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08120110 CITY OF CUPERTINO i +%- xuwe' €,r BUILDING DIVISION PERMIT RC,ONTRAC RINF0RMATION < BUILDING ADDRESS:~ PERMIT NO. 11101 BUBB RD JUST WATER H OWNER'S NAME: PERMIT 155UE DATE A CONTROL N0. IN (510) 293-9901 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH X00 LICENSED CONTRACTOR'S DECLARATION Job Description { 1 Whet,affirm Most 1 Am licensed under provisions of Chapter 9(Commencing with Section 7")of Division 3 of due Business artd Professions Code,and my license is u in full foeeaMeffect REPLC 40 GAL WTR HEATER , j z— License Class LM.9 t„ Dau COMAAC- ARCHITECT'SDECLARATION 1 understood my plans shall W used u public records V kaG Licensed Pmllemkom 3 OWNER-BUILDER DECLARATION I hereby affirm that i am ea,mpt from the Canlnnah Liccne Law ror the COO following recon.(Section 7131.5,Business and Profen bre Code:Any city or county $� which requires a permit In construct,alter.improve,demolish,or repair any swctum _;< priorth its issuance.also requires the applicant for such permit to file a Signed sts ouch, That W is licensed pursuant to the provisions of the Contncter's License Law(Chapter 9 Sq.Ft.Floor Area Valuation B.: that (commencing with Section 7000)of Division 3oflW Business and Profusions Code)ur s`<_ thm he is exempt tWMfmAA.and the basis for the alleged exemption.Any violation of 1276 Section 70313 by any applicant for a pemtit subjects the applicant to A Civil PcnRlly of APN Number Occupancy Type not mo.More five hundred dolWsOi=. 35620004 . 00 ❑I.uowner of tiie pmlerty,omy employ,u with waguas Nest sole compensation, will do the wads and He swctuca is notimrended or offered fonale(Sec.7004,Business and prefeaVOna CAdA:Tim ConVebrs LKenam Law does not apply A,an owner of Required Inspections property who builds ter i m pmm thereon,and who does such work himself or Ilueugh his own employers.provided that such improvements tee not imeeded orofferW(Dale If. however,the building or improvement is sold within ore year of completion.the owucr- W ilder will have the hurden of proving that he did rot Wild w improve for pMpMM of ask.). 1,As owner of Ne property,am exclusively contracting with licensed Conuacurs e construct the projew(Sec.7044,Business and Profassiou Code:)The Contractors Li. cents Law docs not apply As an owner of Property who Wilds or improv Hereon,And, who contracts for such pmjeen with a conuacu r(s)licensed pursuant m she Conuackes Laceme law. ❑I am exempt under See ,B k P C for Nu reason Owner Dau WORKER'S COMPENSATION DECLARATION I hereby arm under Penalty of perjury tine of the following declarations: 1 hive and wBl mainui,•Comificale of Consent m calf-insure fer War4YSCompen- ion,As provided for by Section 3700 of the labor Code.for Ne performance of she work for which this Permit is issued. 1 have and will maintain Workers Compcoutlon Insurance,As required by Section 3700 of de labor Code,for dm performance of Ue work for which this permit is issued. My Worker's Compensation Insurance carrier end Policy number art: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Crbu ectirn mods nwbecompleted if the permit is foram,hundred dollars($100) or 1.) I certify that in the performance of the work for which His permit is issued.I shall not employ any person in try manner an As te become subjecuo the Workers'Compensation Laws of CalifomiR.Dau Applicant NOTICE TO APPLICANT:IL after making this Cer ifiu¢of Exemption,you should become subject As Ne workees Compensation previsions or the labor Code,you most ,,. forthwith comply wish such provisions or this permit shall W deemed revoked. 'Z 0 CONSTRUCTION LENDING AGENCY IWrelb,.Mm loss them ua,oastmcutn lending agency for Ne pefformaue of Ca > the work for which this Permit is Issued(Sec.3097.Civ.C.) ALenders Name , = z undees Address U O 1 certify Nat I have mad Nis application arW sou this the aWne Mfomutien is Ty !' correct 1 agree so comply with all city and county ordinances and sum laws calming to building construction,and hereby aushorim apmscnudv of His city to Amur upon Ne W ahove-mentioned pmNrly for inspection purposes. gy (We)agree to save,indemnify and keep harmless the City of Cupertino against rFw sty liabilities.judgmenW encu and expemcs which may in my way aceroc against said City U'Z in eorace unee of the granting of this permiL `-' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signature of ApplicamuContsmoor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant u future building occupantstmc orhandle hazardous material u defined by the Cupertino Municipal Code.Chapter 9.13.and He Health and Safety Code,Sutton 25533(a)? ❑Yes ON. All roofs shall be inspected prior to any roofing material being installed. Will um applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove II hazardous air coeuminsums m dcfind by the,Bay Area Air Quality Management all new materials for inspection. strict? O Yes ON. I have real Ne bsaardrms mmmO.I1h WMMA taunderCbmm,6.9!ofNeCalifar- nu Noahh d:SafetyCade,SttUmu VIM.25533 sous M34.I uMerzund thmif do Wilding does rut currently bast a tenant Has It is my responsibility As notify IW oumpxt of the mquimmcntswhebmost A,met prior ushansom ofacerolf"moraNpamcr. Signature of Applicant Date Owner car auNorir,d agent Dau' ' 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 . . . . . . . . : 35620004 . 00 DATE ISSUED. . . . . . . : 12/16/2008 RECEIPT # . . . . . . . . . : BS000006837 REFERENCE ID # . . . : 08120110 SITE ADDRESS . . . . . : 11101 BUBB RD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : CHANDRA RAJIT C AND MARIE H ADDRESS . . . . . . . . . . : 11101 BUBB RD CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4956 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 1, 276 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1PPERMITFE FLAT RATE 1. 00 40 . 79 0 . 00 40 . 79 0 . 00 IPRWHEATR 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 s Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 OCUPEkTINO Building Department JOB ADDRESS: PERMITp 11101 Bubb Rd. d a O OWNER'S NAME:Marie Chandra PHONE #408-996-1032 GENERAL CONTRACTOR: JustWater Heaters FAX # 510-783-6360 I am not using any subcontractors: 9-aw- 12/16/08 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 Paving Plastering Plumbing Just Water Heaters 591329 Roofing Septic Tank Sheet Metal Sheet Rock Tile • 0"'am. t� 12/16/08 Owner/Contractor Signature Date 10/28/03 • City of Cupertino Building Permit Application E-Mail Jobsite Address: 11101 Bubb Rd. Date: December 16, 2008 Owner's Name:---Marie Chandra Phone No (408)996-1032 APN#: 356-20-004.60 Project Valuation $1,276.00 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#: C45096282 Carrier: ACE Exp. Date: 4/1/09 Credit Card Information Credit Card #: Name on Card: Just Water Heaters Inc. Expiration Date: 6/11 Visa MasterCard Comments