05060038 (2) CITY OF CUPERTINO ��v� y�"��
BUILDING DIVISION PERMIT hV01\el„� : �VRVi�i�aAIV r7Y
BUILDING ADDRESS: JUST WATER HEATERS INC PERM'ND05060038
OWNER'S NAME: PERMIT ISSUE DATE
ONE: SANITARY OL NO.
ARCHITECTIENGINEER: BUILDINO PERMIT INFO
BLDGELF.L7 PLUMB MECH
ep l� 0 0
700 LICENSED CON RACfOR'SDECLARATION Job Descri room
1 InanityInanityMiltonMiltoMiltonthat 1 am licemop
ed under provisions of Chapter 9(commencing �
with Sun.7IXp)af Division Sof the B.M.and Profcrsinm Cade,and my licence is tit /f.;
in full forth and eHem
'�: umnmclus L .. REPLACE WATER HEATER f
Dam Contractor
ARCHITECTS DECLARATION (5 0. GAL GAS)
1 understand my plana shall bo used as public wourcis
it I
G� Licensed Professional
g 3 E OWNER-BUILDER DECLARATION
I hereby alum u
that I am exempt from mc Conlrmts License Lew for the
E E02 following moon.(Sudan 7031.5,Business and Profession,Code:Any city or county
$ which requites a permit be or.=[.alter.improve,demnlbh.or repair my monurt
prior m its iwuanu,alm requires flaamplicmt far such permiuo III eulgnedmatemam
F o that he Is licensed personal
o the provisions ofthc Conualer's Llronse Law(Chapter 9 SCI.FL Floor Arca UVBIII`C]/QL7639
qFp$ (commencing with Scotian 7000)afnivbion J afdw Buinessmd ProfusionsCore)or 9
Ir d that he in exempt Bannermanand the but&for the alleged exemption.Any violaJon of
Section 7031.3 by any applicant for a permit subjects the applicant re a civil penalty of APN Number Occupancy Type
not mom than In WrAmd dollars(MI
❑Lasower ofthe property,army employees with wages udmirmtecompensation, 36947038 . 00
will do Newark,and mnInctum is notimended conRemd mrsale(Sm.7044,Business Required Inspections
And Pmfumm a Code:no Contractors Limue law data tet apply m an owner of q p
property who builds w Improves thereon,and who dms such work himself or through his
own employme,provided that such impnevemms art not Intended m offered for me.If,
however,the building or Improvement is to within ore year of completion.the awner-
builder will haw we burden of proving that he did not Wild or improv for purpose of
sale.).
❑1,as owner of the property,am emlusively cantnwing with licensed mnaactnrs to
contract the project(Sec.7044,Business and Prof emaan Code:)The Conbmwri L6
cease law does not apply to an owner of property who Wilds or improves woman.and.
who contracts for such pmjec s with acontracmr(a)Ilceneed pursuant m the Contractors
License Law.
❑I am exempt Doom Sec ,B k P C for thio rtuon
1
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby,Man under penalty of perjury ass arisen following dmlantiou:
I haw and will mainiam a CortiRtaw of Consent to self-Insure for WorkeelCompen-
don,As provided far by Section 3700 of the Latwr Code,for the performance of the
work for which this permit is issued.
❑1 ban and will maintain Workers Compenatian Luuranm,as inquired by Semon
3700 of the Labor Code,for the Performance offt work for which this permit is owned.
My Workers Compensation Iuuntrum carrier and Policy number am:
Cartier. Policy No.;
CERTIFICATE OF EKEMP'ON FROM WORKERS'
COMPENSATION INSURANCE
(fhb mains need not becomplem l KtW permit isforaxhundred dollars($IN)
leu.)
1 certify Nat in Ne Performance of Ne work for which this permit is issued,I Chill ata
employ any person in my Amour an As w became subject be the Worked Compensation
Laws of Celimmla.Dau
Applicant
NOTICE TO APPLICANT:IL after making this Cenifrc ea of Exemption,you should
Wcome subject to the Workers Compensation provisions of me labor Code,you mum
.J Q forthwith comply with men provisions or this Permit shall W dmaW revoked. „
CONSTRUCTION LENDING AGENCY
(~ 1Im.by affirm that them iso mosommutn lending agency for tW raftermmmuf
W'? the work for which this permit is issued(Sec.3097,Civ.C.) / ^
W Q Lmdu'e More.
07. z Landers Address
U Q I certify that 1 ban mad this application and mate that the above informatim Is
ly F carted.1 all in comply with all city and county on inantta and saw lawn mating to
QU Wilding construction.and hereby authorim mprexnutiwa of Nb city to cnler upon the
W .hove-mentioned Property for Inspection purposes.
LL (We)agree to an.indemnify and keep harmless the City of Cupertino against
H IlabilitW,judgments,cuts and expenses which may in my my accrue agHnm aid City
U 7 In consequence of the granting of this Permit.
s� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplioH RDate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will theapplicant or future Wilding
e,Chaptmomarand summons
As dented by the Cupertino Municipal Code,Chapter 9.11.and iW Health mtl Safety
cotle,
Became 13531()7 All roofs shall be inspected prior to any roofing material being installed.
❑Y., ❑No
Will the applicant or future Wilding occupant use equipment m dcvima which If a roof is installed without first obtaining an inspection,I agree to remove
it ha'urmus air contaminants u dcfmcd by Na Bay Area Air Quality Management all new materials for inspection.
Isola?
❑Yes ❑Nu
1 hew mN the huudamsmucrialsmquircmenu under ChepW 6.95 of the Califao-
cab No- aSofcryCooc,Srcvau 25703.255]7 and 1333/.1 understood thuif the Willing
dna not cun"aly haw a mnanl dot it u my responsibility m ratify tW amupw of Ne
mquimmcnbwhich must be met prior in issuance oil CeNnesm or Occupancy, Signature of Applicant Date
Owner r euthodmd agent Dom All roof coverings to be Class nBn or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
CITY Of Telephone(408)777-3228
IUPEkTINO Fax(408)777-3333
Buildin Department
JOB ADDRESS: PERMIT #
20281 Pinnta e Pkwy
OWNER'S NAME: Romola Gokhale PHONE # 408-777-8638
GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360
I am not using any subcontractors: �4GY—+QkLV-A1--) 6/6/05
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 Tarek
Sheet Metal
Sheet Rock
Tile
Uk` 6/6/05
Owner/Contractor Signature Date
10/28/03
City of Cupertino Building Permit Application
E-Mail
Jobslte Address: 20281 Pinntage Pkwy. Date: 6-6-05
Owner's Name:---Romola Gokhale
Phone No.(408)777-8638
APN#: 369-47-038 Project Valuation: $ 639.00
Building Permit Info: Bldg---------- Elect__________ Plumb____X_____ Mech___________
Job Description
Replace 50 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. 94545t�yy-
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 #: 5474-6390-0026-5679
Name on Card: Just Water Heaters Inc.
Expiration Date: 9/05
Visa ❑ MasterCard X
Comments