04070186 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT WONT,RACTORINF.URMA aI,ON �
e »an`� "N 2smf a '*kXmvwM1� - 8h�°A
BUILDING ADDRESS: JUST WATER HEATERS INC Pr'kMIT"'04070186
21806 HYANNTRPC)RT ng
•OWNER'S NAME: PERMIT ISSUE DATE
WES JRAIGE
ONE: SANITARY NO. CONTROL NO.
510 293-9901
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�Op LICENSED CONTRACTOR'S DECLARATION -
I hammy affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
Ith Section 7000)of Division 3 of0w Busiand Professions Code,and my license is
mness full REPLACE WATER HEATER
553 S3 3 Uw.Clxss UA.{q Dam Comer (4 0 GAL GAS)
l oth
ARCHITECT'S DECLARATION
I undersand my plum shell be stud As public records
=red Licensed Professional
^
OWN ER-BUILDER DECLARATION
d I heathy alErm that 1 am m m
exempt food Contractor.Licenm Law for the
00 following masen.(Satiun 703 1.5,Business ad Professlum Cade:Any city at county
$ which declaims a permit Ins cmnurucl,alar,improve,demelah,m aped,my structs.
prior te its issuance.also acquires the applicant far such Permitw file a.igmduuemcet
< thatheislimnudpum,antsomeprovisionsoftheCainncufeLicenselsw(Chapur9 Sq.Ft.Floor Area Valuatic$750
Il60 (commencing with Section 7000)of Division 3 of IW Business and Professions Code)or
a that he l.exempt therefrom and me basis for the alleged exemption.Any vulavon of
Section 7031.5 by any applicant fm a permit Subjects the applicant to a civil penalty of . APN Number Occupancy Type
not more than five hundred doll..(5500L
❑1,uawnuafinepmpeny,mmyemploymwithwa{uumeUmleeompenaon, 35613015 . 00
Add do Newark.and the annus isnotkaeded aroRerred fmaak(sec.70".Bull
and Professions;coeur Tax Conuxmre ueense Law dost not ripply a.n lar' D Required Inspections
am ertywhnds.proorimprowa thertanaee who doeseahent himmlfor Wore his D J
howemploy�ilding r improvement
midwithin
itsartne ea of ora drte me If,;]
however.meavethRorimprowrovinguble did not Wild
ofdon.the ncr•
builder will have the burden of proving that be die not build ser Improve far pure at
mlc.). 1.-_ U
❑1.u owner of the property,am exclusively convening with Iicenud can m- I
mmtrom the pe jecl(Sec.7014,Braine.and Professions Code:)Tbe Contractors LI.
cense Law doth not apply m an ownur of property who builds or improves motion.and,
who contracts for such instincts with acentradmR.)licensed puromnt a the Contractor.
License U.
❑I am exempt under Sea ,B h P C far ml.mason
Owner Dam
WORKER'S COMPENSATION DECLARATION
737,00
I hereby affirm under penalty of perjury am of the following declarations:
1 have and will maintain a Certificate ofConmmt to ulf-luum for Warker's Compen.
tian,u provided for by Section 3700 of ds labor Code.for the perfarmance of me
ak fm which this permit is issued.
I have and will III Warkefa Compersman lauuence,u sequined by Section
of the Labor Code.fm me performance of me work fm which this permiti.Issued.
Worker.Compensation Insurance carrier and Policy number are:
ller: Policy No.:
CERTIFICATE OF EXFMP 1ON FROM WORKERS'
COMPENSATION INSURANCE
(Thl.ucfim mW not beennplead dust pe ed,Is foramhundma dollars($100)
ar lest)
1 certify met in me performance of the work fm which this permit is issued.I shall nut
employ any period in say manner an as in become subject to the Workers'Compensation
Laws of Califomts.Dam
Applicant
NOTICE TO APPLICANT:If,after making this cenlOua of Eacmption,you should
become subject in the Worker's Compensation previsions of the Ichor Cede,you muss / I•tJ'�"'
0z foMwith comply wird such pmvivans or this permit.hall be dcemed revoked.
ZCONSTRUCTION LENDING AGENCY
=
'r^+ Ihummy In.mat ft.I..construction lending agency for me performance of
a> the wart for which this permit Is issued(Sts.3097.Cih,C.)
QLandce,Name
Q z Leadcra Add.,
f,Q I unify that I have read this application and sum that the above information is
coma l a{me to comply with all city and county ordinances and sus laws dialing in
Q building constriction.and Hereby authorier rtprcxnmiws of this city in sour upon the
fJd ahove-mentioned property for inspection purpomt
gy (We)acme to raw,indemnify and kap harmless the City of Cupertino against
rp liabilWes,judgments,emu and cape-.-.which may In any soy amuse against mid City
V 2 in consequence of the graining of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature ofAppliaDau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the Applicantorforum Wilding aecmpantrareorAdd! Health usmaurial
u de.Sts by du Cupertino Municipal Code,Chapter 9.11,ane the Health inti Safety
ode, Ely.:ss3z(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yrs ONO
Will the applicant or future building campanl use equipment ar devices which If a roof is installed without first obtaining an inspection,I agree to remove
it haxardnue air contaminants As defined by ft Bay Area Air Quality Management all new materials for inspection.
District?
❑Yin ON.
I haw mM Ne hvsrdnw muarieHmquiremcnu underCNpmrh.97 of me Glifor-
nl.He9thkSafety Cade,Savau2550.5.15533md255N.1un&.UMm ifdc Wilding
dors not currently haw a tenant that it as my oupouibithy a natty tins occupant of the
rryuimmcou which most be met prior to itvuano of o CatiOcau of occupancy. Signature Of Applicant Date
Owner r authowhad agent Date All roof coverings to be Class"B"or better
Community Development
f�o
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
ICUPEkTINO
Building De artment
JOB ADDRESS: PERMIT # O u o o
21806 H annis ort Dr.
OWNER'S NAME: Jrai e Wes PHONE #408-257-5997
GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360
I am not using any subcontractors: Q`- . �4u"`+ -) 6/29/04
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 9 -0-4Q- ' O'A 6/29/04
Owner/Contractor Signature Date
10/28/03
070/ 6
City of Cupertino Building Permit Application
E-Mail
Jobslte Address: 21806 Hyannisport Dr. Date: 7-29-04
Owner's Name:---Jralge,Wes
Phone No.(408)257-5997
APN#: 356-13-015 Project Valuation: $ 750.00
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)293-2022
/I• Address: 1764 National Ave. E-mail: permits@justwaterheaters.net
City,State and Zip: Hayward,CA. 94545
State Contractor's License# 591329 Exp. Date: 3/31/06
Worker's Camp#: 1626288-04 Carrier:State Compensation Insurance Fund Exp. Date: 4/1/05
Credit Card Information
Credit Card #: 5474-6390-0026-5679
Name on Card: Just Water Heaters Inc.
Expiration Date: 9/05
Visa MasterCard
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