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07050159 777, CITY OF CUPE.RTINO BUILDING DIVISION PERMIT CO�iTR�� TOR IYEQRMATIUN BUILDING ADDRESS: PERMIT NO. 10710 ORLINE CT JUST WAFER HEATERS INC 07050159 OWNER'S NAME: PERMIT ISSUE DATE 0 BRIEN JUDY A AND MICHAEL J 3400 INVEST ENT RIAM n,;/17/2on7 LONE: SANITARY NO. CONTROL NO. (510) 293-9901 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 z0 LICENSED CONTRACTOR'S DECLARATION Job Description U p I hereby affirm that I am licensed under provisions of Chapter 9(commencing z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPLACE 40 GALLON GAS WATER HEATER y in full force and effect. ? License Class Lic.# E Date Contractor ARCHITECTS DECLARATION a 1 understand my plans shall be used as public records aV 00 y Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from she Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolLsh,or repair any structure z y prior to its issuance,also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation 1=—$ (commencing with Scction 7000)of Division 3 of the Business and Professions Code)or $1050 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 APNNumber Occupancy Type not more than five hundred dollars(5500). 35922059 . 0 0 ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is notintendcd or offered forsale(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 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.). ❑1,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. E]I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: �]I have and will maintain a Certificate of Consent to self-insure for Worker's 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: Polity 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.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 0 forthwith comply with such provisions or this permit shall be deemed revoked. ((�� 4 " y CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of 11 >~ > the work for which this permit is issued(See.3097,Civ.C.) f7 Q Lender's Name Z Lender's Address C) I certify that 1 have read this application and state that the above information is 4 t-- correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorize 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 2 in consequence of the granting of this permit. Date APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by SOURCE REGULATIONS. Re-roofs Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type,of Roof 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 ❑No Will the applicant or forum building occupant use equipment or devices which If a roof i3 installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes ❑No I have read the hazardous materials requirements under Chapter6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance ora certificate of Occupancy. Signature of Applicant Date Owner or authorized agent Date I All roof coverings to be Class"B"or better CITY OF CUPERTINO 3 ITEMS OF 6 PERMIT RECEIPT OPERATOR: kiersaw COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot : APN . . . . . . . . : 35S22059 . 00 DATE ISSUED. . . . . . . : 05/17/2007 RECEIPT #. . . . . . . . . BSC00001358 REFERENCE ID # • . . 07C50159 SITE ADDRESS . . . . . : 1010 ORLINE CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER 0 ERIEN JUDY A AND MICHAEL J ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4351 RECEIVED FROM . . . . : JUET WATER HEATERS CONTRACTOR GII,ROY, JOHN LIC # 15128 COMPANY JUIET WATER HEATERS INC ADDRESS 3400 INVESTMENT BLVD CITY/STATE/ZIP . . . : HAYWARD, CA 94545 TELEPHONE (53.0) 293-9901 FEE ID UNIT QUANTITY 1,MOUNT 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 01 1 City of Cupertino Building Permit Application E-Mail Jobsite Address: 10710 Orline Ct. Date: 05-15-07 Owner's Name:---Michael O'Brien Phone No.(408)996-0152 APN#: 359-22-059 Project Valuation: S 1050.00 Building Permit Info: Bldg Elect Plumb X Mech fob DE!scri tion 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: dust Water Heaters Inc. Expiration Date: 06/08 Visa Ma;terCard X Comments Community Development 10300 Tone Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEI�TINO _ Buildi g Department JOB ADDRESS: PERMIT # 10710 Orline Ct. OWNER'S NAME: Michael O'Brien PHONE # 408-996-0152 GENERAL CONTRACTOR: JustWater Heaters FAX # 510-783-6360 I am not using any subcontractors: 05/15/07_ 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 Watet Heaters 591329 Roofing Septic Tank Sheet Metal Sheet Rock Tile 05,115/0 Owner/Contractor Signature Late 10/28/03