03080070 (2) CITY OF CUPERTINO - 'x" '^ -' ' �`^ ' `�•`��"° -+
aU1LDIN ,DIVISION PERMIT CONTRACT�ORzINFORMATIO. N,
Bono Nc noDREss: JUST WATER HEATERS INC PERMIT N003080070
8131 PRESIDE DR
OWNER'S NAME: PERMIT LSSUE OATS
1764 NATIONAL AVE
SMITH STRETHER AND TOMASINA M 2003
"E (510) 293-9901 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 0 0
±op LICENSED CONTRACTOR'S DECLARATION
up 1 hereby affrm that I am licensed under provisions of Chapter 9(commencing lob DCSCr1pt100
tZW whh Sccreand 7000)or Division 3of NC Doti nwend Profcssinns Coca,nod mylicense is e'����®
S� in full tome arta cffca REPLACE WATER HEATER F
i q: License Class Lie.a
e Date Contractor (5 0 GALLON GAS)
estd�' ARCHITECTS DECLARATION AUGgg O aao�
Lze I understand my plans hill w used As public records AUG 2 U L
yyU
G Licensed Pmfcainnel
vn OWNER-BUILDER DECLARATION trap MILDI
a I I hereby of firm than I ons exempt from the Contractor's License Law lot the CPU ■is�Yl
ZOO following reason.(Section](131.5,Business and Pmfee.ions Code:Any city or county
m which requires A Permit m cnmwet.site improve,demolish,or repair any strumure
prior In its lsSuaatt,also mqulres the applicant for Such pemlil to file a signed statement
z< that he is licensed pursuant totheprovisionsoftheContractor'aLicenselaw(Chapter9 Sq. Ft. Floor Area Valua[ 129
rj l-O (commencing with Section 7")or Division 3of the Businmaand Profession.Code)or
$ Nat he is exempt therefrom sod the basis far the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Fpciolty of er00 - Occupancy Type
not more than rive hundred dollars(S500).
L As Owner of the property,or my employees with wages an their sole compensation,
will do the work,and the structure is not intended or offered for.ale(Sec.TMq Business R�g11'y.eg� T�gQ� �pp�
and Professions Code:The Comment's License law dors not apply to an owner of 502 - FINAL $Ts' m 1Nti GL�MRGY
property who builds or improves thereon,and who doessuch work himself or through his
Own employees,provided that such improvements are not intended or offered for sale.If, 506 — GAS TEST
howewm the building or improvement is to within one yea of completion,the net.
builder will have the burden of proving that he did not Wild or am prow for purpose of 507 - FINAL PLUMBING
salt.).
El
I,as owner of to property,am exclusively contracting with licensed contractors to
construct the project(Sec.7W,Business and Professions Code:)The Contractor's Li.
come Law does not apply to an owner of property who builds or improves daemon,and
who contracts rot such projects with a conventions)licensed pursuant to the Comranor's
License Law.
71 I am exempt under Sec. ,B&P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby off rm under penalty of perjury oro of the following declarations:
1 have and will maintain a Certificate of Consent to self-insure for Workes As provided for by Section 37W of lie Labor Code,for Ne performance of the
rk for which this Permit is issued.
1 have and will maintain Worker's Compensation Insurance,a mquimd by Section
of Be Labe,Code,for the performance of the work for which this permit is issued.
Worker's Com taxation Insomnia carrier and Policy numer am:
rrier. Policy No.: I _
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not bccompletd If the Nmalk is foronc hundred dollarsolfMp
nr Icss)
1 certify that in the performance or the work far which this permit is issued,I shall not
employ any PcWm in any manner se as to become subject to the Workeri Compensation .
Laws of California,Dat
Applicant
NOTICE TO APPLICANT:If..fiat making this Cari ficet of Escarole.,you should
become subject to the Worker's Compensation previsions of the Labor Code,you must
.JO forthwith comply with such provisions or this permit shall w deemed mwkcd.
Z y CONSTRUCTION LENDING AGENCY
(-r Ihereby affirm that there is a cmnsW¢inn lending agency rot the performance of
�i > the work for which this permit is issued(Sec.3(19'1.Civ.C.)
!gl Lender's Name
jz Lender's Add.,
U 0 1 ccnify that 1 have read this application and sue that me above infi rrooiun is
jy P correct.1 Agree to comply with all city and county ordinsecm and set laws miming to
DU building construction.and hereby authoris representatives of this city to enter upon the
.hove-mentioned property for inspection purposes.
(~ 6. (We)egos to ave,indemnify and keep hamless the City of Calamine against
r..d N liabilities,judgments,costs and exm ws which may in Any way accrue Against said City
U Z in consumeewe of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicaVCanDat
HAZARDOUS
S MATERIALS DISCLOSURE Type of Roof t
Will the applicant or forum hulling occupant score or handle haratdous material
az defined by the Cupertino Municipal Code.Chapter 9.12.and the ficalth and Safety
otic.Section 25532(a)? All roofs shall be inspected prior to an roofing material beim Installed.
pYea ❑Na P P � Y g g �
Will the applicant or mlure wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
tit hazardous air contaminants a defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes ON.
I have mad the hazardous materials requirements under Chapter 6.95 of the Cald(m.
nia Hcalth&Safety COM,Scedom 25505,25553 and 25534.1 understand that if the wilding
does not currently haw a Toon that it is my,eaponiffelity t nod ly the Occupant of the
equirements which must tomet poor to issuance ofaCcrdlncateofOccupancy, Signature of Applicant Date
Owner or authorized.Fent Date All roof coverings to be Class "B" or better
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 8131 Presidio Dr. Date: 7-28-03
Owner's Name:---Smith,Tomasina
Phone No.(408)257-3803
APN#: 356-11-083 Project Valuation: S 1,129.00
Building Permit Info: Bldg----------- Elect---------- Plumb____X----- Mech_---—___
Job Description
Replace 50 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-mail: permits@justwaterheaters.net-
City, State and Zip: Hayward,CA. 94545
State Contractor's License# 591 329 Exp. Date: 3/31/04
Worker's Comp#: 1626288-03 Carrier: State Compensation Insurance Fund Exp. Date: 4/1/04
Credit Card Information
Credit Card #: 5474-6390-0026-5679 c�
Name on Card: just Water Heaters Inc.
Expiration Date: 9/05
Visa MasterCard
Comments