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07030140 CITE'OF CUPERTINO BUILDING DIVISION PE+Rllll$T �li ��G �� BUILDING ADDRESS: PERMIT NO. 10375 FARALLONE DR JUST Wi�TER HEATERS INC 07030140 OWNER'S NAME: PERMIT ISSUE DATE NEWHAGEN PAUL. 3400 INVESTMENT BLVD 03/19/2007 SNE: SANITARY NO. CONTROL NO. (510) 293-9901 ABUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 p LICENSED CONTRACTOR'S DECLARATION Job Description U I hereby affirm that I am licensed under provisions of Chapter 9(commencing :Z� withScction70()U)ofDivision3ofd,cBusinessandProfcssiunsCodc,andmyliccnscis REPLACE 50 GALLON GAS WATER HEATER aM in full force and effect. h? License Class Lic.H F in Date Contractor ARCHITECTS DECLARATION i z a I understand my plans shall be used as public records ;,u U.y Licensed Professional w OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the !p 00 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 r zprior to its issuance,also requires the applicant for such permit to file a signed statement _It that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $1411 t that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of A��l Number Occupancy Type not more than rive hundred dollars(5500). 369310--8 U V ❑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 'Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q p property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended oroffered 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.). ❑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 Owner Date WORKER'S COMPENSATION DECLARATION 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 Workcrs Compen- sation,as provided for by Section 3700 of the 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 Worker's Compensation Insurance carrier and Policy number am: 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,1 shall not employ any person in any manner so as to become subject to the Workcrs'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. M CA CONSTRUCTION LENDING AGENCY r,, =d r-d 1 hereby affirm that there is a construction lending agency for the performance of V :4> the work for which this permit is issued(See.3097,Civ.C.) QLender's Name =Z Lender's Address J 0 1 certify that I have read this application and slate that the above information is ►- correct.I agree to comply with all city and county ordinances and state laws relating to 1 V building construction,and hereby authorise representatives of this city to enter upon the W 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 J Z in consequence of the granting of this permit. Date APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b": SOURCE REGULATIONS. -S— � Re-roofs Signature of Applicant/Comractor Dare Type Of Roof 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)? All roofE shall be inspected prior to any roofing material being installed. ❑Ycs ❑Nu If a roof is 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 Management all new materials for inspection. District? Cl Yes C]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 the building does not currently have a tenant that it is my responsibility to notify the occupant of the _ requirements which must be mel prior to issuance of a Certificate of Occupancy. S Ignaturt'of Applicant Date All roof coverings to be Class"B"or better Owner or authorized agent Dare ' CITY OF CUPERTINO 3 ITEMS OF 6 PERMIT RECEIPT OPERATOR: kiersaw COPY # 1 Sec: Twp: Rng: Sub: B].k: Lot : APN . . . . . . . . : 3(1931018 . 00 DATE ISSUED. . . . . . . : 0:/19/2007 RECEIPT # . . . . . . . . . BS000000725 REFERENCE ID # . . . : 07030140 SITE ADDRESS . . . . . : 10375 FARALLONE DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : NEWHAGEN PAUL ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : LOS ALTOS CA, 94022 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : G=:LROY, JOHN LIC # 15128 COMPANY . . . . . . . . . . : JUST WATER HEATERS INC ADDRESS 32:00 INVESTMENT BLVD CITY/STATE/ZIP . . . : HliYWARD, 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 REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 168 . 04 MASTERCARD --------------- TOTAL RECEIPT 168 . 04 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ----------------------------- ------ ---------------------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING 0--�03o140 City of Cupertino Building Permit Application E-Mail Jobsite Address: 10375 Farallone Dr. Date: 03-07-07 Owner's Name:---Cambridge Mgmt. Phone No.(408)727-3021 APN#: Project Valuation: $ 1,411.00 Building Permit Info: Bldg Elect_ Plumb____X_ Mech ,Job Description Replace 50 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 Heateri Inc. Expiration Date: 06/08 Visa El MasterCard X Comments Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPERTINO Buildling Department JOB ADDRESS: PERMIT # 10375 Farallone Dr. 0__�n30140 OWNER'S NAME: Cambridge M mt. PHONE # 408-7273021 GENERAL CONTRACTOR: JustWater Heaters FAX # 510-783-6360 I am not using any subcontractors: �` ' �0 'r 03/07/07_ 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 Uola,_ 03/07/0 Owner/Contractor Signature Date 10/28/03