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06060243 (2) CITY OF CUPERTINO �, aiwx>L�wy�«h 's,:7Y �� y� i BUILDING DIVISION PERMIT .�,CO R*41,0RANFO ATIUN BUILDING ADDRESS: JUST WATER HEATERS INC PERMITN0.06060243 21427 KRZICH PL OWNER'S NAME: PERMITLSSUEDATE LINDLEY DALE 3400 INVEST Eo SANITARY NO. CONTROL NO. (510) 293-9901 ARCHITECVENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 c LICENSED CONTRACTOR'S DECLARATION Job Description I I hereby storm Nat 1 not Ieansed under prom vou of Chapmer 9(commencing with Sudan 7010)of Divmnn 3 arrive Business and!Professions Coda,and my became is I.fail forceandefrea REPLACE 50 GALLON GAS WATER HEATER z License class Le.P +� Dam odometer ARCHITECTS DECLARATION I undcrawnd my plans shall be used as public wards fdV s Licensed Professional OWNER-BUILDER DECLARATION q I hereby 21TIM that I am exempt from the Contractor's License Law for the 0 o fallowing maven.(Seedan 703 1.5,Business and Professions Cc&:Any city of coomy 5$ which¢ammo a permit he eonmtck Wel.improve,demolim.or repair my structure $1325 -zy prior w its issuance.alm requires Use applicant wrench permit Le file asigned statement that he is licensed parasol to the provisions ofthe Common's License Low(chapter 9 Sq.Ft.Floor Area Valuation �$ (commencing with Section 70DO)of Division 3 ofthe Business and Profcasions Code)or t7 .. thus he is exempt therefrom and Ne basis for the alleged eaempdon.Any violation of Section 7031.5 by any applicant far a permit subjects the applicant m a civil penalty of Occupancy Type not more than five hundrW dollen(SSW). O I,a owner often property,army employees with wages a Oak mlemmp.Mt wRldo the work.and dmsuactume is tmummdedm offered mraale(Sec.7044,Business Required Inspections and Profession,Code:7M Consomme,License Law does ant apply m an PK Mr of 9 P ownpropatywho vends rc impm euuwcprovedwhaamaaaahworh him dfor ffeed hroaN his / own employee;provided Or i Nat such improvements in mm err wbodore oro@red&a ownrsoic.r.. however.the building ser improvement is cold within am yens of mprove for tlta owrcn saw.).r will have the busmen of proving that M did rot build or Improve(or puryou of saw.). O 1.u owner of the properly nn exclusively exa ming with licensed mmruton to / constact the project(Sec.7044.Business and prefe"ans Code:)The Cmammes Li. mn,e law docs not apply man owner of properly who builds ser improves themon,Md. who contracts for such Projects with a mnlractods)licensed punuenm an we Com tam's ^� Lienee law. (/ OIs.exempt under Sm. ,BdPCfor this nature Owner Dam WORKER'S COMPENSATION DECLARATION I hereby aRbm under pe ndby of perjury arc of um following dedarWons: I have and will maintain a Cenifimm ofennsenm m self4mure fm Wofte,Campen. sation,as provided for by Section 3700 of ths Labor Code,for we perlormanm of the work for which this introit is issued. O 1 have and will maintain Workers Compmmdon Insurance,as required by Semen 3700 of the labor Cade,for the pmformmce Orden,wank for which this pmmim is tuned My Worker,Compensation buummO crier and Policy number one: Cartier. Policy No.: CERTIFICATE OF EKEMPITON FROM WORKERS' COMPENSATION INSURANCE (nd,=tied need not he completed ifft permlt Is farom hundred dollars($100) or mss.) I certify them in the performance of the,work far which this permit is based.I Wall am employ any person in my motorman as m loeame abject to rhe Wmkms'Counpenudon Laws of Calif.mia.Dam Applicant NOTICE TO APPLICANT.if,spar making Nb Certificate of Exemption.you Amid become subject an use Worker',CompmWdan provision,of the labor Cade,you mal .,O forthwith comply with smh intention.m fair permit shall be deamed revoked.74 i r~N. CONSTRUCTION LENDING AGENCY [•r I hereby afrnm was ft.I..eo oundawn lending agency far the perfurmanceof !Yi the wish fur which Ws Permit I,Wood(Sec.3097,Civ C.) �W Q Lenders Name z Lenders Address U Q I certify that 1 have read this application and short that the above information is U,I~ comm.l agree to comply with all city and county eminences and sure laws relating m QU building construction,and hereby auehorim represenhotives of this city to mor upon the W shavomcmiuned pnpcny for inspaum purposes. Os (We)agree to save,indemnify and keep hwmlers the City of Cupertino against cn Iiabilides,judgmemacoeu and expenses which may in any way same aget mid City V z in consequence of the grounding of this permit. �+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 62i Date SOURCE REGULATIONS. Re-roofs Signaurc of ApplieanrDam HAZARDOUS MATERIALS DISCLOSURE Type of Roof WIII the applicantmfMun buildings.Chantpec2.and haumousmaterial as OeOrcd by um Cupertino Municipal Cade.Chepmr 9.13,and fan Health and Safety Code.Semlan 25532007 All roofs shall be inspected prior to any roofing material being installed. ❑Yes ONO Will the applicant or futon building accent.,um equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove emit ha and us air cmuminants u defircd by the Bay Ana Air Quality Management all new materials for inspection. District? Oyes ON. Ihave rad row Wad.materials mcpimmem under lummr6.95 ofthe Califon ria Health&Safxy Cabe,Swuons 25505,25533 and25534.i umememl tantrum building does ant curently haw a Wheat.that it 4 my responsibility to notify um amupmt or um rapdromms,which must be met prior to issumme ora Ccniicam or occupancy. Signature Of Applicant Date Owner or suehodaed agent gym All roof coverings to be Class "B"or better CITY OF CUPERTINO !m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36205039 . 00 DATE ISSUED. . . . . . . : 06/29/2006 RECEIPT # . . . . . . . . . : 35065 REFERENCE ID # . . . : 06060243 SITE ADDRESS . . . . . : 21427 KRZICH PL SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : LINDLEY DALE 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 EE 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 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 • aooi�oaJ43 • City of Cupertino Building Permit Application E-Mail Jobsite Address: 21427 Krzich PI Date: 06-28-06 Owner's Name:---Lindley, Dale Phone No.(408)257-7892 APN#: 362-05-039 Project Valuation: $1,325.00 Building Permit Info: Bldg___ Elect____- Plumb _x Mech___ Job Description Replace 50 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: permltdept®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: 4/1107 Credit Card .Information Credit Card #: 5474-6390-0047-8660 Name on Card: Just Water Heaters Inc. Expiration Date: 06/08 Visa MasterCard Comments Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 SCUPEkTINO Building Department JOB ADDRESS: PERMIT# 21427 Krzich Pl. OWNER'S NAME: Lindley, Dale PHONE# 408-257-7892 GENERAL CONTRACTOR: Just Water FAX # 510-783-6360 Heaters I am not using any subcontractors: lJ� t�c� � � 06/28/06_ 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 06/28/06 10/28/03 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 • Fax(408)777-3333 Owner/Contractor Signature Date • • 10/28/03