08020083 (2) CITY OF CUPERTINO
B 6111LDINC'DgVIS10N PERMIT 9 lelNTXi 7.211�I''
to �, w R'i.wV....N"z e>W�tyA ,n',7
PERMIT NO.
BU PERMIT
RD JUST WATER HEATERS INC 08020083
ER'S NALME:7 PERMIT ISSUE DATE
BANGALORE AFHOK 3400 INVESTMENT BLVD 02/13/2008
PHONE: SANITARY NO. CONTROL NO. -
(510) 293-9901
ARCHITECUENGINEER: - BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
30=0 LICENSED CONTRACTOR'S DECLARATION Job Description
VI toreby affirm that 1 am licensed under provisions of Chapmr 9(Commencing I p
`ref with Section 7M)ofDiAmr,3aftheBueincsandProlessionsCode,andmylicanseis REPLC 40 GAL GAS WTR HTR
w in full fame and effect.
D14 License Class Lk,Is
at- Dau Contractor
ARCHITECT'S DECLARATION
1 undencanJ my plans shall he mud u puM1lic ucoNs
po
y✓� Licensed PmRssianal
v, OWNER-exempt RDECe ConumON
COOh shy olEr m 11. ,exempt from dta ContmnCoo License Law for the
i.❑O following msson.(Saban 7 onstr Business and P e,dem li Cook:Any stir at county
rd$ which requires a peril re construct,aloe Improve,demolish,t m mash any swment
t y prior to its issuance,cels.requires the applicant(.touch permit to tilt asignm statement
SS< that he is licensed pursuant to the provisions of the Conmtors License Law(Chapter 9Sq.F1.FIOOr Area Valuation
5! (Commencingwith Satin7000)ofDivision3ofthcBusiness and ProfessiamCode)or $85�
that M is attempt therefrom and the basis for tion alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of �ppl Number Occupancy Type
net mom than five hundred dollar($500). 3 6 61110 7:t.7 U-
❑1.as ownerof Ns property,mmyemplayms with wages as districts eompemadon,
win dolmom.and thanactuu Is matmtended or offered lorxele(Sec.7044,Busiwa Required Inspections
and Profesa mat Cade:The O nummm's License Law dam cal apply to e ns an owso of q p
property who builds or impmvu tiuuon,and who tlaes anh wmk himself arm thmugM1 his
awn emplayem,provided that such improvements aunt intended aroQered for sate.IL
however,the building or improvement is old within ors year of completion,tha ownm-
Wilder will thaw W bu:ken of proving that be did rat build or improv fur Purpose of
sale.).
O I,as avant of the property,am exclusively contracting with Ilcemed contractors an
Construct the project(Sac 71144,Business and Prolmsiam Code:)M Contractor's U.
cam law docs not apply m an owner of property who builds or improves Noun.and,
who contracts for such projects with a co urvor(s)licensed pursuant m the Contractor.
License Law.
O 1 am exempt under Sea. .B&P C for this reason
40 nor Dau
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following deelara lone
O I haw and will maintain a Cereficam of Consent to self-imus fm Workeh Compmn
Milan,as provided fm by Section 3700 of the Labor Cade,for the performance of the
wmk for which this permit is issued.
O 1 have and will maintain Worker's Composition Insurance,u uqueed by Soman
37M of the labor Cade,for the performance of the work for which this Peril is iuced. '
My Workers Compensation Insurance cartim and Policy number art:
CarienzPolicy No.:
CERTIFICATE OF MEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thuumn need not In completed if rise permit is foroan hundred dollar(SIM) '
or leas.)
I certify that in the performance of the work Ire which this perp is issued,l abet eat
employ any person in any mnner an as W become subject a on,Workon'Compensaflan
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you Nauta
become subject to the Worker's Compensation provisions of the Labor Cade you mal
Of..with comply with MCI ptovisiam or this peen shall I decreed mwked.
CONSTRUCTION LENDING AGENCY
(—t I hereby a10r We them its comtrumnn lending agency for the Performance or
a^ the work for which this Permit is issued(Sec.3097,Cih,C.)
W 0 Lenders Nurse ,
0 Z Undoes Address
U 0 1 certify that 1 haw mad this application and scale Wu the above Information is
Li, correct.I agree to comply with all city and county ordinssues and sou taws missing to
0 V building cannuman,and bemby author.repmammadvet of this city in am upon the
W above-mcndoned pmperty(m impaction purposes.
py (We)agree to saw,indemnify rad kap harles We City of Captain.against
W IiabilideLjudgments.coca and expenses which may In any my accrue against mid City
C)Z in consequence of the grating of this permit,
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Signatureof ApplicnVCanu Dele Re-roofs
HAZARDOUS
S MAflatcALS DISCLOSURE Type of Roof
Will the he Cucant m,Muni building occupanthapten morandle hnardom material
dented io the Cupertino Municipal Cade.Chaplet 9.13.and the Haalth and Safety
sec,Section 25533(4)?ED yes C]No All roofs shall be inspected prior to any roofing material being 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
emit havardom air cComminism as defined by 0u Bay Area Air Quality Management all new materials for inspection.
District?
Oyu ONO
I have mad the amem.us matcriab mgobarrem sundcr Chapter 6.95 of the Califor-
meHcaWr&Safety Code,Sued=75505.25533 end 27534.1 undersand that lithe building
does not currently haw a amt.that It a my nalumahilitY W notify the occuPnt of the
mqulurana which mus No met prior to in..ofa Cmtifuamaf Cacupncy. Signature Of Applicant Date
Owners authorized agent Dau-
All roof coverings to be Class"B"or better
C-ty of Cupertino Building. Permit Application
E-Mail
Jobslte Address: 1282 S.Stelling Rd. Date: February 13, 2008
Owner's Name:---Bangalore Afhok
Phone No (408)873-0262 -
APN#: 3(,0(0 111 O-1 i �� Project Valuation .S 850.00
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: Fax: (510)293-2022
Address:3400 Investment Blvd E-mail: permits®justwaterheaters.net
City, State and Zip: Hayward,CA. 94545
State Contractor's License# 591 329 Exp. Date: 3131/08
Worker's Comp#: 01DKRM11001070 Carrier: Nelos Exp. Date: 4/1/08
Credit Card Information
Credit Card #:
Name on Card: Just Water Heaters Inc.
Expiration Date: 6/08
Visa MasterCard
Comments
t
• CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36611107 . 00
DATE ISSUED. . . . . . . : 02/13%2008 _
RECEIPT # . . . . . . . . . : BS000003930
REFERENCE ID # . . . : 08020083
SITE ADDRESS . . . . . : 1282 S STELLING RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BANGALORE AFHOK
ADDRESS . . . . . . . . . . : 1282 S STELLING RD
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5204
RECEIVED FROM . . . . : JUST WATER HEATERS
CONTRACTOR . . . . . . . : GILROY, JOHN LIC # 15128
COMPANY . . . . . . . . . . : JUST WATER HEATERS INC
ADDRESS . . . . . . . . . . : 3400 INVESTMENT BLVD
CITY/STATE/ZIP . . . : HAYWARD, CA 94545
• TELEPHONE . . . . . . . . : (510) 293-9901
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 850. 00 0. 50 0. 00 0 .50 0. 00
1PPERMITFE FLAT RATE 1. 00 40-."79 0. 00 40 .79 0. 00
1PRWHEATR UNITS 1. 00 24 .48 0. 00' 24 .48 0. 00
1TRAVD0C FLAT RATE 1. 00 40.79 0. 00 40 .79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 106 . 56 0. 00 106.56 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD _ 106.56 MC
----------=
TOTAL RECEIPT 106.56
VOICE ID DESCRIP •ON, VOICE ID DESCRIPTION ,
-------- ----------- -------- -------- ---------------------------
518 WATER HEATE
•
Community Development
10300 Torre Avenue
-�' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Buildin Department
JOB ADDRESS: PERMIT #
1282 S. Stellin O W U
OWNER'S NAME: Bangalore Afhok PHONE # 408-873-0262
GENERAL CONTRACTOR: JustWater Heaters FAX # 510-783-6360
I am not using any subcontractors: 9 t`- �-ioj-oa� 02/13/08
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
02/13/08
Owner/Contractor Signature Date
10/28/03