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07080138CITY OF CUPERYINU y�7��ay I � T. BUILDING DIVISION �E1`1vilT BUILDT,p.QD,t T! SHASTA SPRING CT OWNER'S NAME: BRUNO ALPI ARCHITECT/ENGINEER: LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full a and effect. Licens , lass __-----Lic• ii Date r ♦ ,Contractor ARCHITECTS DECLARATION I cndefstand my plans shall he used as public records Licensed Professional OWNER -BUILDER DECLARATION I hcrchy affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior m its issuance, also requires the applicant for such permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (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 Section7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 0 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 for sale (Sec. 7044, Business and Professions Code: The Contractors License Law dots 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 sate. 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.). 0 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code:) The Contractors Li. cense Law does not apply to an owner of who contracts for such projects with a contractor(s)s1 tensed purrsua rty who builds or ito mproves the Contractors License Law' B & P C for this reason 0 I am exempt under Sec. Owner Date WORKER'S COMPENSATION DECLARATION ,z 0 I hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a Certificate of Consent to self -insure for Workers Compen- ttion, as provided for by Section 3700 of the Labor Code, for the performance of the ork for which this permit is issued. ] I have and will maintain Workcr's Compensation Insurance, as required by Section 700 of the Labor Code, for the performance of the work for which this permit is issued. Ty Workers Compensation Insurance carrier and Policy number are: :arrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE JUST WATER HEATERS INC 4 (510)293-9901 'ERMIT NO. 07080138 PERMIT ISSUE DATE ;AMT RY q6- CONTROL NO. BUILDING PERMIT INFO R1 nn ELECT PLUMB MECH Job Description REPLACE 50 GALLON GAS WATER HEATER (This section need not be completed if the permit is for one hundred dollars ($100) Lir less.) certify that in the performance of the work for which this permit is issued, I shall not :mploy any person in any manner so as to become subject to the Workers' Compensation aws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address I certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction. and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (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 in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REGULATIONS. Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE 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(a)? 0Yes ONO Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? 0 Yes 0 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 Lite building does 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 - jOwner or authorized agent Date ,q. Ft. Floor Area 36655025A$U Number issued b, Re -roofs Valuation $1378 Required Inspections Type of Zoof All roof:; shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new ;materials for inspection. Signatuie of Applicant All roof coverings to be Class "B" or better Date Citv of Cupertino Buildin E -Mail Jobsite Address: 11902 Shasta Springs Ct. Owner's Name: ---Bruno Alpi Phone No (408)408-253-2383------ APN#: 366 -55 -025 -------------- Building Permit Info: Bldg----- Elect— A lication Date: August 14, 2007 Project Valuation ,Job Description Replace 50 gallon gas water heater. Contractor Information Company: Just Water Heaters Inc. Contact Name: Address: 3400 Investment Blve. City, State and Zip: Hayward, CA. 94545 State Contractor's License * 591329 Worker'sComp*: O1 DKRM11001070 Credit Card #: Name on Card: Expiration Date: Phone: (510)293-2012 Fax: (510)293-2022 E-mail: permits@justwaterheaters.net Exp. Date: 3/31/08 C<<rrier: Nelos Exp. Date: 4/1/08 Credit Card Information Comments U 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Bl{: Lot: APN 36555025.00 DATE ISSUED.......: 08/15/2007 RECEIPT #.......... BSDO0002382 REFERENCE ID # ...: 07D80138 SITE ADDRESS 11902 SHASTA SPRING CT SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: CathyS COPY # : 1 OWNER BRUNO ALPI ADDRESS ..........: 11902 SHASTA SPRING CT CITY/STATE/ZIP ...: CUPERTINO, CA 95014-5107 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 ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 84.02 --------------- 84.02 VOICE ID DESCRIPTION -------- ---------------------------- 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING REFERENCE NUMBER -------------------- MC VOICE ID DESCRIPTION -------- ---------------------------- 506 GAS TEST Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT # 11902 Shasta Springs Ct. SUBCONTRACTOR OWNER'S NAME: Bruno Ali PHONE # 408-253-2383 GENERAL CONTRACTOR: JustWater Heaters FAX # 510-783-6360 I am not using any subcontractors:. 4c c�,. 08/14/07 Signature Date Please check a licable subcontractors and complete the following information: 08/14/0 Owner/ Contractor Signature Date 10/28/03 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 08/14/0 Owner/ Contractor Signature Date 10/28/03