05120059 (3) CITY OF CUPERTINOn,* ,• Fk
BUILDING DIVISION PERMIT yCONTRACTOIi INk'O_,,It1VIA.TI0,1�1 °
BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT110.05120059
10725 TRESSLER CT
OWNER'S NAME: PERAIMMUEDATE
Alk AMY LIANG 3400 INVESTMENT BLVD 12/13/2005
IF NE: SANITARY NO. CONTROL NO.
(510) 293-9901
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+Op LICENSED CONTRACTOR'S DECLARATION Ib:DeSCfIP tion
C 1 Mrcby All.that 1 am licensed undo ons provisiof Chips,9(comO
mcncing
U with Section 7=)ofDivisiont 3 orae Business uM Profession,CoNsful my licensee
infail force ameffect. REPLACE WATER HEATER
c 4 Z License Clan Lir.R) Date Corrosion-
5 0 GAL GAS
ARCHITECTS DECLARATION
1 I understand my plans shall W dud As public records
w
o U
Licensed Proffeemonal ��
3 OWNER-BUILDER DECLARATION
i 0 I hrehy.(Sac on 11. ,B rept from ac ContractorsCould:
License taw for the
p O following mason(Sxtian PD 1.5,Business and w,c1c oa Codc:Any city st county
3 S Omen reydires n pmmn w cfi rot.plus.Impmw,dcmrch mit o or eyair any sanctum
ZEi thathe its iensedpauo rtgoies previsioc of forme ontractoitwfiarele.c Lacdsutemcm
< (couldisllccnwit pursuant to of Division 3 the Contractor's LJcease Law(Chapter Sq.Ft.Floor Area alua[io 884
Y F G that W is ng with laceform and of Division r the
A elect ma am Proon.My
Code)or
that W u exempt thcrtfr.m and the baso for the alleged exemption.My violation of
Section 7031.5 by any applicant for a permit subjects ac applicant to a civil penalty of
r \
Type
wt...than five hundred d.11ars(SSW). 3AANNNNn100 f114,
C]I,aaeoftpmpmymmyemployerswinweuairmlec.mpeadon,
win do the work and IhesWclure u uctmremcd.aRuW(orale(5x.1046,Business
and Professions epee:The conuaz.rs License Law sax not apply to an awner or Required Inspections
prapeny who builds.impr.thereon,and whedoasuch work himself.,W.ugh hit
Own employ.,provided that such improvements art not imcmm reoffered fur We If.
however,the building or improvement is said within ON year of completion.the owner,
builder will have dte Wrdan of proving that W did sot build or improve for purpose of
ale.).
Q 1,as owner of the property.am evelusiwly contracting with licensed contractors to
c.,wct the project(Sm.10x4.Business and Professions;Cade:)The Conuacmts U.
cense Law eau not apply w an owner of pmpertywh0 Wilds or improves thereon.and.
who conuats for such projects with a canvacmr(a)licensed pursuant to the Conuxtor's
Lie..Law.
❑1 sm eaempt under see ,B&P C for this mars.
Owner Data
WORKERS COMPENSATION DECLARATION
1 Jammy air=under penalty of perjury,arc of tc following declarations
1 haw and will maintain a Ccaulmteof Consent to xlf-inane fur WarkcYs Compeer-
7371M.f
on,a Provided f.by Section 37M of de labor Code.(ar the performance of tW
rk for which this Permit is issucd
1 haw and will maintain workers Compensation husurance,a required by Sectio.
to L W,Code,far the performance ofthe wort for which this p broil,is issuedy Workers Csmpeaauon Insuance artier and Policy number are:
rrier. Policy No,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu mnlnn seed sot W completed if tW permit Is forum hundooddallan($100)
of less)
I anify that in the performance of to work for which this Permit is issucd I shall not
enploy any person in any masnerso u an become subject an the Wurken'Compeaation
Lam of California Due
Applicant
NOTICE TO APPLICANT:If,aria,making this Ccalfrcalc of Excmpu.n,you should
becco a subject in tW Worker's Compcaauon previsions of the Labor Cmc,you muss
w,O forthwith comply with such provisl.a.this permit shall W dammed revoked.
z'^ CONSTRUCTION LENDING AGENCY ,off
[—� � IWebyichm aarmitis Woo (Sm..307,Cing agemy for the performa.a of
a Le wart f.which pis Permit u issued(Ser.3097,Civ.C)
fA Q Lender's Name
= z larders Addren
U 0 1 coolly that 1 have read this application and state to the.Ww information is
ii�F correct.1 agee b comply wish all city and county ordinances and sole lawn relatiag to
0 U Wilding construction.and hereby auth.im representatives of this city in enter draft the
a Ww-menudsmd propertyse for inspectionexpenses
purposes
F 0. (We)agree m ave.indemnify and keep hennks the City of Common against
h incaitia,jmgoftheoatsind espcnseamit. may in anyxwyamuc Against said City
()z in Of the SA permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
_ Re-roofs
Stgttuue ofApplicaHUCir
DOUS MATERIALS DISCLOSURE Re-roofs
of Roof
Will the applfent Of future Wilding Occupant scare in haadk harallous muchal
u deZd by the Cupeni40 Municipal Code.Chapter 9.13,and art Health and Safety
c.der Secti.n 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
7dws ❑Ya �No
Will thea applicant or future Wilding Occupant a: If a roof is installed without first obtaining an inspection,I agree to remove
rp e p ea Air g P
mil Maoist?
a air contaminants u de0md by the Bry Area Air Qdity Management all new materials for inspection.
xuict?
❑Ya ON.
I have rem the huartws.,emir equiremui,under Chapter&95 of the Coulon
n Health&Safety Cade.Sec and 25505,25533 am 25536.1 amms ind taifde building
.at currently have a mans that it u my espo„ihiliry m notify do Occupant of ac
tfairemeatswhichmd.e eLOur toism ance.Isccsuraauofoccupancy. Signature of Applicant Date
Owner.aoWneed agent D,m All roof coverings to be Class rB"or better
Community Development
10300 Torre Avenue
a Cupertino CA 95014
hone(408)777-3228
� CITY OF Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRESS: PERMIT#
10710 N. Blaney Ave. ay.S
OWNER'S NAME: Zeszutek, Dorothy PHONE# 408-25270514
GENERAL CONTRACTOR: Just Water FAX# 510-783-6360
Heaters
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
Dam- 12/12/05
10/28/03
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 10710 N. Blaney Ave. Date: 12-12-05
Owner's Name:---Zeszutek, Dorothy
Phone No.(408)252-7951
APN#: 316-43-008 Project Valuation: S 960.00
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: permitdeptOsbcglobal.net
City,State and Zip: Hayward,CA. 94545
State Contractor's License# 591329 Exp. Date: 3/31/06
Worker's Camp#: 1626288-05 Carrier: State Compensation Insurance Fund Exp. Date: 4/1/06
Credit Card Information
Credit Card #: 5474-6390-0047-8660 Z3 /�
Name on Card: Just Water Heaters Inc. t
Expiration Date: 06/08 u�-
Visa MasterCard
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