03080163 (2) COPY OF CUPERTINO -
BUILDING DlvlsloN PERMIT CONTRACTOR INFQRMATI'0
BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT NO 03080163
OWNER',NAME: 1764 NATIONAL AVE PERMIT ISSUE DATE
ONE: SANITARY 0. CONTROL NO.
(510) 293-9901
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
100 LICENSED CONTRACTOR'S DECLARATION
1 hereby from that I em blamed under pmvisimu of Charm,9lcommencin; Job Description
ma with Section 7000)of Division)or the,Businessand Pmessivas Code.ind my him.is
s=N in full remand cffen,
kqz LiecnxClasa�Lic.N REPLACE WATER HEATER
FINALF-0
�k- Dam Contractor (4 0 GALLON GAS)
qq ARCHITECTS DECLARATION
f a 1 undersand my plans&hall be used as public records SEP 92003
ya
0 Licensed Pmfcuionel
OWNER-BUILDER DECLARATION
COO 1 hereby meson.Sour Net 1 1. exempt tram Ne Caron,Chi Licenx Law for IW Be ILDING
p O following iresaPermit
t ] almr, and Professions Code:Any city or eomny u
COO
which requires a permit re construct.the
plica improve,demolish,or mash any structure
-i a pdonn incensed pursuant
nor In thuhovisio antsof for such Contractor's Bill a
aw(Chned mmem
oio that hetsccgwithSection7 cprDivismo�heComrxmriLitPnxsaw(Code)or Sq. Ft. Floor Area Valua[i(a 734
Jt$ (commencing with Section 7gX1)of Divi&ion]of NC Business antl PmrcasinnxCwm)ur
3 Net he H eacmpt therefrom and Ne basis for But alleged exemption.Any violot(ou of
Section 7071.5 by any applicant for a pool subjects he applicant to a civil Penalty of 3' yt3I1 3 err p _ . Occupancy Type _
nut ream than Eve hundred delta.(S500). -" — ---"
❑ 1.as owner of Ne property,army employees with wages as heir sole cempe sora ion,
will do the work and the structure is not intended or offered for solo(Sm.7044,Business
And Professions;Code:The Communes License law does nos apply a an owner of RC,ca..,red Inspections .
property who builds or improves hemon,and who daessuch work htmxlfor through his 502 FINAL. PLUMBING ENERGY
awn employees,provided that such improvements ax not intended or offered for lie.It. SO6 - GAS TEST
however,the building or improvement is sold within one yew of completion,Ne owner-
builder .will have the W Nen of proving that M did not Wild or improve for purpose of 507 - FINAL PLUMBING
.1.
❑ I.As owner of tW property,am exclusively contracting with Emitted con oxio a to -
con&wct the project(Sec.7)44,Business and Fornication,Code:)The Comneteri U. -
cense Law docs not apply to a owwr of pmpeny who Wilds or improve,themon,and
who contracts for such projects with a couractor(s)licensed pursuant to the Contractor's
License U-
0 1 can exempt under Sec. .B&P C for this mason - ..._._ .
Owner Dere
WORKER'S COMPENSATION DECLARATION .... .. _ -
I hereby e04m under penalty of perjury one of the rallowing declarations: .. . .. _
I have and will mainmin a CcniOna of Conxnuo self.insum ror Workeri Compcn-
&orlon,es provided for by Section 7700 of IW Labor Code,for the performance of the -
work for which this permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,As required by Section -
-- D00 ofthc tsWr Cade.for lbe performance of the work for which this Permit is issued.
My Wolter',Compensation lnxnwe carrier and Policy months, :
Canter. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS' "
COMPENSATION INSURANCE
Thissee6ounced notbecompleadlfthe ormittrtoronchundreddollars($IW)
it,IcssJ
1 cenify that in he performance of the work for which this Permit is issued.I shall not -
employanypersoninanymannersoastobecomesubjectmheWorkeriCompensation
laws a(Califomia.Date
Applicant
NOTICE TO APPLICANT:If,after making Nis CAME=of Exemption,you awuW -
become subject to the Worker's Compensation provisions of the Labor Code,you must
� ,x forthwith Comply with such provisionsor this Permit hall W deemed minimal.
ZOCONSTRUCTION LENDlNGAOENGY
I Ill which
Nim that here is a comtrection l. gemy for lM perfurmenm of �Q
Y. Newark fur which this permit Is issued(Scc.NN7,Co.Civ.C.)
1 0 Lender's Name ..
D z 1<nder's Address
1 certify that I have read this application and sate that the ONOW information is
emrccl.1 agree to comply with all city and county ordinances and state laws relating to
'U building construction,and hereby auhmim reprcxnmtins or this city to enter drum the
4 above-mentioned pmperty for inspection purposes.
(We)some to ave,indemnify and keep harmless IW City or Cupertino against
Co, liabilities.judgments,costs and expense which may in any way ammo against mid City
J z in
eof the goorting of UNDERSTANDS ANDWILLr
CANTWILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
HAZARDOUS
Signature of ApplicaDam
HAZARDOO US MATERIALS DISCLOSURE Type of Roof
Will the applicant u faun ipalCooecopanumrcor and the
Heart and
m defined o to Cupertino Municipal Code.Chapter 9.13,and Ne HcaIN and Safety
ewers Ot 2ss3z(a)? All roofs shall be inspected prior to any roofing material being installed.
' ❑Yes ON.
Will the applicant or future Willing occupant use cyuipmentorJcvices which If a roof is installed without first obtaining an inspection,I agree to remove
it herallous air mr aminauts As defined by the Bay Arca Air Quality Management all new materials for inspection.
dIll?
D Yes ON.
I have read the 1c aNtms amuno lsmquiremenu ower Chapter 6.95 of the Cali Ter
nip Health&Safety Core,Senium 25505.35537 and 25534.1 makinadnd door if the Wilding
does not currently hast a Wheat.Net it u my responsibility In stay tW acupant of the
requirements which must W met prior in issuance of a Ccnhcaa of Occupancy. Signature Of Applicant Date
Owner ur suth n,ed agent Date All roof coverings to be Class °Ba or better
1
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 18700 Newsom Ave. Date: 8-27-03
Owner's Name:---Belur, RangaraJ
Phone No.(408)446-4984
APN#: 375-30-005 Project Valuation: S 734.00
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-mall: 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/l/04
Credit Card Information
Credit Card #: 5474-6390-0026-5679
Name on Card: Just Water Heaters Inc. zv-3
Expiration Date: 9/05 44 if. 61
Visa MasterCard X
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