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03090219 (2) i, CI'CY OF CUPERTINO >7 7,7771 BUILDING DIVISION PERMITCONrRACTORTNFORMATIO BUILDING ADDRESS: NST WATER HEATERS INC PERMIT"003090219 OWNER'S NAME: 1764 NATIONAL AVE PERMR L�UE DATE ROBLES 09/2S/2003 NE: (510) 293-9901 SANITARY NO. CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH �O p LICroom that 11 CONTRACTORS DECLARATION IVC I ion 7 affirm thio 1 am licensed under Provisions n(Chapter 9 my license Job DCSCrIpt100 11 a¢w with Section l(lfl(Bo(pivision]of On Business and Prafessinm Code,and mylicensc is <<,;N in fail fora and effect. REPLACE WATER HEATER FINALE® J q? License Class Lic.x ;moo Dam Conlrulnr (40 GALLON GAS) ARCH ITECTSDECLARATION - DEC O 2003 I 1 understand my plans shall be used as puNic records le. Licensed Professional Oat I am exempt from DECLARATION BUILDING a S I mason. .(Beta Not 1 I exempt tram the essionmm's License Law for the m which ng meson.(cocoon 703 IS.Business and improve. de nm Code:Any city or county which requires s c,also re aures the epee nt for su h Permit o or repair any avucmm iy that poohe sl lensed Pursuant to the theapplicantfar such Permit miccasc ned aw(Chaemem aSSSS (commesccenmdpSectiontorhepmviainnsofNaConviness ndProflaw(Coamor Sq. Ft. Floor Area Valuatio} 2'7'7- _ tithe is ithgcclirn]IXIItheo(Dbaiisfon r of the he alleged dexe prion.Any Aitgan or $ Section el io is315 exempt any applicant and the boa for be allege0 exemption.Any l Pen Pty of a mm mon. o3L56y vryreddantr,($50nniuubjects On applicant to&civil penally of 3Aelgl11a16er00 Occupancy Type nor more Nun Bw hundred dollars(fSfA). - — --- p y -—- ❑I,o owner of the prapeny,or my employees with wages as their sole compensation, will do She work,and thm.neure stoat intendedor.Rartd Polish,(Sec.70al Business r•}� V�(�,,ys 7Y�� F �y�n� and Profusion&Code:The Contractor's License Law docs not apply an an owner of 502 - FINAL t'�V MI511V V C G1V RGY prapeny who builds or improves thercon,and who doessuch work himwl(or through his own employe..provided that such improvements are nor intended oroaered for Sale.If. 506 — GAS TEST however,Ne building or improvement is mid within one year of completion,are owner builder will have the burden of proving that he did not Wild or improve for purpose of 507 - FINAL PLUMBING sale.). ❑ h as owner of On propany,ma..elusively convecting wit licensed contractors to construct the pmject(Sec,1044,Business and Professions Code:)The Convector's Li cense Law does nor apply,o an owner of progeny who bulids or improves Ihemon,and, who contracts for such projects with a convacmr(d licensed pursuant to the Convacmri Licene,law. - ❑ 1 am e.empt under Sec. ,B A,P C for this moon Owner Data - WORKER'S COMPENSATIONDECLARATION 1 hereby aRrm under penalty of perjury one of Ne following decluaioo: 1 have and will maintain a Certificate of Contin to selfdnsum for Worker'sCumpca- 7c,"Y", n ,o provided for by Section 3100 of the tabor Code,for Use performance of the k for which this permil is issued. I have end will maintain Worker's Contras ion Insurance,u requited by Section o of Nc labor Code,for Ne performance of Ne work for which Nis permit is issued. Workds Compensation Insurance canner and Policy number am: rin: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This eccarm need not heaamPleled if the Permit is fnrone hundred dollars($100) leo.) I cenify Nat in the perfnm once of the work for which this Month is issued.I shall not employ any permn in any manner an as in become subject to the WorkersCompensation Laws of California.Data Applicant NOTICE TO APPLICANT:IL after making this CeniBcate of Exemption,you should become subject to the Workers Compcnsatinn provisions of the Iabm Cnde,you must =O forthwith comply with tech Prnvisinns or this Permit shall ha deemed revoked. z ti CONS TRUGTIONLENDING AGENCY Ihereby affirm thetmit i issued(Sec.3097lending agency for Pcrfurmance u( Z Newark for which this permit is issued(Sec.]f91,Civ.C.) 'y Q ndr's Name U =z Lcndeh Address _ ;)Q 1 cenify that I have read this application and¢tire that Ne above information is yy (✓ COMM 1 agree to comply with all city and county onlinames and sum laws relating to V building consuucdon,and hereby euNamn mpresenmiws or this city to enter upon On aabove-mentioned property for it i peNon purposes. (We)agree to¢eve,Indemnify and keep harming,The City of CupL'nino against tiv� liabilities,judgments.costs and ca panes which may in any way accrue against said City J Z in cameguenee of Ne gr&nling of This Permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs HAZARDOUS Signature o(ApplicaDO Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant tar(inure building occupant store or handlealth and u defined material by IM Cupertino Municipal Cwk. He Chapter 9.11,and the Health and Safely ode,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes ❑No 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 havaNnm air contaminants as d.fned by On Bay Area Air Quality Management all new materials for inspection. is are, ❑Yea ON. - I have mad the haominas materials mquiremcnts under Chapter 6.95 of the Califor. nix Health X SafeyCode,Secdmu 25505,25533 ond25534.I undersand that alone building does not currently haw a tenant.Nat it 4 my msp onsibility m notify the occupant of the myuiraments which must be met poor to issuance of a Cenificete of Occupancy. Signature Of Applicant Date Owner or mdmn.d agent p„e All roof coverings to be Class "B”or better 03 9 City of Cupertino Building Permit Application E-Mail jobsite Address: 20415 Via Volante Date: 9-25-03 Owner's Name:---Mr. Robles Phone No.(408)257-5270 APN#: 316-01-028 Project Valuation: S 277.00 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: 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# 591329 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 Name on Card: just Water Heaters Inc. Z 3 2�7 Expiration Date: 9/05 / © 6 I Visa MasterCard X Comments