08100051 Bull LNG u1'ISION!- PERMIT ' CQNTRACT'OR IATFQRM�TION
BUILDING ADDRESS: ^ PERMIT NO.
7518 RAINBOW DR JUST WATER HEATERS INC 08100051
OWNER'S NAME: PERMIT SUE DATE
WASSERMAN FRANCES 3400 INVESTMENT BLVD 10/09/2008
)NE: (510) 293-9901 SANITARY NO. CONTROL NO.
ARCHREC7/ENGINEER: BURRING PERMITrhfFO
BLpG ELECT PLUMB MECH
20, LICENSED CONTRACTOR'S DECLARATION O O O O
@I hereby affirm Ned al 1 am licensed under pmvisiam of Chapter 9(commencing Job Description
withSectlon7OX)ofDivlsion3oftheBusiness mid Proletarians Code.and mylicense is RPLC 40 GAL WTR HTR
n in full force and affect
jai Lkeoe Class fY.P .
n Fp Dete Contractor
7W ARCHf1ERS DECLARATION
, u I undewnd my pWU Nil be used as public recerds
S O Licensed Professional
u701 OWNER.BUILDER DECLARATION
i i Z 1 hereby affirm Nat I un exempt from the Contractor's License Law for the
O econ O following moon.(Seed.703 1.5,Business and Pmlicam m Cade:Any city or county
K S V which Hope=a permit w crecou t,after,impmw,demolish.Or repair any stmewure
yii Prim to its Or...ala,Here.nuc applicanl for much Permit to fileasigred matrons
< that he is licensed possums omeprovisiomofthe Conlmmur'sLiecamLaw(Charter 9 Sq.Ft. Floor Area $ Valuation
x�g (commencingwithSection7000)ofDivision3oftheBusinessandProfessimtsCode)or 858
Nat he is attempt Ihmefmm and Ne bus for the alleged exempdon Any violation of
Section 7031.5 by any apple=,for a permit subjects the applicant m a civil penalty of Number Occu ane e
tot mom than row hundmd dallam(3100} 36611046 V64 Occupancy EYP
1,u owner of ile pmpeny.m my wploym with wages a Nub roto cmnpewtion,
cord do f..i IS andN The C1ont Ia en Mesiaderaw dr at 1 (SCL.IOU.ow.Of
and property
lou Cade The Cenmmon.Liscuromndwho date doer wort apply la arert awma i Required Inspections
pmpenywW�uiparvidmprots such
imps andwho aressuch retiedwork amaclfsurNmadeugh his
awnemployees,dingor i prsuchimps midwiitamml earofcmoRmad for role B,
builder.Ne buildingarnmerrovemant4 soldwithinecoyes orrompktive.Ne ownvf
Wilder wall have IW 4srden of proving Our W did Out dtiW or improv for puryas:of
aleJ.
1,as Owner of the pmpeny,am exclmiaely comMing with liceaed conb.ctom to
continues NC pm)ttl(See.7044,Business and Professional Code)The ConVaebrs LI.
cede Law doer not apply b an owner of property who Wilda or impmws thereon,and
who contracts for such projects with aconeumr(s)licensed punusnl to the Commences
Lksme Law.
I am exempt under See ,B&P C for this mason
Owner tela
WORKERS COMPENSATION DECLARATION
40 1 hereby affirm under penalty of perjury am of the following deelamtions:
I haw and will maintain a Certifiale of Consent to self-insure fm Worker's Compeer
ration,as provided for by Section 37W of the Labor Code.fm the per(ormamm of nuc
work for which this Permit is Issue&
❑I haw and will maintain Wortefs Compensation Iasuanm,as required by Section
37W (the saber Code.for me Performance of Ne work fmwbich itis permit is issued
My Woskca.Compensation Nsumna aHi.and Policy number am:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ibis section need not W completed if Ne Permit is fmone hundred dollars(SIM)
or less)
1 cntify that in the performance of the work for which this Permit u issued I s1Wl not
employ any Fuson in any ruencrm a a become subject to Ne Workers Compensative
Laws of California Date
Applicant,
NOTICE TO APPLICANT:If,after making this CamEam of Eaemplion,you should
become subject to the Worker's Compcmnion provisions of tiro Laker Code,you nmR
vJ O forthwith comply with such psoriSons or this permit shall the deemed mmkcd.
zh CONSMUCnON LENDING AGENCY
[+ I hereby affirm NU Nem is a construction lending agency for the performance of
lYi .mow de work for which this permit Is issued(Sec.3097,CW.C.) '
GQ Lender's Name
.7 z L udees Addmas
U Q 1 cattily that 1 haw mad his application W auto that the&bow information is
gy E' corrin.I agree to comply with all city and county on inan es and sue laws relating to
Wilding construction,and hereby autherine mpmaceudws of Nu city to enter.p..ftW abow-mentioned property for inspection purposes "
I„ py (We)agrce to saw.indemnify and keep harmless the City of Cupertino against
IA Iimilito,judgemms.emis and expenses which may in any way acenc aS of Mid City
U,z in consto mono of the graming of this permit.
ati APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature a(AppliaO e
Da
HAZA
HAZARDDOUS MATERIALS DISCLOSURE Type of Roof
Will the a Cupertino
m fMuni Wilding occupant r 9.1 or handle henNoa maerial
ss defined by the Cupertino Muniripai Cade.Chapter 9.13.and the Halm and Safety '
iCode,Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Y. 0 N
Will the applicant or future Wilding occupant use equipment m dcdaa which If a roof is installed without first obtaining an inspection,I agree to remove
it huardnus it comaminanu as defined by the Bay Amo Air Quality Management all new materials for inspection.
District?
C]Yes [I No
I hast mad the hamndoess maeriau requirememts under Chapter 6.95 of the Califon
nia Health h SafclYCede,-.,do.23M.25533 and!25534.1 undenundtins dura Wilding
docs ml comedy how a tenser.than It is my responsibility to notify the occupant of nuc
rer.tHrums which must W mel Prior to issuance ofa CcniOcam of Ocapamy. Signature Of Applicant Date
Owner or suthorixd&gem Dam'
All roof coverings to be Class'%"or better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36611046 . 00
DATE ISSUED. . . . . . . : 10/09/2008
RECEIPT #. . . . . . . . . : BS000006312
REFERENCE ID # . . . : 08100051
SITE ADDRESS . . . . . : 7518 RAINBOW DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WASSERMAN FRANCES _
ADDRESS . . . . . . . . . . : 7518 RAINBOW DR
CITY/STATE/ZIP . . : CUPERTINO CA, 95014-5237
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
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 858 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1PRWHEATR UNITS 1 . 00 24 .48 0 . 00 24 .48 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 106 . 56 0 . 00 106 . 56 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
--------------- -----------
CREDIT CARD 106 . 56 MC
---------------
TOTAL RECEIPT 106 . 56
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
518 WATER HEATER
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
«:UPEkTINO
Building Department
JOB ADDRESS: PERMIX #
7518 Rainbow Drive oxlimo5l
OWNER'S NAME: Wasserman, Francis PHONE # 408-257-4089
GENERAL CONTRACTOR: JustWater Heaters FAX # 510-783-6360
I am not using any subcontractors: V-af=Q- 10/09/08
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
Pavin`g �
Plastering
Plumbing Just Water Heaters 591329
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
• (D-a"e 4 �o� C�Qu`ct�^-) 10/09/08
Owner/Contractor Signature Date
10/28/03
ObOD0sr
•
City of Cupertino Building Permit Application
E-Mail
jobsite Address: 7518 Rainbow Drive Date: October 9, 2008
Owner's Name:---Francis Wasserman
Phone No (408)257-4089
APN#: 366-11-046- 1% Project Valuation .$ 858.00
Building Permit Info: Bldg-__-_-- Elect-_ __ Plumb__---X--- Mech_—__
Job Description
Replace 40 gal 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: permits@justwaterheaters.net
City, State and Zip: Hayward,CA. 94545
State Contractor's License# 591329 Exp. Date: 3/31/10
Worker's Comp#: 045096282 Carrier: ACE Exp.Date: 4/1/09
Credit Card Information
Credit Card #:
Name on Card: Just Water Heaters Inc.
Expiration Date:
Visa MasterCard
Comments