03110036 (2) CITY OF CUPEWfINO v'
I;mLDINGDIVISION PERMIT ffCON�TRACrORINFORMATION
BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT NO03110036
OWNER'S NAME: 1764 NATIONAL AVE PERMITESSUEDATE
C.J. SHE" 2003
NE' (510) 293-9901 SANITARY NO, CONTROL NO.
ARCHmE-CDENGINEER: BUILDING PERMIT INFO.
' BLDG ELECT PLUMB MECH
O D L� =100 LICENSED CONTRACTOR'S DECLARATION
�to F❑ 1 hereby,from that I..licensed under provisions of Chapter 9(cnmmcncin{ Job Description
6W with Bcction]0(4])nf DivisionJaf NC Businrav end Profculnm Code,andmyllttnse is
±ate imm�mrceandeffea REPLACE WATER HEATER FINALE®
y z Licenu Class Lic.N ,
t o Dam can(nemr (5 0 GALLON GAS)
££� ARCHITECTS DECLARATION u NOV [a rLloo']
WI understand my plans shall W used public moods
U U J
6
a o In Licensed Professional
OWNER-BUILDER DECLARATION BUILDING
0 0 I hereby affirm dol 11. ,Bumps from Bot Contractor's License law for the Y
p ryO' following moon(Suntan]onstrBusiness and Pefcuinne Code:Any City or county
LL. poor,.
which IiQYiress.n c..1Permit ne construct.almf,improve,h me iitu or repair any strutwentum
pnonniu lensed parson to the lheappliam for Comormitwicense Law(Chapter
ESG (comm, licensed the 3Ofthe nsfuerindPraclaw(Chaplcr9 Sq. Ft. Floor Area Valua[io$'7'72
e F (cat he is
(commencing with and
of Division,of the Business exempt on.Any
alfanCode)of
10� Nal he u exempt memfmm and the buil for the allebed exemption.Any violation of
Section 7031.5 by any applicant for a permit subjccu the applicant to a civil penalty of 3 @01904a"cr0 0 Occupancy Type
not mom man five handed done.(5500). Pane Y YP
❑L As owner Of the pm xeoy or my employees with wages as their auto compensation,
will do the work,and the sometime isnot inunded or offered for sale(Sec.7060,Business
and Pmfassions Code:The Convamors License Law docs not apply to an owner of Required Inspections
property who builds or improves themon,and whodu s such work himaelf or through his
own employees,provided that such improvements are not intended oroffemA for ole.If.
however,the building or improvement is sold within can year of completion,the owner.
builder will have the burden of proving mat he did not Wild or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively convecting with licensed con race.to
camlmCf the project(Sec.70a4,Business and Professions Code:)The Contractors Li.
came law does not apply to an owner or property who Wilds or improve thereon,and,
who contracts for such projects with a commuters)licensed pursuant o the Contractor's
License Law.
❑1 an,exempt under Sec. ,B 6 P C for this moon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby aRm,under penalty of perjury one of the following declarations:
I have and will maintain a CeniEcate of Consent a selbiosue for Workers Compen-
sation,as provided for by Section 3700 of the labor Code,for the performance of the
work for which mil permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as required by Section
3](10 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy norther am:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need no W completed Rite permit Is foroac hundred dollars(11(4))
less.)
1 certify that in the performenc,of the work far which this pcmidt is issued,1 shall nut
employ any person in any manner so as to Wcome subject to(hc Workcri Compcnsaeon
Laws of California.Dae
Applicant
NOTICE TO APPLICANT:if.after making this Cci ificem of Exemption,you should ,
become subject to the Worker's Cmepensalion provision,of the Lebnr Code,you must
,O forthwith comply with such provisions or(his permit shall W deemed evoked.
ti CONSTRUCTION LENDING AGENCY
j—t I hereby affirm the there is a conawninn lending agency for the performance of
O:. the work for which this permit is issued(Sec.3097,Civ,C.)
U Q Lenders Namc
= z Lcnd,rs Address
V Q 1 corify that I hays read this application and sue c s athend shave information is
U correct.I agree to comply with all city and county ordinance,and sum laws r hint e
�(,7 ab000mentioned construction, hembyauthorimrposeemafives o(NisCity menmrupon me
ahovn(We)agree
a arysave for impccuon purposes.
(We)egme t.save,indemnify and keep harmless w City of Cupertino against
Fw h in C.Osoct.udgmenho tats anding expcmeswhich may in any way accrve a{Bion sold City
A APPLICANT
of the granting of this permit.
V^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS,
Re-roofs
HAZARD
SiBnawre of ApplicaO Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me a Cupertino
future Wal Co lk.Chapter
or handle Health
d Safety ety
as defined io the Cupertino Municipal Lode,Chapmr 9.11,and the Health and Sa(cly
Code.Section 35532(6)? All roofs shall be inspected prior to an roofing material beim
' ❑Yoe ON. P P Y g g installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it huardnus air contaminants as defined by me Bay Area Air Qualify Management all new materials for inspection.
""flet?
❑Ycs ❑No
1 haus mad!the NuArdtms materials eyuirements under Chapter6.95 of the Califor.
nia Health&Safety Code,Secuons 25505,35533 and 25534.Iundcewd that ifine Wilding
does nor currently have a tenant,mm it is my repomibilhy On notify the emodurt of the
mquimmcnu which must be met poor to issuance of a Ccdfcate of Occupancy. Signature of Applicant Date
Owner oraumm oCdapent Dam I All roof coverings to be Class "B"or better
t� (-D O "'
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 7718 Seeber Ct. Date: 11-7-03
Owner's Name:---Sheng C.J.
Phone No.(408)996-3893
APN#: 366-26-042 Project Valuation: S 772.00
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 3 ��
Name on Card: Just Water Heaters Inc.
Expiration Date: 9/05 ��-�
Visa MasterCard X
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