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09040100 CITY OF CUT? RTINO BUILDING DIVISION PERMIT • PERMIT NO. BUILDING ADDRE�ENMQ�RET�� 1018 JUST WATT, H pE(tM1Tl$SIIEDATE OWNER'S NAME. '2Ar)O TA-117 A 2 E) CONTROL NO. jNE: (510) 2 9 3 -non' BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH ti Q p C LICENSED CONTRACTOR'S DECLARATION Job Description VI hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is RP LC TNK L S WATR H EATR "4 y in full force and effect. Lle N v�Z License Class Contractor 3 y p Date ARCHITECT'S DECLARATION C` I understand my plans shall be used as public records �yU O t- Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the p o following reason.(Section 703 1.5,Business and Professions Code:Any city or county 9 which requires a permit to construct,alter,improve,demolish,or repair any structure Valuation y=N prior to its issuance•also requires the applicant for such permit to tilt a signed statement Ft.Floor Area C Z< that he is licensed pursuant to the provisions of the Contractor's License law(Chapter 9 `q 3 0 9 8 F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occup an Type Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number p not more than five hundred dollars(SSW). 3 6 215 0 3 . 00 I,as owner of the property or my employers with wages as their sole compensation, Required Inspections will do the work and the structure is not intended or offered for sale(Sec.7044.Business and professions Code:The Conuwtors 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.). I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(See.7044,Business and Professions ode improves thereons .Li . cense Caw does not apply to an owner of property P who contracts for such projects with a contractor(s)licensed pursuant to the Contractofs License Law. B&P C for this reason 0 1 am exempt under Sec Owner Date WORKER'S COMPENSATION DECLARATION I 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 Workees Compensation Insurance carrier and Policy number ate: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ('this section need not be completed if the permit is for one hundred dollars(S 100) or less.) T 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 Workers Compensation provisions of the Labor Code,you must 2 forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY CA 4 1 hereby affirm that there is a construction lending agency for the performance of Lx> the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name Do Lenders Address I certify that I have read this application and state that the above information is LUL 0 cortccL I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the above-mcntoned property for inspection purposes. Gla W (We)agree to save,indemnify and keep harmless the City of Cupertino against Hliabilities,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 b): SOURCE REGULATIONS. Re-roofs Signature of Applicant/Contractor Dare T of Roof HAZARDOUS MATERIALS DISCLOSURE Type 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(x)? All roofs shall be inspected prior to any roofing material being installed. Cl Yes C]No 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? [3Yes ONO 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 d p not currently have a tenant.that it is my responsibility to notify the occupant of the Signator,,of Applicant Date requirements which must be mel or to issuance of a Certificate of Occupancy All roof coverings to be Class'``or better \ Owner or authorized agent Date ' �? 01 0o City of Cupertino Building Permit Application E-Mail Jobsite Address: 1018 Kenmore Ct. Date: April 20, 2009 Owner's Name:---Hyland, Beverley Phone No (408)257-8942 APN#: 362-15-039, p 0 Project Valuation $3,098.00 Building Permit Info: Bldg----------- Elect----------- Plumb------X----- Mech----------- job Description Replace tankless water heater. Contractor Information Company: Just Water Heaters Inc. 'hone: (510)293-2012 Contact Name: Dulce F ix: (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: 3/31110 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 El MasterCard X Comments Community Development a 10300 Torre Avenue ; ,. Cupertino CA 95014 Telephone(408)777-3228 s �T F Fax(408)777-3333 CUPEI�TINO _ Buildi:n Department JOB ADDRESS: PERM�I # 1018 Kenmore Ct. tJ� 0� OWNER'S NAME: Beverly Hyland PHONE # 408-257-8942 GENERAL CONTRACTOR: JustWater Heaters FAX # 510-783-6360 I am not using any subcontractors: '' ` � ' �"' 04/20/09 Signature Date Please check a licable subcontractors and complete the followin 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 04120/09 09 Owner/Contractor Signature Date 10/28/03