05040105 (2) ;. 7578
ITY OF CUPERTINO
BUILDING DIVISION PERMIT 7'1
BUILDING NFORMATIQ
ILDING ADDRESS: JUST WATER HEATERS INC PERMIT NUO 5040105
NORNER'S NAME: PERMIT ISSUE DATE
LING SU 3400 INVESMENT BLVD 04/19/2005
ONE: SANITARY NO. CONTROL NO.
(510) 293-9901
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�Uto
LICENSED that
CONTRACTORS DECLARATION
YwCr 1 ionhereby70 affirm Ilial I w licensed under and
Protna of Chapter a(commencing Job DeSCflp[IOn
<ZW with Section an effect. Sof dm Busirw•.aM Professions Code.and mylicertse is
Torn°fo 'naeB n REPLACE WATER HEATER
S EJ= License ClassLie.N
Ego Dam Contractor (4 0 GAL GAS)
44 ARCHITECTS DECLARATION
I
?W u understamail my plans all he used as public mcerds
Licensed Professional
3 OWNER-BUILDER DECLARATION
<E I homey affirm that I am exempt from the Conummoes License Law for the
i o O following mason.(Section 7031.5.Business and Profession Code:Any city or county
$K which requires a Permit to construes alter,impmw,demolish,or mpair my structure
HZaprior i its issuance,also aquims the applicant for such permit to rile a signed statement
that he is licensed pursuant o the prevision of the Contractor's Umbe Law(Chapter 9 Sq.Ft. Floor Area Valuatic$)755
€$ (commencing with Section 700(pof Division 3 of the Business and Professiom Onde)or
Nat he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031,5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy
not mom than Jim hundred dollars(S500). 36617062 . 00 pane y Type
1,is owner of the property.or my employees with wages M their able compensation,
will do the monk,and Ne swctume Is not intended oreffered for We(Sec.70th,Business
and Professions Code:The Comumrs Lt..Law don ant apply m.n no,of Required Inspections
property who bis ills er improves thereon,and who does suc h work himself or dumugh his
owncer.too es,provided prsuchimprovementsanenot ewofoor"eerW the forsake.
builder .Neave ffigorimprovementissoldwithinmm Wild ofmprove for theose of
Owner-
builder will have Ik burden of proving that he did trot build or improv far purpose of
salt.).
❑Les owner of the property am exclusivelyand
contracting with licensed
onnews ors i- j
Construct the,pmnot apply
t o n Business and Profusions Code:)The Conddrora nd
cense law cola not apply a an owner of property who builds or improves Commuc red,
whocontractsLaw.for such protects with a convacmr(s)licensed purwant in the Cenuacsors
License Law.
❑Lem exempt undo Sec. ,BkPC for this moon
Owner Dille
WORKER'S COMPENSATION DECLARATION
i hereby affirm under he
of perjury one of Ne following dalarstions:
1 ham and will maintain a Cerlifiam of Conecnt to self-intim fww"rkcrsCompen-
xion,as provided for by Section 37W of the labor Code.for the performa=of Ne
work for which thi.permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
37W of the fatter Cade,for Ne Pwform.ncc tithe work for which this permit is Issued.
My Workers Compensation Inwuance,Cartier and Policy number we:
Cannier: Polity No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This seca
tion need not be cnpleted if the permit is forone hundred dollars(SIM)
or less.)
1 Cxmfy that in Oc performance of Ne work for which this permit u issued.I shill not
employ any person in my romper an as In become subject to tM Wotkeri Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making Nis Cmdricate of Exemption,you should
become subject ro the Worker's Compensation provisions of the Labor Code,you most
.,O forOwith comply with such provision at this permit shall bo decreed revoked,
'zy CONSTRUCTION LENDING AGENCY
(, I hereby affirm that dire is a co ono lending agency for the perfurmma of
5 murk for which this Permit is issued(See.3097,Civ,C
Le Permit
Lenders Name
z Landers Address
U Q 1 ttnify Nat I haw mad Nis applirnion and sum that the about infomuuun is
ty F COMM I agree in comply with all city and County Ordinances and male laws misting to
C)U building construction,and hereby authoum rcpresenutivn of this city to enter upon the
above-menuomed at,cny for inspection puryosea
F 6 (We)agree to saw,indemnify and keep hafmless Ne City of Cupenino against
rue in consequence
Cntr and oapeneawhich mar in any way accrue against said oily
U,x A ePLIC NT of the UNDERSTANDS
of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Sngewtnc of AppI CmVComracmr Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will six applicant of future building occupant store or handle haiwO us material
as
"Iduly the CuNnino Municipal Code.Chapter 9.11,and the Health and Safety
odc.5ecuhe 155}3(a)7
❑Yes ❑Nu All roofs Shall be inspected prior to any roofing material being installed.
Will thc applicant or future Wilding Occupant use If a roof is installed without first obtaining an inspection,I agree to remove
Pp d P Area
Air Qu of Manna which Qi
it hasartlnus air mntaminans n dcfncd by cmc Bay Arca Air Quality Management all new materials for inspection.
7docs
strict?
❑Yes ONO
I have mad the hvaNmumamrials requirements underChapmrd.95 of the Califor-
Hcildt h Safcty Code,Scene.15505.35533 md25534.1 unMnand that ifdm Wilding
not currently hams a inane that it u my responsibility to beauty dm"ccuPanl of the
oiements which must k met prior m issuaoe of a Certificate of Occupancy, Signature of Applicant Date
ner or authorind agent n„e All roof coverings to be Class"B”or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
IrCITY OF Fax(408) 777-3333
UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
7578 Normand Way 6T-U lZeq O-5
OWNER'S NAME: Su, Ling PHONE If 408-507-4962
GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360
I am not using any subcontractors: �� '��� 4/18/05
Signature Date
Please check applicable subcontractors and complete the followin 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
/18/05
Owner/Contractor Signature Date
10/28/03
PS i
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 7578 Normandy Way. Date: 4-18-05
Owner's Name:---Su, Ling
Phone No.(408)507-4962
APN#: 366-17-062 Project Valuation: 5 755.00
Building Permit Info: Bldg----------- Elect___________ Plumb_____X----- Mech___________
Job Description
Replace 40 gal gas water heater.
Contractor Information
Company: Just Water Heaters Inc. Phone: (510)293-2012
Contact Name: Dulce Fax: (510)783-6360
Address: 3400 Investment Blvd. E-mail: permits@justwaterheaters.net
City, State and Zip: Hayward, CA. 94545
State Contractor's License# 591 329 Exp. Date: 3/31/06
Worker's Comp#: 1626288-05 Carrier: State Compensation Insurance Fund Exp. Date: 4/l/06
Credit Card Information
Credit Card #: 5474-6390-0026-5679 /
Name on Card: just Water Heaters Inc.
Expiration Date: 9/05
Visa MasterCard
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