03100117 (2) CITY OF CUPEWrINO
BumulNc mvlsloN pERMIT CONTRAC'TnR`INTORMATION
t 'x T-'", 'Yroi Y✓z¢,+s^?"srmS�se s.4;L�m'
-
BUILDINOADDRESS: JUST WATER HEATERS INC' PERMITNO.03100117
OWNER'S NAME: 1764 NATIONAL AVE PERMIT ISSUE DAM
(510) 293-9901 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
00 LICENSED CONrRACTOR'S DECLARATION
u I hereby affirm that I em licensed under provisions of Chapter 9(commencing lob Description
'Z with Section 7gK)of Division J tithe Business and Professions Code.and my license is s
nfnuforceandenect. REPLACE WATER HEATER
(M- License Class Lie.N
ja•� °ate Cmao.lor (50. GALLON GAS)
pp ARCHITECTS DECLARATION
C U 1 understand my plans shell be used As public records O
eon Licensed Professional
3 OWNER-BUILDER DECLARATION
f 1 hereby affirm that I am exempt from the Contractor's License Law fur the
a G 0 following moon.(Section 7031.5,Business and Professions Code:Any city or county
5$ which mquires a Permit In construct.alter,improve.Ocmolch,or repair any strunutc
.¢i fourth itsounarc'e,aBotcipins thcapplicantforsuch permit to file a signed nalement
Gthat he is licensed pursuant to the provisionsor(be Contractor'sLicense Law(Chapter 9 Sq. Ft. Floor Area Valuat�l2a2
2 $ (commencing with Section 7")at Division 3 or the Business and Pro(cssinns Code)or
] that he 11 exempt therefrom and are,basis for the alleged exemption,Any violation of
Section 7071.5 by any applicant for a permit subjects the applicant to a civil penalty of 3*RN M011ef 0 0 Occupancy Type
not more than fire hundred della.(SSW).
0 1,As owner of the property,or my employcu with wages As their tole compensation,
willdothewerk.andthuwcture is not intended oreffemd for sale 70".Business Required Inspections
and Professi0ns Code:The Contractor's License law does at apply tom owner of q P
ppeny who builds or improve themhgand who does such work himself ordtrough his
own employ=.provided that such imProvemeMS arc not intended or offered formic.If.
however,Ne building or improvement is sold within one year of completion,the owner.
builder will ban the burden of proving that he did not build or improve for purpose of
talc.).
0 I,as owner of Ne property,em exclusively contneting with licensed contractors to
consume(the project(Sec.7094,Business and Profusions Code:)The Contractor's Li.
ea.Law does at Apply As An ownR of property who little.ar Improve Nert(In,ted, '
who contracts for such pmjects with a courroun-B)licensed pursuant to the Contractor's
License law.
01 Am exempt under See .B 6 P C for Nis mason
Owner Data
7!mlyWORKER'S COMPENSATION DECLARATION
1 hereby a(liren under penalty of perjury one of the following declarations:
I has and will maintain a Ccmfieam of Consent to sel611131mo for Worker's Compcm
ll'l
on,u provided for by section 7]00 of the labor Code,for the per(ormeme of the
k for which Nis pr mit is issued.
1 ban and will maintain Wafkeis Compensation Insurance,az mquimd by Section
l of the labor Code,for Ne performance of the work for which Nis permit is issued.
Worker's Compenaatinn Insurance carrier and Policy numher art:
ier. Pal icy No.: -
CERTIFICATE OF EKEM PTION FROM WORKERS'
COMPENSATION INSURANCE
(This aectisr and not ht,mrap emd if the permit is for..hundred dollars(SIM)
or leu.)
1 certify that in the performance of the work for which this permit is issued,I thall nut
employ any person in any mannerso as to become subject to the WarlocWCompensation
Laws of California.Det.
Applicant
NOTICE TO APPLICANT:IL olio making his provision'
of of Exemption,you should
st
become subject to the Worker Compensation provisions of the coed Labor Code,you mutt
�O fonhwiN comply with such provisions w this Permit be deemed revoked.
z� CONSTRUCTION LENDING AGENCY
1 hereby affirm Net there its construction leadingageney for the performance of
5 ti the work fur which this permit is issued(Sec.3097,Civ.C.)
4La
n. Lc
Q Under's Name
Z ndcr'e Address
J C) I certify that 1 have read this application and start that the about information is '
P correct.I agree to comply with all city and county ordinances and state laws relating to
0 U building construction,end hereby nwhmize repreaemnivea of Nis city mentor upon the
W have mentioned property fox inspection purposes.
IS. (We)agree to save,indemnify and keep harmless 0e City of Cupeninu against
pj liabilities,judgments,costs and expenses which may in any way accone against old City
J Z in consequence of the Standing of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicaDate
HAZARDOUS
MATERIALS DISCLOSURE Type of Roof
Will the c Capeti or forum building Co occupant store 9.1 or handle haeaNuns material
az den Sed by 15 Cupertino Municipal Code,Chapter 9.11,mJ the Health and Safety
aJe,Section 25512(.)?
❑res 0N All roofs shall be inspected prior to any roofing material being Installed.
7Will 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
it hazardous air contpminants as neared by the Bay Arca Air Quality Management all new materials for Inspection.
strict?
OPcs ON.
1 have mad Ne hanrdnm materials mquisements under Chapter 6,95 of the Cali for
i
nia Health&SafclyCnde,Sections 255(15,25577 and tha 25574.1 understand ft ifWilding
Joaz nm curtcntly hat a tenant,Nm it u my respoui hility m harry the Occupant of the
requirements which must M mel prior at issuance of a Certificate of Occupancy. Signature Of Applicant Date
Owner or nothmi'rod Agent Date All roof coverings to be Class "B" or better
17
City of Cupertino Building Permit Application
E-Mail
jobsite Address: 10576 Merriman Rd. Date: 10-15-03
Owner's Name:---Lin, Katty
Phone No.(408)973-9416
APN#: 342-16-124 Project Valuation: $ 1,282.00
Building Permit Info: Bldg---------- Elect----------- Plumb------1L---- 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: 1764 National Ave. E-mall: permits@justwaterheaters.net
City, State and Zip: Hayward, CA. 94545
i
State Contractor's License# 591 329 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 3 r Z
Name on Card: Just Water Heaters Inc.
Expiration Date: 9/05 G�
Visa MasterCard
Comments
i