05120058 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT xQQNTRACT0RjNF0RMATI0N
BUILDING ADDRESS: JUST WATER HEATERS INC """0512005844
TIPTOE TiN
OW NER'S NAME: PERMIT ISSUE DATE
JULIA MCASEE 3400 INVESTMENT BLVD 12/1 -1 /2005
NE: SANITARY NO, CONTROL NO.
(510) 293-9901
ARC HITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
14.
0 0 0 0
l o j LICENSED CONTRACTOR'S DECLARATION - Job DaSCrI
'.I F 1 bereby affirm TNv
I I n Boosted under pmvisimu of Chapter 9(commencing
on 3 ofthe Business and professions Code,and my license is
,Zd +nrallroaanderta REPLACE WATER HEATER
,,J_ Lignac Clesr Lk.at /
Fp Date Cmmos r 50 GAL GAS ✓q�
S
7th ARCHITECTTDECLARATION
I s understand my Plans shall E S u publicrecordat
tl
JyU
e LL Licensed Professional O(s
ta 3 Oat I am cumpt from
DECLARATION ((//
0 0 1 hereby affirm NoI I I.S..Bump(from Ne Casio.Code:s License Law far my
o O following vires a ermit t ?ID strBusiness and P e,dOnn ll h.oAny dsy or county va
120'. which its Loa a Permit w cnnstmct,alcor,improve,demolish,of repair any smucture
muni �J
i� prior to itscensed Nurnamgo th,do apmoscOf a.Cmatrecons Utmost Law summent
'1 `0 mhan he is unmencing it pSeuant lalhc of Division
of theo Business LiconulawlChodu+9 Sq.FL FIOOr Asea (y(n Valua[io 883
e� that he la;uuwith ScNon?andthe ivuion3 aflhcegedassandon.Any
Cade?or
i 9
that he u exempt sang ap li and the buil for the alleged spitball
to Any l violation of
.1
Section 7031.5 five
mry ted dons for a permit subjects the applicant I^a civil Penalty of AFN Number Occupancy Type
trot roam than fico baMred dollars(g50p1 35932050 . 00 p y YP
❑I.uowmr oftN pmputy,or my wployaa with waguuthmvmle eampewthan,
will do the work,and NesWcame a notimmnded oreRered formic(See.TON,Business
and PrefeNau Cade:The Contractors License Law does Out apply in an owner of _ Required Inspections
property who WiMsorimproves thermn,and whodoessuchwart himself"hough his
awn employ=.provided that such improvements are not intended ororrerod forsaln If.
however,the building or improvement is mid within one year of completion,the Owner.
builder will have In burden of proving that he did not build or improve for purpose or
ale.).
❑1.u corer of the property,am eaGuhnsly connecting with licensed...mums to
co arm s the project(Sec.70",Business and Profession Code:)The Contractors U.
cense law docs not apply in an owner of prapertywho Wilds or impmwa thereon,and
who contracts for such pmjecs witha cutracmRs)restated pomtant to the Connors
License Law.
❑lamsumar"undersee, ,B&PCienthumaron
Owner Date
WORKERS COMPENSATION DECLARATION
I Nmby affum under pmWty,of perjury one of thm folbwing deciaralim e
1 have and will maintain•CeNfcaa of Consent to self-insure for Workers Compcn-
7371W
an.u provided fm by Section 3]00 of use labor Cade,for thas Performance of the
rk for which this permit is issued.
1 haw and will maintain Workers Compensation Imsounce,u hatuiod by Section
of the Latour Codc,for the pcnfermance ofuse work forwhich this permit u issue&Wort s Compenution Inmra em artier and Policy number am:
rtier. Policy NO.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This secid.need acnaccomplemJ ifthe permit is forge turned dull.($100)
nr hese)
1 certify that in Ne performance of the work for which this Permit is issue&1 shall cwt
employ any punch in any ma erumm as m become subject on she Wortan'C^mpertauon
Laws Of C31tennia.Dace
Applicant
NOTICE TO APPLICANT.If.after making this ono(ate of Escmption,you should
become subject to Ne Workers Compensation provisions of the labor Codc,you most
.J O foMwith comply with such PrONTOO s w this permit shall to deemed mwted.
'Z� CONSTRUCTION LENDING AGENCY
(—r thereby affirm than them is a couuunino lending agency for the Performance of
a > the wart for which itch permit is issued(Sec.3(191,Civ,C.)
.M Q Lenders Name
7,Z 1<ndcrs Address
U Q I certify that 1 have mad this application and sac Nu the aWw mitomutiun is
P corms 1 slime m comply with all city and county ordinances and sum laws miming in
pU Wilding Imoutelioo.and hereby amhorire represenmiwes or this city to onus upon the
r Lu ahovc6mc judgments.
udger property for insp estions.purpowhich ms
G (We)agree to son.indemnify and kap harmless IM City or Cupertino I'm I
Z liatoiliues Judgme Of thecortsr and ea this ummit. may in anyway acme agaiesssaid City
mal Of
U Z APPLLIICCANTcUN UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Srgnuua or AppliwDam Re-roofs
HAZARDOUS DISCLOSURE Type of Roof
Will the applicant or(mum Wiling e.Chaptnom m handle Hatdoes material
u de.Zc by the Cupertino Municipal Cade.Chapter 9.13.and the Health and Safety
Cole,Section 25533(.)?
❑Yes 0N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it havardou air common us at Jefncd by the Bay Area Air Quality Mamgcmcns all new materials for inspection.
District?
❑Yu ON.
I have mad the tocco n o materials mquimments under Chapmr&95 ofthe Collins.
nig Hesl"Safely Codc.SeNcm35505.25533 and25534.1 wrkrsand thaif ism Wilding
does out currently have a mnanl,out it u my mapomihilk,w nnofy the occupant Of the
his
which most W met prior W issumses of Coultas,of occupancy. Signature of Applicant Date
Owner or mthmixed.,car Dam All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
,CCITY 01 Fax (408)777-3333
UPEkTINO
Building Department
JOB ADDRESS: PERMIT#
10580 White Fir Ct. b S"-/ -2- ,:5-0 o
OWNER'S NAME:Wu, Fang PHONE # 408-773-3252
GENERAL CONTRACTOR: Just Water FAX # 510-783-6360
Heaters 1
I am not using any subcontractors: �� �� �°^ 12/12/05
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 l
12/12/05
10/28/03
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 10580 White Fir Ct. Date: 12-12-05
Owner's Name:---Wu, Fang
Phone No.(408)773-3252
APN# 359-05-122 Project Valuation: S 999.00
Building Permit Info: Bldg____ Elect__ PIumb__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: permitdept®sbcglobal.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: 4/1/06
Credit Card Information
Credit Card #: 5474-6390-0047-8660 /
Name on Card: Just Water Heaters Inc. -4 2
3
Expiration Date: 06/08
,pTL o
Visa MasterCard ® U
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