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04070107 (2) f CITY OF CUPEWHNO a.* BUILDING DIVISION PERMIT 'CONTRACTOR INFORMATION: 'l' BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT No 04070107 1,0870 K7STER OR a OWNER'S NAME: PERMITISSURDATB MURRAY WALKER 17eili NATTnN7\T, Aim 27120-/2004 ONE: SANITARY NO. CONTROL NO. (510) 293-9901 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH �Oo LICENSEDCONTRACIOR'S DECLARATION d� 1 hereby affirm w the,1 Am licensed order ptvidona of chapter 9(Commencing Job Description with Site ..70M)Of Division 3 of We Boomer and Ptfcsaiom Coda and my license is aj/\\Il,�nl � F in ran force Andoffem. REPLACE WATER HEATER ��D j�.�. License Class Lie.A /1 z Dam Contractor (5 0 GAL) A UG r� q qq ARCHITECTS DECLARATION U v ZOOy �Z2s I understand my plans shall k used as public records iLLU 0t;; Licensee Pinmm aAmn OWNER-BUILDER DECLARATION i1 henry affirm That I am exempt from the Contractor's Licensn law for the O O following mason.(Section 7031.5,Business and Pro o simts Code:Any city or county WWW $ which,equims a permit to construct,alta%improve,demolish,or repair my anuetem prior o its issuance,also inquires the applicant for such permit o file a signed Antietam That he is licensed purniana to the previsions of the Contractors License Law(Chapter H Sq.Ft. Floor Area Valuati�fl700 �$ (commencing wi in Section 7rlB0)of Division d of the Business and Professions Code)or '7 — that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects do applicant to a civil penalty of APN Number Occupancy Type nes mom then fin hundred dollars(SSW). , 01,alt owner Of the property,or in,empmyees with wages aA thehsme compansanon, 35602046 . 00 r will do the work.and Ne swore is nom intended in offered for sale(Sec.7044,Business and Professions Code:The Contractor's License Law Cora not apply to an owner of Required Inspections property who builds or improves thereon,and who does such work Councilor through his own employcas,provided that such improvements arc not intended oroffered for sale.If, however,the building or Improvement is said within one year of completion,dteowner- builder will have the burden of proving out be did not Wild or improve for purpose of sale.). I]1,as owner of the pmpeny,am exclusively contracting with licensed contractors to Cons mer the project(See.7044,Business and Professions Came:)The Cmbacota Li- enu law does not apply to an owner of property who Wilda or improves thereon,and who contracts for such pmjeets with a conditionals)licensed pursuant to the Contractor's License Law. I am exempt under Scc. ,B&P C for this reason Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby afnrtn under penalty of perjury,tote of the following declarations: I have and will maintain aCenificam of Coment to self-insure for Worker's Compen- anion,as provided for by Section 3700 of the Tabor Code,for me performance of the work for which Nis permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,As required by Section l700 alto Labor Code,for Ne performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy numkr am: Cartier. Polity Na.: CERTIFICATE OF E%EMP ION FROM WORKERS' COMPENSATION INSURANCE (This second need not he completed if The permit is for one hundred dollars(SIM) e comfy Nater the performance of the work for whish this the W it issued.I shall not employ any person in any manner so as m kmmc subjcn m rite Workers Compensation AppsCalifornia.aApplicantData NOTICE TO APPLICANT:IL atom making this provisions of of Exemption,you should become h subject 10 the Worker's Compensation its provisions Of the labor Code,you most .J O forthwith comply with such provisions or this permit shall k deemed revokcJ. '�`-' CONSTRUCTION LENDING AGENCY [-+�+ I hereby affirm that Ware is a conximeinn lending agency for the lcrfunnanee of (L' the work for which This pemtiI is issued(Sec.3N7,Civ.C.) W Q Isndcr's Name z Lender's Address U C I comfy that 1 have mad this application and sate That We above information is W F correct.I agree 10 comply with all city and county announces and sum laws mining to OU building constriction,and hereby auburn,representatives of this city to enter upon The ab se-dartiancd progeny for inspection purpoxs. (Wc)agree To save,indemnify and keep harmless the City of Cupertino against Ff,I liabilities,judgments,cost end expouses which may in any way accrue against said C,y U Z in consequence of the Stuart ng of This permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signature of Applicant/Contractor Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Willy t applicant or furore building Occupant lir 9.1 or handle Health and Safer l C al Setl by rite Cupertino Municipal Cada Chapter 9.11,and The Health and Safety Coal Suction 25532()1 All roofs shall be inspected prior to any roofing material being installed. ❑Yin ❑NO Will the applicant or future building occupant use equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove 11ousmoor mit hpvamnus air contaminants u defined by The Bay Area Air Quality Management all new materials for inspection. ❑Yes ❑Nu i have mad the li annus materials requirements under Chapter 6.95 of the Cali foo snoemlyhamamyrtonothacoes noteunendy hoc a mnanh Nm it is my mspmmihilny to nosily We arupanTofthe equirement%which MustkmetpnortoiismnttofaCabncateOfCoMpancy. Signature Of Applicant Date authorized agent Data All roof coverings to be Class"B"or better ., Community Development (� 10300'rorre Avenue Cupertino CA 95014 Telephone(408)777-3228 SCITY Of Fax(408)777-3333 CUPEKTINO Building Department JOB ADDRESS: PERMIT # 10870 Kester Dr. o 7 o o OWNER'S NAME: Walker, MurrayPHONE # 408-253-9212 GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360 l am not using any subcontractors: 9" t"2- �� 7/12/04 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 4-40`-+aL_C� 7/12/04 Owner/Contractor Signature Date 10/28/03 670107 City of Cupertino Building Permit Application E-Mail Jobsite Address: 10870 Kester Dr. Date: 7-12-04 Owner's Name:---Walker, Murray Phone No.(408)253-9212 APN#: 356-02-046 Project Valuation: $ 700.00 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)293-2022 Address: 1764 National Ave. E-mail: permits@j ustwaterheaters.net City, State and Zip: Hayward, CA. 94545 State Contractor's License# 591329 Exp. Date: 3/31/04 Worker's Comp#: 1626288-03 Carrier: State Compensation Insurance Fund Exp. Date: 4/1/04 Credit Card Information Credit Card #: 5474-6390-0026-5679 2 �p Name on Card: just Water Heaters Inc. J , Expiration Date: 9/05D `l Visa MasterCard Comments