05080032 (2) (w-
OF CUPERTINO + '�d�iKz +�3✓/'r.�� (we° «�f'''T'Pa'P ;ins '3 s
ILDING DIVISION PERMITsC,ONTRACTpR I1VF0}yRMATIOI�T >
G ADDRESS: JUST WATER HEATERS INC PERMIT NO.05080032
5 RAINBOW DR
NAME: PERMIT I SUE DATE
WILLIAM ALBRETS 3400 INVESTMENT B 08/04/2005
SANITARY NO. CONTROL NO.
(510) 293-9901
ECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 E 0
SoLICENSED CONTRACTOR'S DECLARATION IobDescription
�uale affirm slut I w Iluiued under provision of Chapter 9(mmmcain{
on 7000)of Division 3 of Business and Profusions Code.and my license is
n'1remdeRat REPLACE WATER HEATER
� laea Lk• 40 GAL GAS
Contraction
`n
ARCHr1ECrS DECLARATION
t I uMcuunJ my plain Nall W used u Public ranrN
a G Licensed Pmfcasional
OWNER-BUILDER DECLARATIONConum
�I I thereby affirm UteeContrmrm Net 1 am exempt frontmr's License Law for the
p O following mns reason.(Section 7031.5.Basiand Professions Code:Any city or county '
5$ which mquims a permit in construct,eller.Improve,demolish,or repair my structure '
prior te its issuance,Wit,mguires the applicant for such permit m file s signed statement
£
that he is licensed ruminator W the provisions of the Contractor's Ueensc Law(Chapter 9 Sq.Ft.Floor Area U..4 ;Innq Valuat [1269
i?€0 (commencing with Section 7000)of Division 3 of the Susitwsand Professions Code)or
dot ha is exempt themfrom and Use basis for ge aileged exemption.Any violation of
Secdon 7031.5 by any applicant for a permit mbjecu the applicant in a civil penalty of APN Number , , Occupancy Type
not mom than five humped doWs.(fl O. 3 6 2 11 Q 4 5 , 0 0
I,uowmr of tie moi'` _v`a
❑ pestrac,ur myempwyem wW wagu asgehinkmmpematim,
will dothawork.aod the hs,Cm midar,s not taMW mugertd forst apply to Is Busxwerof Re wired ns ections
ness
and ery who
Code:The Coanamen.Uttme law arcs not apply 1f an rouser of q „P
is
Own amwho Wildsored thalesthereon,andwho dreasueh work h offetertluouse If.
ownemployes,provided improvement
id wit tient IntendedmogcmA forme Owner.
however.Nebuilding uimpmwmentis mid within one wrz of completion.me Owner.
Wilder will have the burden of proving Net he did not build or Improve fm purpose of
tile.).
❑I,as owner of the Sec.property.setexclusivelysineand connecting with:)Mued conuacmn i. rli
construct gas project(Sec.7014, ser of and Profuaiam Cadre The Guaiacins nd 6� p
wholaw dao not apply b us owns of pmpeny who sedWilftp m Improve gasman,and, M/`}[]✓r�l/Ary �O
Lic.. w.for such pmjecm with amntrmmr(q lluttsedputuummthe Convacmra ® O5
❑I em uempt undo See. .B!P C for thio renin -
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby alarm under penalty or perjury nm of gas fallowing declarations: f;,.1
I haw and will maintain a Certificate of Consent m self-izaum for Worker'sCommas-
1307100
ion,u provided for by Section 3700 of gas IsWr Code,for the performance of me
rk for which this Permit is issued.
1 have and will maintain Workeri Compensation Imurmm,u required by Section
of Ne labor Code,far the performance of Ne work fm which this permit is issued.
Worker's Compemagon Imunnca cartim aM Poliry number am:
Mm: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(TW;section need antbucompleted If tie permit la foramhmdreddo0us({100)
or leas.)
I easily that in the performance of gas work for which this permit is issued.I shall not
employ any person in my naar m IS m became subject to gm Wermot Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.If,after making this Ceniflum of Exemption,you Mould
become subject in the Workers Compensation provisions of Out Utter Code.you must
.JO forthwith comply with Inch provisions or this Permit Mello deemed mvoked,
Z CONSTRUCTION LENDING AGENCY
[r> Iha,whichrmt Permit
isacd(See.innrl,Ch, agency for the performance of
C Ne work fur which Nis permit la issued sura.3097,Clv.C.)
lenders Name
z Lenders Addrus
U0 I really that I haw rcad this application and sum this the show information b
V.P COTOWL I agree m comply with all city W county mainanas and sum bora mating m
02 building corporation,ad hereby mmorim representatives of this city m mtm upon ft
W above-miummul property for inspection purposes.
(We)agtec to taw.indemnify and keep harralcas the City of Cupertino against
liabilities,judgments,emu and expenses which may in my way memo against raid City
t.)7 In consequence of the Starting of this permit.
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:S Date
SOURCE REGULATIONS.
_ Re-roofs
Signuurt o(ApP1I HA _ Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof ,
Will the applicant or future Wilding Occupant smrc or handle hazardous material
lDbuict?dcOned by the Cupenwo Municipal Code,Chapter 9.13.and the Health and Safety
ade.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
Oyu ❑No
Will the applicant or future building Occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit haurdnas air coomminanm u defined by the gay Ama Air Quality Mangement all new materials for inspection.
❑Yes ❑NO
I hew mW the hmordas materials requirements under Chapter 6.95 of Ne Celifao-x Health S Safety Calc,Satiate 25505,25533 and 25534.I mJcrswb thmif the Wilding
rs not cunemly hew a mmnt,that it is my maponsihlllty m mufy tie uecupmt of the
gmmmcnm which must be met prior to issuance car a ccrdrmam of occupancy. Signature of Applicant Date
wmr or authorized agent Date All roof coverings to be Class t'B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
CITY OF Telephone(408)777-3228
Fax(408)777-3333
ICUPEkTINO
Buildin Department
JOB ADDRESS: PERMIT#
8005 Rainbow Dr. 0 fwd etr'03 2--
OWNER'S
—OWNER'S NAME: Albrets, William PHONE# 408-253-5018
GENERAL CONTRACTOR: Just Water Heaters FAX# 510-783-6360
I am not using any subcontractors: v-`d'�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
Tile
7/04/05
Owner/Contractor Signature Date
10/28/03
• 2-
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 8005 Rainbow Dr. Date-904-05
Owner's Name:---Albrets,William
Phone No.(408)253-5018
APN#: 362-11-045 Project Valuation: $ 1269.00
Building Permit Info: Bldg Elect Plumb____X_ 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-mall: permitdept®sbcglobal.net
City,State and Zip: Hayward,CA. 94545
State Contractor's License# 591329 Exp.Date: 3131/06
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.
Expiration Date: 06/08
Visa MasterCard
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