04090283 (2) CITY-OF CUPERTINO -
BUILDINGDIVISION, PERMIT_ CONTiCT '�" �"� N t` •Y4 ,
" ..
BUILDINGADDRESS: JUST WATER HEATERS 'INC PERMITNO04090283
0387 SCFNTC' RT-17T)
OWNER'S NAME: ,.. .. PERMITISSURDATE ._,.
JEUBAEN CHOI
ONE: SANITARY 0.. CONTROL NO.
(510) 293-990
ARCHITECT/ENGINEER: BUILDINO PERMITINFO
BLDG ELECT PLUMB MECH
u00 LICENSED CONTRACTOR'S DECLARATION - Job DBSCTI _
rd 1 hembY affrm dust
u s 1 am licensed umkr provisions of Chapter 9(commencing -
with Section 7004)of DTA km 3.f the Business and Profesinna Code.and my license is _
I.fullfmceand.ren. REPLACE WATER HEATER' .
jfaZLicense Clasa Lic.p
Dale Comment, (5 0 GAL GAS) OCT Jr, 2004
ARCHI'IECTSDECLARATION
lmdaram e!my ill....hall he used as public records
Mu
;8� Licensed POfesi...l - - -. ,. - BUILDING _--^--�
OWNER-BUILDER DECLARATION
<F - ng as .(Sere o n 1 am exempt tram Ne Contractor's License c Law for the -
i O O following recon.(Section]031.5,Business and improve,
dA oIl Coot:Any city or county
x$ which myustu n permit re car a llu elmG improv,demolish, fi repair any ntuctum
pdarto its iauence.aleu mquimsthe applicam for pcnnisto fk aaignW sammcm
�CNat he is licensed pursuant to thin pmvisiom or the Contractors License Law(Chapter 9 Sq.Ft.Floor Area Valuati057 a.o,o.,, ..
ad (commencing with Section 7000)of Division 3 of the Buaincsand Professions Code)or
Nat he is exempt therefrom and the basis far Ne allcgcd exemption.Any viala0on of ..
Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of APN Number Occupancy Type
not ream than five hundred dollars($500).
E]1.an owner of the property,or my employees with wages az theirwle compenenton, -35702012 . 00 - - -- -
will dothe work,and the structure is notimenrledorOffered raise.(Sec.7044,Business - - .
and Profesions Cade:The Contmcmrs License Law docs trot apply to an Owner or - Required Inspections ,. .. -
property who builds orimprovmthercon,and who doessuchworkhimeelf orthrough his -
Ownemployces,provided thatauch improvements arc nasinanded oroQered foraah.IL
however,the building w improvement is said within one year of completion.the owner-
builder will have the human of pmvibg that M did not build or improw for putpwc of
Asia.).
❑1,as owner of the property;am exclusively contracting with licensed eonnacton to
contract the project(Sec.7044,Business and Professions Code:)The Contractor's Li.
...law docs noupply to an owner of property who builds Or improves thereon,and - - -
whocontractsfor such projects with a contnetor(s)licensed parmanS to he Connaaofs ...... - •._ v .,.,._-,. -- s,a-.�.: - -- ___
License Law.
❑1 am emmps under Sec. ,B R P C for this reazan
Owner Data WORKER'S COMPENSATION DECLARATION
I hereby aff on under penalty of perjury one of the following dacarations:
I haw and will maintain a Ccnifmace of Cansent to self-insure for Workcre COmpen-
scion,an provided for by Section 3700 of the Labor Code,fm the performance of the
work for which this permit is issued. '
❑1 have and will maintain Worker's Compensation Insurance,az mquimd by Section
3700 of the tabor Code.far the performance of the work for which this perm0 is issued.
My Worker.Compensation Inwnnc,canis,and Policy numbs,am: -
Carver. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE - �
(rhis Mellon need nolbecomplemd If the permit is Intone hundred dollen($100)
or less.) .. _ ..
employ certify nyr et the performance Of Ne work for which this permitrl isuc4l shall not
LaAe,o California.ninany mannmmslo become subject to the Workers'COmpenAstion .�
Laws of CalifoData r-
Applicant
NOTICE TO APPLICANT:IL after making this Cenificate of Exemption,you should
become subject 0 the Worker's Compensation provisions of Ne labor Code,you most
Oforthwith comply with such pravakins or this permit shall W deemed oinked. -
'Z .yNiCONSTRUC'GON LENDING AGENCY
'[•r I hereby Atli,.that Nem is a constr inn lending Agency to,the perfurmancOur
Q'. the work for which this permit Is isuud(Sec.3097,Ch,G
;4 Qen
Lder.Name
.7 z Lsnderh Addmu
U I ceniry that I have mad thin application and late,that the show information is .
I]r F coned.1 agree to comply with all city and county ordinances and sale laws mlating to
pU building construction,and hereby Mthoriec nepmMneLina of this city to enter upon Ne
IW above-mentioned property for inspection purports.
6. (We)agree to an.indemnify and keep homiest the City of Cupertino against
pF'y v/ liabilities,judgments,eon;and expenses which may In any way seems against said City
U Z in consequence of the granting of this permit. ,
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIONS.
Re-roofs 'Date
Signal=of ApplicaHAZA DO Dem
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the,applicator sir future building occupant Chapterreor handle Health ad
az defined by the Cupertino Municipal Codc,Chapter 9.11,and the Health and Safely
Co do.Secuon15531(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes [3 No
Will the app sal or.tum building«aap.nl equipment a,..viae.which a roof is installed without first obtaining an inspection,I agree to remove.
emit hmardous air contaminanu as defined by the Bay Area Air Quality Management all new materials for inspection. .
Dlahnct'
❑Yes No
1 have mad ore Weardnus materials requirements under Chapter 6.95 of the Califon
nia Health A Safety Code,SCeuons 15505.15533 and 15534,1 undersantl that if d¢building
docs not currently ban a.nam that it is my responsibility in notify the occupant of the
requirements which must be mm prior m issuance of a Cerufcaa or Occupancy. Signature Of Applicant Date
Owner oraathorindagent Dale All roof coverings to be Class"B" or better .. .
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
& CITY OF Fax(408)777-3333
UPEkTINO
Buildin De artment
JOB ADDRESS: PERMIT #
10387 Scenic Blvd. �{ o 0
OWNER'S NAME: Choi,Jeubae PHONE # 408-255-73
GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360
I am not using any subcontractors: 9`� 9/29/04
Signature Date
Please check applicable subcontractors and com Tete the followin 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
Uji- -
Owner/Contractor Signature Date
10/28/03
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 10387 Scenic Blvd. Date: 9-29-04
Owner's Name:---Chol,Jeubaen
Phone No.(408)255-7353
APN#: 357-02-012 Project Valuation: S 800.00
Building Permit Info: Bldg----------- Elect----------- Plumb......7t____ Nech___--------
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: 1764 National Ave. E-mail: permits®Justwaterheaters.net
City, State and Zip: Hayward,CA. 94545
State Contractor's License# 591329 Exp. Date: 3/31/06
Worker's Comp#: 1626288-04 Carrier: State Compensation Insurance Fund Exp. Date: 4/l/05
Credit Card Information
Credit Card #: 5474-6390-0026-5679 2 Z
Name on Card: Just Water Heaters Inc. ?Y(46 z
Expiration Date: 9/05 0 / •
Visa MasterCard
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