05040106 (2) .77
CI
BUILDINGUDPEROONNO PERMIT IRON
&CTQRiINFORMATION z
BUILDING ADDRESS: JUST WATER HEATERS INC PE1eMRN%5040106
'10360 STOKER AV
OWNER'S NAME: PERMIT ISSUE DATE
4g 1h DAVID DINELLI 3400 INVESTMENT RT.VT)
ONE: SANITARY NO. CONTROL NO.
510 293-9901
ARCHDIC'MOENGINEER: BUILDING PERMIT INFO
LDG ELECT
XLED
PL MFCH
o o LICENSED CONTRACTOR'S DECLARATIONJob1 ion 7 afrum Wt l 3 fft Bu under Provision of CNpter 9(oommencin{
In full
ullootice And e)ecDivision lO(Jte Budnesaand Profession Code.and my license is
_ Iemseameandercet. REPLACE WATER HEATER
License Clue Co N
Dam Comment. (4 0 GAL GAS)
ARCHITECTS DECLARATION _\] 70 2005
3
I undcrwnJ my phos shall W used u public records gq^Jk ,pn�/�
5�
Licensed herebyProlesion's m U I L I p �
OWNER-BUILDER DECLARATION
ay 1 hereby amrm that 1am 1. .Bumps from the fes ons Ca e:Any C taw for Ute
O O fallowing meeDa(Section]031.5,Business and improve,
de oli Cale:Any tan ores vera
$ which mquime a Permit m ennnmm,alter,improve,h iscruit u li e a sir any suucwm
FAX' Pnorm itstensed e,alsomquly prom Appos.ftm iedrerme.1.1 Ase U.(etswmcm
FE< (Cemei ncingwidiS=tion7 )ofDission3thiCBusi wr'aMftflaw(CMpter9 Sq.Ft. Floor Area Vacua 1285
58 (comme coarept SesUon]OW7 of basis flnftbo Business endon.Anyavi Cole)or
Wt W u a.mpt therefrom and the bait for she.Inc{td assumption.My violation of
Section]031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy
not more than Eve hundred doll.(3500). p y Type
❑I,wmwoftkepmpeny.wmyemploycuwiffimM u ensa
theksolecompdon, 32647(]15 ' ()()
willdothewOrk,andtheanuctumisnotinwndedoronendfonale(sec.]t11A,Buainus Required Inspections
and Profusion, mmw e
Code:The COnmes Llan.law Joos rent Apply an owner of q P
property who buildsor lm amu theccon,and who doessuchlarkhM.If orthrough his
Own employcou.provided that such improvements an,notthtended moneyed forsam,if.
hmvever.the building or improvement is mid within one year of oompmtian,the awrter-
Wilder will have the burden of proving that ha did no,build or Improve far purpose of
Bak.).
❑1,As owner of that propeny,am exclusively contracting with licensed contractors to
construct the project(Sec.7010.Business and Profusions Code:)The Conlracmr's Lh
came taw docs not apply in an owner of propeny who builds or improv humor.and
who contracts for such projects with a eomr.wr(O licensed pursuant to til COnoacwr'a
Liana.Law. .
❑1 ins exempt under Sec. .B k P C fa this.0.
Owner Date-
WORKERS
am
WORKER'S COMPENSATION DECLARATION
1 Nrtby elllrm under penally of perjury,one of the fallowing declare don:
1 Nae and will mmmad.•Cenifi^,•ufCon.m m.If-insure for Warker'aCanpcn-
statlon,u provided for by Section 37M of the labor Code,for the Performance of due
work for which this permit is issned.
❑1 have and will mainuin Worker's CompemaUon Irwnms,u raqui ed by Section
37M of the labor Code,for the Performance of the work for which this Permit is issued
My Worker's Compensation Insurance caller and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section rued notbecompleted lithe permit hi form hundred dollars($100)
M lass)
1 Certify that in the paformance of the work for which this permit Is Issued,l Mali nm
employ anyper.n In any manner an As m become subject in the Workers'Comp mution
Laws Of California.Data
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you Mould
become subject to the Worker's Compensation provi ion,of U.labs Cade.you muss
,J O fOMwith Comply with such provisions w revalued.this permit all be doomed revalued.
CONSTRUCTIONLPNOINGAGENCY ' rr _�
[tip I for by which
the thereuamnwni097,Ci,.C.) yfor Urc Performance of /'�'^Y(Ayn✓^`�tJ` '
Ci Le lurk for which thla permit u issued(Soo.7097,Cie Cd
dQ Lendcr'a Name
.7 z Lender's Address
U0 I eertiry,mat I have reed osis application and mos Nat the above informadun Is
U.r,••r corte0.I&goes 0 comply with all city and county ordinances and sate laws relating in
C)CSJ' Wilding tonwuetbn,and hereby authmies representatives of this city to creta upon J.
W above-mami.ned property,for inspection purposes
y (We)a3'me As save,indemnify and tamp homeless the City or Cupertino a{aieW
y liabilities,judgmereu.costs and expenses which may in any way.ene Against A iu City
V 7 In camequence of the granting of this permit.
A APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicanUCoARDO Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Willy 1.applicant or future WilMunicipal
Cg aesupantswro strand t e Health us and Safety As de.Soc by the Cupertino Municipal Codas,Chapter 9.12.and Uw Health and S&Icty
Code.
SOyu z5532(D7 All roofs shall be inspected prior to any roofing material being installed.
❑Yca ❑Nu
Will the applicant Or future Wilding occupant um equipment adevices which If a roof is installed without first obtaining an inspection,I agree to remove
II havaNnus air Contaminants as coined by the Bay Arta Air Quality Management all new materials for inspection.
7NAaict?
❑Yee ON.
I have mW the huaNrms materials requirements undcrCNpwr 6.95 of the Califor-
Health h Safety Cade,Section 25505.25533 atu125534.1 undenused thatlrme Wilding
cs not currently haw A tenant,that it u my vpanibility m notify the uaup en of the
uiremenas which man W=I Pdarm Issuance ora cenifieate ar Occupancy. Signature of Applicant Date
ners wthomcda cm Date All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
► Cupertino CA 95014
Telephone(408)777-3228
CITY OF�
UPEI�TINO Fax(408)777-3333
Building De artment
JOB ADDRESS: PERMIT # l /
10360 Stokes Ave. 6 ti ° 6
OWNER'S NAME: Dinelli, David PHONE # 408-725-0401
GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360
I am not using any subcontractors: � � �^-� 4/18/05
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
UKdj'Q' 3/18/05
Owner/Contractor Signature Date
10/28/03
City of Cupertino Building Permit Application
E-Mail
Jobslte Address: 10360 Stokes Ave. Date: 4-18-05
Owner's Name:---Dinelli, David
Phone No.(408)725-0401
APN#: 326-47-015 Project Valuation: S 1,285.00
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-mail: permits@Justwaterheaters.net
City,State and Zip: Hayward,CA. 94545
State Contractor's License# 591 329 Exp. Date: 3/31/06
Worker's Comp#: 1626288-05 Carrier:State Compensation Insurance Fund Exp. Date: 4/l/06
Credit Card Information
Credit Card #: 5474-6390-0026-5679
Name on Card: Just Water Heaters Inc. 3S�
Expiration Date: 9/05
Visa MasterCard
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