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05080031 (2) CITY OF CUPERTINO �7.r II BUILDING DIVISION PERMIT xCONTRACTOR INFORMA N BUILDING ADDRESS: JUST WATER HEATERS INC PERMITNO.0 5 0 8 O O 31 10351 ORANGE AVE OWNER'S NAME: PERMIT ISSUE DATE PAM LEVENS 3400 INVESTMENT BL 08/04/2005 NE: SANITARY NO. CONTROL NO. (510) 293-9901 OWNER'S BUILDING PERMIT INFO BLDGELELT TRPLUMB MECH I� 0 0 l0, LICENSED CONTRACTOR'S DECLARATION JbDescription 'r! F I lemby affirm that 1 am licensed under provision o of Chapt:r 9(Commencing with Section 7M))of Division 3 of Ne Business and Pralessium Code.and my license is +'1 infull foreeandeffccL REPLACE WATER HEATER ;i License Clan 4 0 GAL GAS N Lk. �S �l tom W © 12 o Dam Lt.9Contractor ARCHITECTS DECLARATION f!r I understand my plans shall he used as public records 5yU s v.t; Licensed Profesai...I `mg OWNER-111.1UILDER DECLARATION P I�f ZO05 <I 1 hereby am.that 1 em sxempt from the Conuacto's License law for the C I O O following moon.(Secuun 71131.5.Business and Professions Code:Any city Or County 5 5$ which mqumCa a permit to construct,eller,improve,demolish,or repair any structure -a< a In its issuance,also res the cant for such t w file a signed s amment sssrvc,' s psir onto psi Perm. g that W u licensed puseam N Nc of Division of dm Canu Business nd Prof Law(Chapter 9 Sq. Ft.Floor Area FM t,� � 9 ��Valuario 8 2 5 E�n (commencing with Scnion7000)of Division)of NC Business and ProfessinnsCMc)dr A ' iU "i Icy% II Is -' that he u exempt therefrom and Ne basis for the alleged esemption.Any violation of `7 genion 7031.5 by any applicant for a Permit subjects Ne applicant in a civil penalty of APN Number Occupancy Type not more Nan fin hundred dollars MIKE). 35715062 . 00 P y YP p 1,ss o-nu of the pmpmy,m my employcn with wages u Noir mle compenudon. will do the work,and the suucmre is not intended oroRered forsale(Sec.7011,Business and Professions Code:The ConuacNra Liesme Law docs Out apply be an owner of Required Inspections property who Wildsorimprows thereon,and whodoessuchwork hireselforthrough his own employers,provided thassuch improvements ere not intended orolfered for sale.It. - howewr.Ne building or improwmenl is sold within oro year of completion,dm owner. builder will Mw the Widen of proving that W did not Wild or improv for purpose of sale.). ❑1.as Owner of the pmNny,am exclusively contracting with licensed contractors to construct the project(Sec.7041.Business and Professions Code:)The Conmemr's Li- cense law does not apply in an owner of property who builds or improves thereon,and who contracts for such pmjects with a contractor(s)liceved pursuant to the Contractor's License Law. 0 l am esempt under Sec. ,B A P C for this mason Owner Dem WORKERS COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: . I haw and will maintain a Certificate of Covent N self-insure for WorkeesCon pon- sation,as provided for by Section 3700 of the Labor Code.far Ne performance of the work for which this permit is issued. ❑I banand will rorimsin Worker.Compensation Insurance,as required by Section 3700 of the labor Code,for Ne pcdorm uici of the work forwhich this p.it is issued. My Wmkcls Compensation Inwrmce came and Policy number me Cartier. Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thuacction need nothe completed iflhe Permit is(mune hundred dollars(2100) or las.) P ccnify Nat in thc performance of the work for which this Permit is tuned,l shall not employ any person in any mannersn u to become subject in the Worker'Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:If,after making Nis Comficam of Eacmp hni.you should become subject to Ne Worker's Compensation provisions of the Labor Code,you mud .J z foMwith comply with such prmitiau or Nu remit Nall be deemed mwkcd. zOF CONSTRUCTION LENDING AGENCY iWreby aRro that them uacmtsueclending agency for lM performance of lY work fur which Nu permit u issued(Ser.30 3097,Civ.CJ Le fA L.n am Lenders Ne z LenAddressef s Address U Q 1 certify that 1 have mad this application and sum that the above information is F-' cornea I agree m comply with all city and county ordinaries and sum Iaws relating in 0U Wilding construction,and hereby mNorire represenutiws of this city to enter upon thc HLit ahove-mcnudned property for inspection purposes f1 (We)agme W sate,indemnify and keep harmless due City of Cupertino against Uz in equence f ts,the gem and expenses which may inanyway accrue against said City n consequence of the germing of this permit, APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:S4( Date SOURCE REGULATIONS. Signature of APPIinnVu Conacmr Dam Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof will the applicant or(drum Wilding occupant ttom w had,hauNons mamrirl u defined by the Cupenino Municipal Code,Chapmr 9.13,and the Health and Safety otic.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes ON. Will Nc a ficant or future Wilding Occupant Tse If a roof is installed without first obtainingan inspection,I agree to remove pp g p equipment or devices Management it hvardnu air contaminants u defined by IW Bay Area Air Quality Management all new materials for inspection. isuia? ❑Yes ON. I have read the hmardous materials requirements under Chapter 6.95 of Ne Califon nla Health k Safety Code.sectors 35505.]5533 and 255X.1 understand!NL ifthe Wilding does.11...dy ban a mnam,Nal it u my mspmuibility m noury I,occupant mf IW requiromcnu which must W mel prior w iuum¢co(a Ccnificam of occupancy. Signature Of Applicant Date Owner of authoriv4d agent Dam All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY 01 Fax(408)777-3333 9CUPEkTINO Building Department JOB ADDRESS: PERMIT# 10351 Orange Ave. ofd Cr °3 OWNER'S NAME: Levens, Pam PHONE# 408-446-0426 GENERAL CONTRACTOR:Just Water Heaters FAX# 510-783-6360 I am not using any subcontractors: 9_"&Q_ 7/04/05 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 (T�i'lle U'xdw_ t �a �v�� 7/04/05 Owner/Contractor Signature Date 10/28/03 City of Cupertino Building Permit Application E-Mail Jobsite Address: 10351 Orange Ave. Date:-04-05 Owner's Name:---Levens, Pam ' Phone No.(408)446-0426 APN#: 357-15-062 Project Valuation: 5 825.00 Building Permit Info: Bldg— Elect__ Plumb_-- 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: permitdept®sbcglobal.net City, State and Zip: Hayward,CA. 94545 State Contractor's License# 591329 Exp. Date: 3/31/06 Worker's Comp#: 1626288-05 Carrier:State Compensation Insurance Fund Exp. Date: 4/1/06 Credit Card Information Credit Card #: 5474-6390-0047-8660 Name on Card: ,Just Water Heaters Inc. I r 3 b Expiration Date: 06/08 0 ,�)-. Visa MasterCard ® Comments.