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05010137 (2) CPPY OF CUPBILTINOa, BUILDING BUILDING DIVISION PERMITCONeTRACTORINFORMATIOs,N .,� BUILDINGADDRESS: JUST WATER HEATERS INC FERMI IN005010137 OWNER'S NAME: PERMIT ISSUE DATE JEAN LIW 01/25/2005 ONE: SANITARY NO, CONTROL NO. 510) 293-9901 ARCHITECUENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 loo LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I.m licensed ander provisions of chapter 9(commencing Job Description 1U. with seorceandeffecOmtaon3of the Business and Prore:.duns Code. my license �� !a E� in full Clwsderrea REPLACE WATER HEATER gy6 ?,k 'n � 2 Liccnm Clio Lic.N tt' t O-1 a ,;m Dam Contract., (5 0 GAL GAS) Z°-J ARCHITECT'S DECLARATION as c U 1 understand my plans shall he used as public records o N Licensed Professional MAR 9 2005 S OWNER—BUILDER DECLARATION a o 1 hereby.Ilion that I I. exempt from the Contractor's Con Licence city o for the p a�ny,u od which re moon.Section 7tnstr Business and ve de int.Conte:Any city.,county nuchum ! <m wnlpn nyahes.permit u.mncwn.alms.improve,acmoud,,lir repair- stmaum ort.its issuance.also the applicant for such Permit to Glc signed statement -� ].i phi 4o the Ppr Pc g - . (the,he commencing WithSection70XBofvivionao the oftheB sinesssndPrseLaw(Chapm,9 Sq. FL Floor Area Valuati($1866 cert (comm , .cru With Section d d tracis for the the Business and PmfAny QMc)or i�$ Nat heI,aempl thertfrom and the baso for the allegc0 exemption.Any violmion of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than fin hundred dollars(S500). P Y YP ❑1,asowner othe pmparty,or my employees with wages asmeirxolecompensation, 32630107 . 00 will do the work.and the..,tum is not intended or offered far eale(Sec.7044,Business and Pool...Code:The Convector's License Law does not apply to as owner of Required Inspections property who hildhUm inag o sta therooaand wh.Loessuch work himself.,through his Own employees.provided that uch improvements arc not intended conflicted for sale.If. however.Ne building or improvement is sold within one year of completion,the owner builder will have Be burden of proving that he did not hit ld or improve for purpose of sale.). ❑1,as owner of One property,am exclusively commucting with licensed contractors 10 cum o cr the pmject(Sec.7W.Business and Professions CMe:)The Contractors U cense law docs not apply to an owner of property who Wilds or improves therton,and. who contracts for such projects with a contranods)licensed pursuant to the Commetors License Law. ❑I am exempt under See. ,B&P C for this reason Awwwase, Date WORKER'S COMPENSATION DECLARATION 1 hereby afrim under penalty of perjury one of the following declarations: 1 ban and will maintain a Cenificam of Consent to self-insure for Workers Cumpcn- suation,u provided for by Section 37M of the labor Code,for the Fathomana of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation insurance,as required by Section 3700 of the Labor Code,for the performance of One work for which this Penni,is issued. My Worker's Compensation Insumnm seamier and Policy number are: Cartier: Poli,No.: CERTIFICATE OF EKEMPn0N FROM WORKERS' COMPENSATION INSURANCE (This section recd not be c.mplemd iOhe permit is for one hundred dollars(SIRB or less.) 1 terrify that in Be a rfa mmoe of she work for which this Permit is issued,I shall not employ any person in any manner W as m become Subject o IM Wofkeri Compensation Laws of California.Date Applicant NOTICE TO APPLICANT.Ir,after making this Cenlficate of Exemption,you should become h comp 1.the Worker's vision of this provisions los Ne Lahr evoke you must p become scomplywit.ouchConnslirthin pproisions rtedeemedr Cods.. / Z y CONSTRUCTION LENDINGAGENCY 1 hehcny orf on Nat there is a construction lending agency ter the performanceor Y> the work for which this permit is iuocd(Sec.3197.Civ.C.) y Lcndcr's Name z Lender's Address � J Q 1 certify that I have reed thisapplication and county and stain that the above information is y F torten.1 agree to comply with all city and county nNtives Of and stem laws relating e V building ion.and forebysuthohimrcprcecmatives of his City to enter upon the C shove (We) to for inspection keep ea (Wc)ague to cast,indemnify and which harmless Be City of Cupertino against Z liabilities,judgments.egrassand es pens es which may in any way acerae against said City J Z A PLIC NT ND RSTAgranti s of this D WILL ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by: Date SOURCE REGULATIONS. Re-roofs HAZARDOUS Signalmc.(ApplicaDate lIAZARDOUS MATERIAI.SDISCLO$URE Type of Roof Will the applicant or furore building c.Chapter more or and the hvardoos material as defined by the Cupertino Municipal Gale.Chapter 9.1 i.dna the HcallM1 and Safety We.Section zss3z(ap All roofs shall be inspected prior to an roofing material being installed. ❑rax ON. P P Y g g Will the applicant or future budding«cupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove fir hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. Islriel7 ❑Yes ❑Nu 1 have mall the MnWnusmaterialsmquimmentsunderCeapWr6.95ofIncCalifor aHcalth&SofmyCodc,Sections25X)5.25533 and 25534.T understandNatifNe building es nut eurrenlly ban a trrant,thio it is my respnnsihili,y W nodly the occupant ofthe qulrementswhichmustInmetpriorloissuanceofaCen;ncateoracuPNcy. Signature of Applicant Date Owner or lotborind agent Date All roof coverings to be Class "B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 SCITY OF Fax(408)777-3333 UPEkTINO Building Department JOB ADDRESS: PERMIT # 10451 Glencoe Dr. a a t 3 OWNER'S NAME: Liw Jean PHONE # 408-253-9638 GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360 I am not using any subcontractors: Q.J�CQ- 12/3/04 Signature Date Please check applicable subcontractors and complete the following information: 6d ISUBCONTRACTOR 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 U."� 14CA � 12/3/04 Owner/Contractor Signature Date 10/28/03 City of Cupertino Building Permit Application E-Mail jobsite Address: 10451 Glencoe Dr. Date: 12-3-04 Owner's Name:---Liw Jean Phone No.(408)253-9638 APN#: 326-30-107 Project Valuation: $ 866.00 Building Permit Info: Bldg-----_-_ Elect___—___—_ Plumb------X_—__ Mech - Job Description Replace 50 gal gas water heater. Contractor Information Company: just Water Heaters Inc. Phone: (510)293-2012 ® Contact Name: Dulce Fax: (510)783-6360 Address: 1764 National Ave. E-mail: permits@j ustwaterh eaters.net City, State and Zip: Hayward, CA. 94545 State Contractor's License# 591 329 Exp. Date: 3/31/06 Worker's Comp#: 1626288-04 Carrier: State Compensation Insurance Fund Exp. Date: 4/l/05 Credit Card Information Credit Card #: 5474-6390-0026-5679 / Name on Card: just Water Heaters Inc. �(�� Expiration Date: 9/05 Visa MasterCard Comments