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06060050 CITY OF CUPERTINO BUILD1i.G DIVISION PERMIT � To 0? MTI€I1�1 BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT 110- 06060050 22126 LINDA VISTA PL PERMIT ISSUE DATE OWNER'S NAME: KU MARTIN 3400 INVESTMENT 06 SANITARY NO. CONTROL NO. NE: (510) 293-9901 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH p C LICENSED CONTRACTOR'S DECLARATION Job Description VI hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 70(10)of Division 3 of the Business and Professions Code,and my license is t?y in full force and effect. REPLACE 50 GALLON GAS WATER HEATER v�Z License Class Lle•N p Date Contractor t ARCHITECTS DECLARATION i a< 1 understand my plans shall be used as public records cul O y Licensed Pmfcssional OWNER-BUILDER DECLARATION a1 hereby affirm that I am exempt from the Contractor's License Law for the DO following reason.(Section 7031.5,Business and Professions Code:Any city of county C,O 0 6� which requires a pcmtit to construct,alter,improve,demolish,or repair any structure y prior in its issuance,also requires the applicant for such permit to rile a signed statementValuation Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area j�- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of I` Occupancy Type not more than five hundred dollars(5500). ❑I.as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered forsale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- ccnse Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sec. B&P C for this reason Owner Date _ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I hive and will maintain a Certificate of Consent to self-insure for Worker's Comp- j cation,as provided for by Section 3700 of the Labor Code,for the performance of the J 1 work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. i_ My Workees Compensation Insurance carrier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is Cor one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z, CONSTRUCTION LENDING AGENCY rCA. I hereby affirm that there is a construction lending agency for the performance of LY> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name Lender's Address U C) I certify that I have read this application and state that the above information is [L correct.I agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby authorise representatives of this city to enter upon the W above-mentioned property for inspection purposes. /17 (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities.judgments.costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date ►" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. Re-roofs Signature of Applicant/Contractor Date T Of Roof HAZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(x)? 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 emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes ❑No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a certificate of Occupancy. Signature of Applicant Date All roof coverings to be Class 'B or better Owner or authorized agent Date CITY OF CUPERTINO m 1 of 3 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35608011 . 00 DATE ISSUED. . . . . . . : 06/06/2006 RECEIPT # . . . . . . . . . : 34715 REFERENCE ID $# . . . : 06060050 SITE ADDRESS . . . . . : 22126 LINDA VISTA PL SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER KU MARTIN ADDRESS . . . . . . . . . CITY/STATE/ZIP . . . : 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 ---------- ------------- ---------- ---------- ---------- ------- BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BPWHEATER PER HEATER 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 84 . 02 0 . 00 84 . 02 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ------ 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING C:)�.QOf�0 X50 City of Cupertino Building Permit Application E-Mail jobsite Address: 22126 Linda Vista PI. Date: 06-05-06 Owner's Name:---Ku,Martin Phone No.(408)253-3339 APN#: 356-08-011 Project Valuation: $500.00 Building Permit Info: Bldg Elect Plumb____X_ Mech .Job Description Replace 50 gallon gas water heater. Contractor Information Company: just Water Heaters Inc. Phone: (510)293-2012 Contact Name: Dulce Fax: (510)293-2022 Address:3400 Investment Blvd. E-mail: permitdeptesbcglobal.net City,State and Zip: Hayward,CA. 94545 State Contractor's License# 591329 Exp.Date: 3/31/08 Worker's Comp#: 044510091 Carrier:ACE Exp. Date: 4/1/07 Credit Card Information Credit Card #: 5474-6390-0047-8660 Name on Card: dust Water Heaters Inc. Expiration Date: 06/08 Visa MasterCard X Comments Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 ITY F Fax(408)777-3333 CUPEKTINO Building Department JOB ADDRESS: PERMIT # 22126 Linda Vista P1. OWNER'S NAME:Ku, Martin PHONE # 408-253-3339 GENERAL CONTRACTOR: Just Water FAX # 510-783-6360 Heaters I am not using any subcontractors: 06/05/06 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 06/05/06 10/28/03