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07090099tUE i<a t�2 tad .oma jinC e2m9 �^v =C tFa L CITY OF.CUPERTINO �r -�pp. '�7 Ar*��-� BUILDING DIvisibN PERMIT D ESS: BUILD�� MC CLELLAN RD JUST WATER HEATERS INC PERMIT NO. 07090099 OWNER'S NAME: PERMrr ISSUE DATE HITESH PATEL 3400 INVESTMENT BLVD 09/17/2007 NE: SANITARY NO. CONTROL NO. (510)2-c,3-9901 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH a 0 a a LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70M) of Division 3 of the Business and Professions Code, and my license is WATER I [EATER in full force and effect. License Class Lic• # Date Contractor ARCHITECTS DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby 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 Sq. Ft. Floor Area Valuation prior to is issuance, also requires the applicant for such permit to file a signed st_tcoml License Law that he is licensed pursuant to the provisions of the Contractor's (Chapter9 Professions Code) $1100 (commencing with Section 7000) of Division 3 of the Business and or that he is exempt therefrom and the basis for the alleged exemption. Any violation of 357050-r,5 A,p Number : C7 Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (x500). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, Required Inspections 9 P will do the work and the structure is not intended or offered for sale (See. 70". Business 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 sale J. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Couraetoes 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 Conuactoes License Law. Q I am exempt under Sec B & P C for this rnsoo Owner Date WORKERS COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a Certificate of Consent to ulf-insure for Worker's Compen- sation, as provided for by Section 3700 of Elie Labor Code, for the performance of the 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. 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 for one hundred dollars ($100) or less.) 1 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 r 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 (See. 3097, Civ. C.) Lender's Name Lenders Address I certify that 1 have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to jbuilding construction, and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against r3 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 Issued b) Date SOURCE REGULATIONS. Re -roofs m Type of Roof Signature of Applicant/Conlractor Date DISCLOSURE HAZARDOUS MATERIALS 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)? All roofs shall be inspected prior to any roofing material being installed. ❑ Yes Q Nu If a roof .s installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Managcmem all new materials for inspection. District? ❑ Yes ❑ No I 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 ifft 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 or a certificate of Occupancy. Signature of Applicant Date _ All roof coverings to be Class "B" or better Owner of authorizcd agent Date - City of Cupertino Bui Idin E -Mail Jobsite Address: 22347 Mc Clellan Rd. . Owner's Name: ---Patel, Hitesh Phone No (408)252-8669------ APN#: 357-05-055--------- Buildina Permit Info: Bid EI ect--_ 1 Permit Application Date: September 12, 2007 Project Valuation $ 1,100. 00 Plumb ------ X ----- M ech----------- 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 Phone: (510)293-2012 Fax: (510)293-2022 -mail: perm its@ju stwaterheaters. net �1D Ll tr Exp. Date: 3/31/08 Worker's Comp#: 01 DKRMI 1001070 Carrier: Nelos Credit Card Information Credit Card #: Name on Card: Just Water Heaters Inc. Expiration Date: 6/08 Visa 1-1 Ma ;terCard X Comments Exp. Date: 4/1/08 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT' RECEIPT Sec: Twp: Rng: Sub: Bl}:: Lot: APN ........: 35"05055.00 DATE ISSUED.......: 09,'18/2007 RECEIPT #.........: BS000002666 REFERENCE ID # ...: 07090099 SITE ADDRESS .....: 22;147 MC CLELLAN RD SUBDIVISION ...... CITY .............: CUPERTINO IMPACT AREA ...... OPERATOR: suew COPY # : 1 OWNER ............: HI-ESH PATEL ADDRESS ..........: 22:47 MC CLELLAN RD CITY/STATE/ZIP ...: CUPERTINO, CA 95014-2768 RECEIVED FROM ....: JUST WATER HEATERS CONTRACTOR .......: GILROY, JOHN LIC # 15128 COMPANY ..........: JUS)T WATER HEATERS INC ADDRESS ..........: 3400 INVESTMENT BLVD CITY/STATE/ZIP ...: HA"WARD, CA 94545 TELEPHONE ........: (5:_0)293-9901 FEE ID UNIT QUANTITY hMOUNT PD -TO -DT THIS REC NEW BAL ----------------------- PPERMITFEE FLAT RATE ---------- 1.00 -------------------- 40.79 0.00 ---------- 40.79 ---------- 0.00 PRWHEATR UNITS 1.00 24.48 0.00 24.48 0.00 TRAVDOC FLAT RATE 1.00 40.79 0.00 40.79 0.00 TOTAL PERMIT ----------- ---------- 106.06 0.00 ---------- 106.06 ---------- 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- CREDIT CARD 106.06 -------------------- MC --------------- TOTAL RECEIPT 106.06 Community Development 10300 Tone Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT # 22347 Mc Clellan Rd. BUSINESS LICENSE # OWNER'S NAME: Patel, Hitesh PHONE # 408-252-8669 GENERAL CONTRACTOR: JustWater Heater FAX # 510-783-6360 I am not using any subcontractors: ' `�d`"-� 09/12/07 Signature Date Please check annlicable subcontractors and complete the following information: Owner/ Contractor Signature 09/12/07 E ate 10/28/03 SUBCONTRACTOR BUSI:vESS 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 �. Owner/ Contractor Signature 09/12/07 E ate 10/28/03