Arta Air Quality Management all.new materials for inspection.
❑Yet ❑Nu
I have mad Ne haSaWv materials mquimmenu under Chapter 6.95 ofthe Cabral.
aff &SafnyCode,Secdau25505,25533and25534.IundetundNnifNa building
wtcurrently Moe a Tuan.Nathu mymapovlldlitym netifyNeacupamofthe
rements which must be met Prior W issuance of a certilkaur of Occupancy. Signature Of Applicant Date
Owne,a,.aNariyxd. ant Dam All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
aClOF Fax(408)777-3333
,CUPEkTINO
Building Department
JOB ADDRESS: PERMIT#
20680 Gardenside Cir.
OWNER'S NAME:Wan , ShirleyPHONE # 408-431-3097
GENERAL CONTRACTOR: Just Water FAX # 510-783-6360
Heaters
I am not using any subcontractors: �� ' ' `—� 06/13/06_
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
06/13/06
10/28/03
CITY OF CUPERTINO
�m 2 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32632011 . 00
DATE ISSUED. . . . . . . : 06/16/2006
RECEIPT #. . . . . . . . . : 34897
REFERENCE ID # . . . : 06060147
SITE ADDRESS . . . . . : 20687 PARK CL
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : SHIRLEY WANG
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
SIEE 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
---------- ---------- ---------- ----------
TOTAL PERMIT 84 . 02 0 . 00 84 . 02 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
' City of Cupertino Building Permit Application
E-Mail
Jobslte Address: 20680 Gardenslde Cir. Date: 06-13-06
Owner's Name:---Wang,Shirley
Phone No.(408)431-3097
30a
APN#: .326-32-011 Project Valuation: $1,200.00
Building Permit Info: Bldg____ Elect Plumb__ 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:3400 Investment Blvd. E-mail: permitdept®sbcglobal.net
City,State and Zip: Hayward,CA. 94545
State Contractor's License# 591329 Exp.Date: 3/31/08
Worker's Comp#: 044510091 Carrier:ACE Exp. Date: 4/1/07
Credit Card Information
Credit Card #: 5474-6390-0047-8660
Name on Card: just Water Heaters Inc.
Expiration Date: 06/08
Visa MasterCard
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