03050027 (2) CITY OF CUPERTINO ^",' '., '^e"*s" '" `dt%v^'�.' ,� " `^+ '", " .`
BUILDING DIVISION PERMIT CONTRACTURaINI'ORMATJON -
s, 9", -47°Fs
BUILDTNOADDRMS: JUST WATER HEATERS INC PERMIT".
03050027
OWNER'S NAME: 1764 NATIONAL AVE PERMITfssWn7/2003
MURPHY
"E` (510) 293-9901 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
] O O O O
�tOZ, LICENSED CONTRACTOR'S DECLARATION
(� I hereby affirm that 1 am Ilcenud under provisions of Chapter 9(commencing lob Description
z with Section 70100)of Division 3 of the Business and Professions Code.and my license is
<� nfall force anda "` REPLACE WATER HEATER �.�����'®
5 Lq? Lica.Class Lie.M
Dam Contractor (4 0 GALLON GAS)
tq- ARCHr1ELTS DECLARATION 'I ,g
Y
>? I tmetan ual my plan.mall hwa an
e ed public mrds MAY 1 t 2003
Yrs
Lkcntod Parasol anal
OWNER-BUILDER DECLARATION
y I hereby a(Bmt that 11. exempt sum the Contractor's License Law for the BUILDING
a o fallowing reason.(Section TID sr,Business and Improve,
de ons Cade:Any city or county structure$� which rt9ulrea a permit to construct,epee Improv,Jcmaliah,nr repair any IIrvctum
piorto its issuance.also requires theapplicanl formch permitu,slcasignl statement
q�Q that he is licensed pursuant the provisions of the Contractor's License law(Chapter 9 Sq.Ft. Floor Area Valuation
a zC$ (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or
and he is eampt therefrom and Ute pais for Ne alleged exemption.Any violation of
Section 7031.5 by ary applicant fora permit subjects the applicant to a civil penury of APN Number Occupancy Type
not more than fire hundred dol Ws(5500).
❑ I.aawmerofthe Property,Ormycmpinyecawith wagsatheir sole campewwon. 36930036 . 00
will do the wart,and construct..I.not Intended or offered for sale(Sm.TDM,Boutin Re Ued Ins eChODS
and Prorevions Code:The Commutes Lt.Law does act apply to an owner of 502 - FINAL PLmlrJMB I N� ENERGY
property who builds or improves thereon.and who dos such work himself or through his
Own employes.provided that such Improvements am not intended orulfered forale If. 506 — GAS TEST
however,the building or improvement Is sold within one you of completion,the owns.
bulkier will have the harden of proving that he did not build or Improve for purpose of 507 - FINAL PLUMBING
ale.).
❑ I.as owner of the properly,am exclusively contracting wit licensed contractors to
construct the project(Sec.7044,Bwiness aM PrOlas ons Code:)The Contractor's Li.
am law dos not apply to an awx+of property who build,at Improv thereon.and,
who contracts for such projects with a conuanar(s)Ucensed pursuant to the Comoselor's
License taw.
❑1 am exempt under Sec. ,B&P C for this recon
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby aiRron under penalty of perjury am of the following deckaa0ons:
I have and will maintain a Certificate of Consent to saff-mu.for Wmkera Compere
ation,as pmvided for by Section 37M of the Labor Code.for the performance of Ne
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insuance,a required by Section
3700 of the labor Cade.for dte performance of the work for which this permit is iaued.
My Workers Compentuan Insurance artier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSAMON INSURANCE
(This section need not betcompleted If the permit h faro.hundred dollars(SIM)
or less.)
1 certify that in the performance of the work for which this Permit is issued.I shall not
employ any person in any man.rm as to become subject m the Workerl'Compenatan
Laws of Califords.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
became subject to the Worker's Compensation previsions of the labor Code.you must
.JZ foMwalb comply with such pmvisiow or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
'Er - l hereby alfscm that them its construction lending agency for the performance of
Qv.7 the work fur which this permit Is Issued(Sec.3097,Ci,C.)
10 Lender's Name
.7 z Iendcrs Address
U O I=try that 1 have read thi..,liea m.aM state the the above Information is
LL correct.1 agree to comply with W city and county ordinances and sum lawn relating m
O building construction,and hereby authorise representatives of this city to enter upon the
G above-mentioned prepay for Inspection purpasaa
F (We)agree to ave,indemnify and keep huntleas the City of Cupertino against
py liabilities,judgments,costs and expenses which may In my way acme against said City
U7 in consequence of the grafting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicmulConuactor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant of future building occupant store of handle haardous material
as,defined by the Cupertino Municipal Code.Chapter 9.13.and the Health and Safety
ode.Sad.35533(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes ONO
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
mit haafdous air contaminants an,defined by the Bay Area Air Quality Management all new materials for inspection.
Diafict7
❑Yes ❑No
I have reed the haudms materials requirements under Chapter 6.95 of the Cuifna
out Health h Safety Code,Sections 35505.35533 and 35534.1 understand dw if Ute Wilding
does not currently haw•rmml Nat It s my responsibility to modify the..put of the
requirements which must be met prior to issuance of a Ccrafcate of Occupancy. Signature Of Applicant Date
0wner oreuthomcd agent Dam All roof coverings to be Class"B"or better
a3ps-� z �
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 20132 Las Ondas Ct. Date: 5- 7-03
Owner's Name:---Murphy, Dan
Phone No.(408)366-0306
APN#: 369-30-036 Project Valuation: 5 894.00
Building Permit Info: Bldg----------- Elect----------- Plumb------X----- 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: 1764 National Ave. E-mail: permits@justwaterheaters.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 Dn
Name on Card: Just Water Heaters Inc. Z �o
Expiration Date: 9/05 ',
Visa MasterCard
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