08020066 (2) CITY OF CUPERTINO
�BUILDIN(S DIVISION
PERMIT CONTRA TQRINF®RMATIpI :a
aulI_Jnq;tpgµEsMPERMIT NO.
ERRITT DR JUST WATER HEATERS INC 08020066
41VER's NAME: PERMIT ISSUE DATE
BARBARO THOMAS C AND TRACY C 3400 INVESTMENT BLVD 02/12/2008
PHONE: SANITARY NO. CONTROL NO.
(510) 293-9901
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG E
PLUMB MECH
�o Zp LICENSED CONTRACTOR'S DECLARATION Job Description I hemby affirm last1 am licensed under provisions of Chapter 9(commencing
t� with Scclkm70(10)ofOlArion 3ofthe Ron.and Professons Code.and my licew is REPLC 40 GAL GAS WTR HTR
p H in full(urea and effeeL
j�Z License Lt. Lte.s
k- Dau Cuninew,
ee ARCHITECT'S DECLARATION
tl I understand my plats Mall he used as public record,
6
ho Licensed Proposal enal
7N OWNER-BUILDER mDECLARATION
i<E I hereby.(sero that 11. eBusin s an rite Coniuero6 License Law for the
a o following reason.(Section NO str Business and wa,de inns Crede:Any oily m county
$� which nqulas a pomp m comwcL alar,improve,demolish,Or mpair any structure '
Zi prior to its issuance,also requires taw applicant rot such permit to file a signed wtemenl
p"p G that he is licensed Formant to the provisions of the Conuaica'aLimesLaw(Chapter 9 Sq.Ft. Floor Area 995 Valuation
y (commencing with Section 7000)of Division 3 of the Business and Proressiom Code)or
e`<! that M is exempt Nerermm ted the basis for the alleged exemption.My violation of
Section 7071.5 by any applicant for a Permit aubjecu the applieut to a civil penalty ofNumber Occupancy Type
nut mom then Res hundred doll.(SSW), 316 3 5 0 0 9 jlff
I,uhewerof Ne pmprrctre is uth ayeu with wgdude'vsete W.Bumbm,
sold de IW wart,and the he Cort u Out handed or offered wdo s W apply
an Bassi r Of
tea arty who
Code:The e dustan,Laeram Law dna rot apply m rt eauuh of Required Inspections
property who ben II4,or improves Nether.and who does such mat bimrtlr car through his
ownwor,th Wiprovidedthesorbinti mid wit teenot year
Of( mollere.(m tele IL
builder,du building ntrimpmamrnt u old within arc)ear or mpro a for the owe of
builds will hive de buNeri of moving that k dM at bald or improve for purpose or
ute.).
0 1,as wrcr of W proinny,am aeluuvely cemractmg with Iimaed contracun Or
emnima the project(Sec.7044,Business an Profasiear Co(e:)114 CwnWwwaa Li-
cmse Law does not apply in so owner of propeny who Wild,or improv thertm,ted
who contracts for inch projects with a murnomr(s)licensed Panamint to the Combear's
Liuenae law.
❑I am exempt under See .B k P C for this moon
40 rcr Dau
W ORKE.R9 COMPENSATION DECLARATION
I hereby affl m under panty of perjury ane or the following deGvuions,
0 1 haw end will maintain•CeruOromof Consdnt ro self-iaurt forwarteYa Camper
udon,u provided for by Section 37M of the labor Code,for the pdrfonnaero of the
work for which Nis permit is issued
0 I hive and will maintain Worker',ComPeMnlon bnurnco,u required by Section
3700 of the labor Code,for the performance of the work rot which thin permit is issued. '
My Worker's Compensation Ia tramm artier and Policy number art:
Cartier; Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This utdiew uecd Out W completed irthe permit laforme hundred dollar($100)
or tete)
I unify that in the pefewar.of the work for which thin Permit is Wood,I,hall not
employ any person in my marctso as to become subject ode Worker'Compensation
Laws of Califomis.Dau
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
haeme,abject in the Weiser.Compensation proA.ieM of the Labor Code,you mus
.,O forthwith comply with such provisions m this permit shall W dmriied meted.
z CONSTRUCTION LENDING AGENCY
[-m Ilumhyaffinn war der 1.a comemseunn lending agency,for thd lafmmanm of
fY> the work for which this permit h issued(Sec.3097,Civ.CI
4 Lattice.Name ,
7z Lmltes Address
U O 1 emify that I have tad this application and sum the the above information is
ty corrin I agree in comply with all city ted county ordinuas and sum laws relating in
C) building construction,and hereby mmona rtpmamuuves of this city to enurupan the
LV above-mentioned Property rot inspection purpose.
M (%)agme to save,indemnity ted kap bsrmlw the City of Cupertino against
sow(A liabilities,judlmcnts.costs and experues which may In my way accrue against cid City
U Z in consequence 9r'the grueling of then Fermi.
�--� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS,
Re-roofs
Signore o'ApplicanVConlrndor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building oecuputstom or handle hauNou material
definal by the Cupertino Municipal Code.Chapter 9.12 and de Health ted Safety
de, enus32(a)7
Oyes ONO All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding oampant use equipment or devima which If a roof is installed without first obtaining an inspection,.I agree to remove
emit havallou air conuminmts u defined by thd Bay Area Air Qu.1h,Msoagemam all new materials for inspection.
Claim?
0ya ONO
I haw read the hamdas meerisls requirements underCNper6.95 o(NeCallon.
nuHealmdrSarmyCode.Sections 25505,35573 uu125534.1 mgrmand rheif the Wilding
does Out currently have a mar.met it u my responsibility to notify de occupmt of ft
requirements which mnsthe mrpd.,touss.Of.Certificate orDrsmmcy. Signature of Applicant Date
Owner or authonywd agent Dam All roof coverings to be Class"B"or better
o �tiao ()� S�
City of Cupertino Building Permit Application
E-Mail
Jobslte Address: 19735 Merritt Dr. Date: November 20, 2007
Owner's Name:---Wu,Carol
Phone No (408)679-1588
APN#: 316-35-009 Project Valuation f 995.00
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: Fax: (510)293-2022 _
Address:3400 Investment Blve. E-mail: permits@Justwaterheaters.net
City,State and Zip: Hayward, CA. 94545
State Contractor's License# 591329 Exp. Date: 3/31/08
Worker's Comp#: 01 DKRM11001070 Carrier: Nelos Exp.Date: 4/1/08
Credit Card Information
Credit Card #: 5474-6390-0047-8660
Name on Card: ,Just Water Heaters Inc.
Expiration Date: 6/08
Visa MasterCard
Comments
• CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31635009 . 00
DATE ISSUED. . . . . . . : 02/12/2008
RECEIPT #. . . . . . . . . : BS000003913
REFERENCE ID # . . . : 08020066
SITE ADDRESS . . . . . : 19735 MERRITT DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BARBARO THOMAS C AND TRACY C
ADDRESS . . . . . . . . . . : 19735 MERRITT DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2406
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
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 995 . 00 0. 50 0. 00 0 .50 0. 00
1PPERMITFE FLAT RATE 1 . 00 40.79 0. 00 40 .79 0. 00
1PRWHEATR UNITS 1. 00 24 .48 0. 00 24 .48 0. 00
1TRAVDOC FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00
------- ---------- ---------- ----------
TOTAL PERMIT 106..56 0. 00 106 . 56 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 106. 56 MC
---------------
TOTAL RECEIPT 106 . 56
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
518 WATER HEATER
Community Development
10300 Torte Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY Of Fax(408)777-3333
CUPEkTINO _
Building Department
JOB ADDRESS: PERMIT #
19735 Merritt Dr
OWNER'S NAME: Wu, Carol PHONE # 408-679-1588
GENERAL CONTRACTOR: JustWater Heaters FAX # 510-783-6360
I am not using any subcontractors: �.�. � �( �4 � 11/20/07
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
11/20/07
Owner/Contractor Signature Date
10/28/03