03090206 (2) CITY OF CUPERTINO r�wtvw•r + "p& �'� '
' BUILDING plvlSloN PERMIT CONTRACTnR INFORMATION
a BUILDING ADDRESS: JUST WATER HEATERS INC """'03 090206
ow"ER'SNAME: 1764 NATIONAL AVE PERMIT SUBOATE
JOHNNY
"E' (510) 293-9901 SANITARY NO, CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
loZ, LICENSED that
CONTRACTORS under
DECLARATION
�u❑ 1 hereby affirm thea I am licensed Du under Provialons or Chapter w(commencing Job Description
ZW with Section lglll)tf Division Sof NC Business and Profcssinns Code.andmylicense is
<< Lmdmr.aana effect. /
l�?
License Close Llc.x /Q
o Dam Corrector (4 0 GALLON GAS)
ee YY ARCHITECTS DECLARATION
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<C I understand my plans all he used as public records y
?i
'QLicensed Pmfcuionel 3
3 OWNER-BUILDER DECLARATION
<2 I hereby affirm Nat 1 am exempt finita the Contractofs License Law for the
p 0 following mason.(Sao ..VUl I.S.Business and professions Coda:Any city nr county
$ which rtquiras a permit an construct,elle,improve,demolish,or repair any atmcture
prior to its issuance,also require the applicant for such permit to fide a signed stammctt
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. FloorArea Val uatio$750
R $ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
Nat he is exempt tltcrafrom and Urt basis for Ne alleged exemption.Any violaunn of
Section 7031,5 by any applicant for a Permi t subjects the applicant to a civil penalty of 3Affi3 DIOIlbIg'LOO_ . .._ __ Occupancy Type
not more than Eve hundred dollars(5500). - "' -' --— — P Y yp --- -
O 1,as owner of the property,or my employee with wages u theirsolc compensation,
wilt do the work,and the swmum is not intended or offered far ad.(Sec.7014.Business ]�egy� �f I(( pg �Jf
and Psoressimts Code:The Contractor's Lineae Law docs not apply to an owner of Cj O2 — FINAL PL'UMB INCiGth'LV h'RGZ'
property who builds or Improves 0areon,and who doessuch work himulfor through his
Own cmploycu,provided that such improvements we not intended or offered rot ade.d' 506 — GAS TEST
however,the building or improvement is sold within ane year of completion,the owner
builder will have the burden of proving Net he did at build or improve for purpose of 507 - FINAL PLUMBING
ale.).
0 I,or or,of to property,em exclusively contracting with licensed contractors to - --
construct the pmjcct(Sec.7064,Business and Professions Code.)The Contracbri Li. _
cense Law doe not apply to an owner or property who Wilds or im proves thereon.and n
who contracts rot such projects with a commoners)I learned pursuant o the Contractors
License low,
❑ l am exempt under sae. ,B&P C for his moon
Owner Data
WORKER'S COMPENSATIONDECLARATIDN -
I hereby affirm under penalty of perjury one of dte following Ueclanioos: _ -
:haw and will maintain a Certificate of Consent to self-insum for Workers Compere
7371M
on,u provided far by Section 37M of the labor Code,for Ne performance of the
k for which Nis permit is issued. -
1 have and will maintain Workers Compenxalon Insurance,u required by Section
of the Labor Code.for the performance of the work forwhich this permit is issued.
Workers Compensation Insurance carrier and Policy number amier. Policy Na.: _
CERTIFICATE OF EXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(Thisonionneedantheemni,emdifthe permit isfora¢hundred Uull.f1li )
in Law.)
I certify that in the performance of the work for which this pmrnia is issued,1 shall nus
employ any Person in any manner an as m become subject o the Workcri Compensation
Laws of California,Data
Applicant
NOTICE TO APPLICANT:If,after making Our Cenificam of Exemption,you should
become Subject to the Worker's Compensation provisions of the Labor Cade,you mus
�Q forthwith comply with such provisions in this Permit shall W deemed revoked.
Z h CONSTRUCTION LENDING AGENCY
I hereby affirm Nat there its consmoction lending agency for the performance of
1e > the work for which that N.it is issued(Sec.3097,CO.C.)
JJ Q Iandcr's Nom3. Landers Addrer -
J 0 I certify Net I have read this application and state Nat the above information is
L✓ correct.1&gree to comply with all city ad county ordinances and state laws relating to
7(J building construction,and hereby aehorine representatives of this city to motor upon Ne
ahow-mentioned properly for inspection purposes.
pi� (We)agree to save,indemnify and keep harmless the City Of Cupcnino against
N liabilities,judgments,costs and expenses which may in any way accmc against aid City
JZ in consequence of the granting of this permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature ofA,PlicantiCantractor Data
HAZARDOUS MATERIALS DISCLOSURE
.orhanl Type of Roof
Will theapplicant or future building .Ch,pW,9.1orhandle Held ,smemnd
a d.,So by the Cupertino Municipal,COUc.Chapter 9.17,anti the Health end Safety
ode,Scotian 25532(a)7
❑Nu All roofs shall be inspected prior to any roofing material being installed.
' �Ym
WIII the applicant or future building amm"wt use eyuipmcm or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
t hovardous air contaminants a defined by the
Arca Air Quality Management all new materials for inspection.
s..m
0Ycs ON.
1 have reed the hooddaus materials mquiremcnu under Chepmr6.95 orthe Califon
tie Health&Safety Code.Satimu 25XIS.7SSlJ ad 25534.1 undersuna thuif Ih building
dura not currently haw a accent Nn it is my nobaeidify to testify the a:.,no of the
requirements which masa be met pour to issuance of a Certificate of Occupancy.
Signature of Applicant Date
Owner or wthorircd agent Date All roof coverings to be Class "B"Or better
r
3
City of Cupertino Building Permit Application
E-Mail
jobsite Address: 1284 Primrose Way Date: 9-24-03
Owner's Name:---Zhang,Johnny
Phone No.(408)887-9122
APN#: 366-18-014 Project Valuation: S 750.00
Building Permit Info: Bldg_----_-- Elect--_-____ Plumb------X____ Mech-----_----
- Job Description
Replace 40 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
Name on Card: just Water Heaters Inc. Z3
Expiration Date: 9/056 .6 /
Visa MasterCard
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