The URL can be used to link to this page

06060052 CITY OF CUPERTINO BUILDiirG DIVISION PERMIT roT I �T�� "' ` BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT No. 06060052 10167 DTI S ON AV PERMIT ISSUE DATE OWNER'S NAME: HAO LI 3400 INVESTMENT RT-VD 06/09/2006 SANITARY NO. CONTROL NO. VE: (510).293-9901 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 a a O p LICENSED CONTRACTOR'S DECLARATION Job Description W affirm I hereby arm that I am licensed under provisions of Chapter 9(commencing Z�, with Section 7000)of Division 3 of the Business and Professions Code.and my license is REPLACE 40 GALLON GAS WATER HEATER I"ll y in full force and effect r 2 Z License Class Lic•k G Dam Contractor F m ARCHITECTS DECLARATION i�< I understand my plans shall be used as public records :0. O I- Licensed Professional OW NER-BUILDER DECLARATION aI hereby affirm that I am exempt from the Contractor's License Law for the :2 o following reason.(Section 7031.5•Business and Professions Code:Any city or county $690 e m g which requires a permit to construct.alter,improve,demolish•or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement S Ft.Floor Area Valuation ?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 fl 4 F (commencing with Section 7000)of Division 3 of dtc Business and Professions Cade)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of r not more than five hundred dollars(5500). ❑1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended oroffered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law docs 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 '71 sale.). ❑I•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- cense 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 W Ll Ll L Owner Date J -' WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: 1 I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑1 have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's 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 for 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 z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of a> the work for which this permit is issued(Six.3097,Civ.C.) W Q Lender's Name az Lender's Address U 0 1 certify that I have read this application and state that the above information is [I.E"1 correct 1 agree to comply with all city and county ordinances and state laws relating to G,U building construction.and hereby authorize representatives of this city to enter upon the above-mentioned properly for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against HCs) 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 Dare Type Of Roof HAZARDOUS MATERIALS DISCLOSURE yP 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 Cole,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes 13 No If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or rddevices which all new materials for inspection. :mit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑Yes ONO 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 Date requirements which must be met prior to issuance of a Certificate of Occupancy. Signature Of Applicant All roof coverings to be Class'B"or better Owner or authorized agent Datc' CITY OF CUPERTINO m 3 of 3 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 31628024 . 00 DATE ISSUED. . . . . . . : 06/06/2006 RECEIPT #. . . . . . . . . : 34715 REFERENCE ID # . . . : 06060052 SITE ADDRESS . . . . . : 10167 DENISON AV SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER HAO LI 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 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ -- OTHER 252 . 06 MASTERCARD TOTAL RECEIPT 252 . 06 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING ' b b�OC�b City of Cupertino Building Permit Application E-Mail Jobsite Address: 10167 Denison Ave. Date: 06-05-06 Owner's Name:---Hao Li Phone No.(408)279-8979 APN#: 316-28-024 Project Valuation: $690.00 Building Permit Info: Bldg Elect Plumb X-- Mech ,fob 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:3400 Investment Blvd. E-mail: permitdept@sbcglobal.net City,State and Zip: Hayward,CA. 94545 State Contractor's License# 591329 Exp.Date: 3/31/08 Worker's Comp#: C44510091 Carrier:ACE Exp. Date: 4/1/07 Credit Card Information Credit Card #: 5474-6390-0047-8660 Name on Card: .Just Water Heaters Inc. Expiration Date: 06/08 Visa MasterCard Comments Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 OF Fax(408)777-3333 f..',UPEI�TINO Building Department JOB ADDRESS: PERMIT # 10167 Denison Ave. OWNER'S NAME:Hao, Li PHONE # 408-279-8979 GENERAL CONTRACTOR: Just Water FAX # 510-783-6360 Heaters ` I am not using any subcontractors: ` �'� C� � 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