05020097 (2)CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
JUST WATER HEATERS INC
P""MITN05020097
OWNER'S NAME:
PERMIT ISSUE DATE
JO
ONE:
SANITARY NO. CONTROL NO.
(510)293-9901
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECTO PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 homeyprovisionso
mby affirm t 1 am licensed under provisions of Chapter 9 mmonumcing
with Section 7000).rDI0sMn 3.1' the Business and Profrssium Codi and my license is
rerun some And effect.
Lkena Clan fY. N
REPLACE WATER HEATER
(7 5 GAL GAS)
Dam Contract
ARCHITECTS DECLARATION
I underuand my puma shad be usual as public recmN
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby alarm that I am exempt from the Communes Licenso Law for the
following mason. (Section 7031.5, Business and Professions Code: Any city or county
which mqulra a permit in enm rent. eller. Improve, demolish, m repair any suunure
prior m Its Issuance, also require the applicant for such permit to rile a signed stalemem
that he Is Heated pennant to the provisions of the Conwacmri License Law (charter 9
Sq. Ft. Floor Area
Valua"g 00
(cammmeing with Section 7000) of Division 3 of the Business and Profession, Can) or
that he o exempt therefrom and the basis for the alleged exemption. Any vlosul,on of
APN Number
Occupancye
'EYP
Section 7031.5 by any applkmt for a pent, subjects the applicant to a civil penalty of
N
not marean live hundred dollars ($503).
32632020.00
01. As owner ofthe pmpeny, or my employees with wages At their sole eompemation,
Required Inspections
uW Proffession Cod7T`eConaicabYi Liatue`roffead , Butness,
`apply
de: Law does not m� awns of
property who built orimproves Neon, and who doessuch work himsnrorthiaugh his
that amentch ed for Mone(.
owneen.
)
f
is sold wivaans can
theWildin Or I fempletiod
however,illhow mass urmprowmantuanld didnot year of mprove fr Neowrcr-
build. will love the buNan of proWng that he aid m, bald or regrow rm purpose of
t r I(
\
❑ 1, as owner of the with cenuanwn m
construct the proie, (Sec. 7064, Business and Promsdms Code:) The Contranue. Li-
property, a ser propvely
of ray who ri impad
ams law dos not appy N an own. of progeny who builds or impovu Norton, and,
ply i
a e Convado
who contracts for such pmJecu with aconlnemrtO Ikemed panacem Nh
mlaw.
0 1 em exempt arid. S.C. ,Bh PCfar this mown
Owner Dow
WORKER'S COMPENSATION DECLARATION
I hereby dinrm under penalty of perjury am of the following dulandans:
1 Mw and will maintain •Certificates of Co nam to self -ileum for Worker's Compcn.
cation, u provided for by Section 3100 of the Lebon Code. for Ne performance of Ne
work for which this permit is issued.
❑ 1 haw and will maintain Workers Comperladoo Imurana. u required by Section
37CO of the Lab, Cade, for the performance of tine work forwhich this permit Is tomel
My Workers Compensation curie and Polity number am:
Carrier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This amine need stat mcompleted If the permit Isforone hunEmAdollars ($100)
or leu)
1 certify that In the performance of Ne work for which this permit H Issued, l mail not
employ any person In any manrorso m b become subkct to the WorkersCompensadon
Law. .(California, Dam
Applicant
NOTICE TO APPLICANT: atom making this of, abor o you should
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worker's Compensation u prevision, of lobar Cede you muss
provisions of d
become momp
/f V
y it
(oMwith cemplY with such provisions or Nis permit shall he decreed reveled.
s ac
CONSTRUCTION LENDING AGENCY
1 hereby affirm that Nem is a construction lending agency for the performance, of
Na work f, which tho permit is is ad (Sec 3097, Civ. Q
Iendch Name
lenders Address
I catty that i haw read this applicuion and slow that Ne .have information is
_
cotnx7. I agree to comply with all city and County atinanm and sum lave tatting to
building construction. and hereby authada repmmmalives of this city to now upon the
show -mentioned properly for Impemion purposes.
(We) agate to now, indemnify and keep hasmmsa (be City of Cupertino agaim,
IlabilldesJudgmenW costs and expenses which may in any way tame against mid City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Type of Roof
signature of ApplieanVCanDam
HAZARDOUS MATERIALS DISCLOSURE
WIII the applicant or future Wilding aaupant nom, MMk havandous ety
As donned by dm Cuatw Municipal Code, Chapter 9.11, and the HealthHealthandd Safety
ode, Secun^ 35631(.)7
All roofs shall be inspected
to any roofing material being install0ed.
es ON.
prior
If a roof is installed without first obtaining an inspection, I agree to remove
iNc applicant or future building a cupam use equipment or devices which
Emir Inntnus air mm stimm s m defi,J by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yet 0 N
I haw mW the hustouv mewrlalamyuimments under Chopterri.95 of the Cafifor.
^ice Healtha SafetyCode, Seniom 35N15,35533 and 33534.1 undentshe Nuif dm building
daes not currently haw a meant, that i, is my responsibility in notify Me Occupant M the
requirements which must be met prior to iavaae aft Concave of OccuPmoY.
Signature Of Applicant Date
All roof coverings to be Class "B" or better
Owner mAuthorized agent Dow
�Q
CITY OF
•: UPEkTINO
.,
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
10163 Park Circle West
PERMIT #
4t 6,S -V Z o o ? 7
OWNER'S NAME: Wai, John
PHONE # 650-307-8121
GENERAL CONTRACTOR: Just Water Heaters
FAX # 510-783-6360
I am not using any subcontractors:
2/11/05
Signature Date
Please check applicable subcontractors and complete the following information:
L -"�'40" /' 2/11/05
Owner/ Contractor Signature
Date
10/28/03
21
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
L -"�'40" /' 2/11/05
Owner/ Contractor Signature
Date
10/28/03
•
0
C
E -Mail
0S--vZo0%7
of Cupertino Building Permit Application
Jobslte Address: 10163 Park Circle West
Owner's Name: --- Wai, John
Phone No.(408)307-8121
APN#: 326-32-020
Building Permit Info: Bldg -----
Date: 2-11-05
Project Valuation: $ 1,800.00
Job Description
Replace 75 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: permlts®justwaterheaters.net
City, State and Zip: Hayward, CA. 94545
State Contractor's Llcense # 591329 Exp. Date: 3/31/06
Worker's Comp#: 1626288-04 Carrier: State Compensation Insurance Fund Exp. Date: 4/1/05
Credit Card Information
Credit Card #: 5474-6390-0026-5679
Name on Card: Just Water Heaters Inc, 12
Expiration Date: 9/05 ¢ O
Visa ❑ MasterCard ® �[
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