05090080 (2) CITY OF CUPERTINO %
BUILDING DIVISION PERMIT CQNTRACORINFQRMATTONt
9u1LONG ADDRESS: JUST WATER HEATERS INC PERMIT"°'05090080
OWNER'S NAME: PERMIT ISSUE DATE
STEVE LIM 34 05
NE: SANITARY NO. CONTROL NO.
(510) 293-9901
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
OELECT PLOMECH
�oG LICENSED CONnlACDWS DECLARATION Job Description
1 hereby of oro than 1 an licensed under provisions of Chapter 9(sommcoulml M—P
with Section]gkl)nf DlHsion3of Ne BualwaaeM Pro(cesium Code.and mylicense is rl_„Rj��- /i`ea 11 Il.-.®
InWifomeandeffect. REPLACE WATER HEATER RULED
14�CjTa(IJ"aa
j jE License ClwLe.0
Date coronion 50 GAL GAS
ARCHrrECrS DECLARATION
�i 1 undersand my plans sludl be used u public records
ased Licensed Professional
5<i y OWNER-exempt R DECLARATION rt p�q W+E� tt`'t,{7� t)s�
1 herch affirm Net I am exempt from the Canusemh License Law for the It\NBi�lyp. I�yj+�- ���`(/y�,p'IJjj{l�`}�I)eJI$(Art',—'�v/—j
p� fallowing mason.(Section 7031.5.Business and Profeuian Code:My city or county
which requires a permit In construct,dor.improve,demolish,or repair any atrwmre
t•�'t^ prior to is issuance.also requires she applicant for such permit to flea signed statement
z<
that he is Icencd punwm an the previsions of Ne Contrsear's Limow Law(Chapter 9 Sq. Ft.Floor Area Valuatio 900
fat$ (commencing with Section 7000)of Division 3 ofthe Business and Predilections Code)or
l6i 3 Nu he u exempt therefrom and the bub for the dleged eumpRon.My Anhui of
Section 70313 by any applicant for a permiuubjec.,the applicant an a civil penalty of APN Number Occupancy Type
not more Nen five hundred dollars($500). 36651031 . 00
0 I,as owner of Ne progeny,ormy employees with wages u their sole compemation,
will do the work.and Nestmctum boo,intended croRered rorsdc(Sm.7044,Business Required Inspections
and Profession Cade:The Committers License Isco does not apply an e an owner of q P
property who bui Ida or Improves Hereon.and who don such work himself or through his
awn cmploym,provided Hauwh impmmmebaam nminonded waQemd fwule.If.
however,Ne building or Improvement is cold within one)ear of mmptetion,thermal.
builder will have He burden of proving that he did not build or Improve for purpose of
ale.).
❑1,as owner of she property am exclusively contracting with licensed mnuutaa o
conceit Ne project(Sec.7014.Business and Prefutians Code:)The Cmtsacmh Li-
come,Law dm not apply an an owner of property who builds or improves thereon.and
who contracts for swh projects with a eonuacanr(d flamed purswm in use,contractor's
Lkense law.
0 1 am exempt under Sec. .B At P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby mfimm under penalty of perjury cote of the following declarations:
I is.and will mdnain a Cemfmute o(consent an self-Ware for Worlwas Cooper. _
1CMI",
on,u provided for by Section 7]00 of the Inbar Cade,(m He performance of the
rk for which this permit is Issued.
I have and will maintain Worker's Compensation Insusance,u required by Section
0 of the lsba Code,for Na performance of Ne work for which Nb permit is Issued.
Worker's CompensWon Insurance nnier and Policy number a e:
ller. Policy Na.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section wed not ccompleted If tet permit Is forme hundred Mllars OH00)
or less.)
1 anify that In the performance of the work for which this permit Is issued.l shall not
employ any person in any manncr an as to become subject in the Workers'Compema0on .
Lawn of California Dam
Applicant
NOTICE TO APPLICANT:If,eller making this Ccrtifieste of Exemption,you Nauta
btthwi subject an the Workers Compensation Permit
provisions or Nc Labor Code.you muse
.J O wenow s comply with he fuck 's Comns or Nls permh Nall be Mamcd revoked.
„zs 0CONSTRUCTION LENDING AGENCY
H I hereby dTum Nat Nem I,....due kndingagmncy for the perfamanauf
a'> the work for which this permit is wood(Sec.3097.Co.C.)
141 0 Lender's Nstw ,
,7 z Iender'a Address
f,Q 1 certify that I have read this application and sate that the above Information b
Nr
correct.l agrm an comply with all city and county ominanas and sate lawn relating an
0 building construction,and hereby mobar)u representatives of this city an moor upon Ne
{4I alwve-mentioned property,for inspection Purposes.
(We)agree an save.indemnify and keep harming Use City of Cupertino stmt
r y liabilitW,judgments.case and expenses which may in any way actrw against said City
in conscmunce,of the APPLICANT UNDERSTANDS of IND
AWILL COMPLY WITH ALL NON-POINT Issued by: Date.
SOURCE REGULATIONS.
Re-roofs
Signmute of AppliaMCOntramor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will she applicant m Aurum Wilding oaupam am or handle haamons mai mid
as defined by the Cupenino Municipal Cade,Chapter 9.17,and the Hellish and Safety
Me,Section 35532()7 All roofs shall be inspected prior to any roofing material being installed.
Oyu ON.
Will the applicant or future building Occupant use equipment or dewim which If a roof is installed without firstobtaining an inspection,I agree to remove
it ha'ramous dr mmaminana u defined by the Bay Amu Air Quality Management all new materials for inspection.
wict7
0 Y 0 N
1 have mW the haumous materials mcginor ata under Chapter 6.95 of Ne Califon
nla Hualth is Safety Codc,Section 75505,23333 and 35534,I understand that aft building
not not currently have a tenant,Nu It Is my reaporWhility an musty Nm omupant of dm
mquiremena which most be mel prior toiaaana ofs Certificate of Occupancy. Signature Of Applicant Date
Owner munwriadsign Date All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY r Fax(408)777-3333
ICUPEkTINO
Building Department
JOB ADDRESS: PERMIT# D�
11518 Rock Spring Ct. os-of 0
OWNER'S NAME: Lim, Steve PHONE # 408-204-2301
GENERAL CONTRACTOR:Just Water FAX# 510-783-6360
Heaters
I am not using any subcontractors: �� °�� �� 9/12/05
Signature Date
Please check applicable subcontractors and complete the following information:
bfj 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
9/12/05
10/28/03
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 11518 Rock Spring Ct. Date: 9-12-05
Owner's Name:---Lim,Steve
Phone No.(408)204-2301
APN#: 366-51-031 Project Valuation: f 900.00
Building Permit Info: Bldg Elect Plumb____X_ Mech
fob 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. 94545
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 #: 5474-6390-0047-8660
-.o
Name on Card: Just Water Heaters Inc. 03 l
Expiration Date: 06/08ain
Visa MasterCard ® f'
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