06100116 CITY OF CUPERTINO
BlliDllvii,'3IERTI PERMIT � � '
BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT NO. 06100116
19986 RODRIGUES AVE
PERMIT ISSUE DATE
OWNER'S NAME:
WEY CHANG 3400 INV
SANITARY NO. CONTROL NO.
NE:
(510) 293-9901
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
O p LICENSED CONTRACTOR'S DECLARATION Job Description
u p 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z" with Section 7000)of Division 3 of the Business and Professions CMc,and my license is
y in full force and effect. REPLACE 50 GALLON GAS WATER HEATER
m ? License Class Lic.#
F DateContractor
ARCHITHCPSDECLARATION
i a< I understand my plans shall be used as public records
1yU
U.
o H Licensed Professional
H OWNER-BUILDER DECLARATION
'> I hereby affirm that I am exempt from the Contractors License Law for the
3 p o fallowing 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
?Z prior to its issuance,also requires the applicant for such permit to file a signed swement Valuation
_ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area
F (commencing with Section 7000)of Division 3 of time Business and Professions Code)or
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 F 0 0 Occupancy Type
not more than five hundred dollars($500).
❑1,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
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 contractors)licensed pursuant to the Contractor's
License Law.
❑1 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: /\
L]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 are: J
Carrier. Policy NO.: /\\v/,�
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
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 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
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
Z 2 CONSTRUCTION LENDING AGENCY
[~.r 1 hereby affirm that there is a construction lending agency for the performance of
a.7 the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lender's Name
az L.endees Address
U 0 I certify that I have read this application and state that the above information is
(L►�+ correct.I agree to comply with all city and county ordinances and state laws relating to
0 U building construction.and hereby authorise representatives of this city to enter upon the
U above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
V) liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z 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 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 roofs shall be inspected prior to any roofing material being installed.
❑Yes ❑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?
❑Yes ❑No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&SafclyCodc,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 met prior to issuance of a certificate of Occupancy. Signature of Applicant Date
Owner or authorized agent Date I All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEKTINO
Building Department
JOB ADDRESS: PERMIT #
19986 Rodrigues Ave.
OWNER'S NAME: Wey Chang PHONE # 408-802-914
GENERAL CONTRACTOR: Just Water FAX # 510-783-6360
Heaters
I am not using any subcontractors: 4 .10/10/06
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
U,X&Q- 4 - 10/10/06
10/28/03
CITY OF CUPERTINO
,m 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN 36904046 . 00
DATE ISSUED. . . . . . . : 10/16/2006
RECEIPT # . . . . . . . . . : 36451
REFERENCE ID # . . . : 06100116
SITE ADDRESS . . . . . : 19986 RODRIGUES AVE
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER WEY CHANG
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . :
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
-- ---------- ------- --- -------
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 NUMBER
- --- --- ------- --- --- ----- ---- ------------
OTHER 84 . 02 MASTERCARD
TOTAL RECEIPT 84 . 02
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING