09080092 CITY OF CUPERTINO BUILDING PERMIT
BUILDLNG ADDRESS: 1 123 SCOTLAND DR CONTRACTOR:JUST WATER HEATERS PERMIT NO:09080092
INC
%R'S NAME: JDS PROPERTY MGMT 3400 INVESTMENT BLVD DATE ISSUED:08/11/2009
OWNER'S PHONE: 4082641166 HAYWARD,CA 94545 PHONE NO:(510)293-9901
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT f— PLUMB
License Class Lic.#
MECH RESIDENTIAL COMMERCIAL
Contractor Date
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE 40 GAL WATER HEATER
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
1 have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the Sq.Ft Floor Area: Valuation:$1096
performance of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:36226053.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree tocomply with all city and county ordinances andof
state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmlcss the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
.;re Date
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
❑ OWNER-BUILDER DECLARATION installed without first obtaining an inspection,I agree to remove all new materials for
' inspection.
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons: Signature of Applicant: Date:
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&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE
1 hereby affirm under penalty of perjury one of the following three 1 have read the hazardous materials requirements under Chapter 6.95 of the
declarations: California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain a Certificate of Consent to self-insure for Worker's compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Compensation,as provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(a)should 1 store or handle hazardous material.
performance of the work for which this permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I have and will maintain Worker's Compensation Insurance,as provided for by contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Section 3700 of the Laser Code,for the performance of the work for which this Health&Safety Code,Sections 25505,25533,and 25534.
permit is issued.
I certify that in the performance of the work for which this permit is issued,1 shall Owner or authorized agent:
not cmpl:fy any person in any manner so as to become subject to the Worker's _. Date:
Compensation laws of California. If,after making this certificate of exemption,I
becomt:subject to the Worker's Compensation provisions of the Labor Code,I must CONSTRUCTION LENDING AGENCY
forthwith comply with such provisions or this permit shall be deemed revoked. I hereby affirm that there is a construction lending agency for the performance of work's
foi which this permit is issued(Sec.3097,Civ C.)
APPLICANT CERTIFICATION Lender's Name
I certify that I have read this application and state that the above information is
correct. 1 agree to comply with all city and county ordinances and state laws relating Lender's Address
tt , Iding construction,and hereby authorize representatives of this city to enter
ie above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
inw.iimity and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional _
9.18.
Signature_ ___ _ __Date__
Um oocp_
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 1123 Scotland Dr. Date: August 7, 2009
Owner's Name:--JDS Property Mgmt.
Phone No (408)264-1166
APN#: 362-26-053 Project Valuation $ 1,096.00
Building Permit Info: Bldg---_— Elect— Plumb---X-__ Mech____
.Job Description
Replace 40 gal water heater
Contractc r Information
Company: Just Water Heaters Inc. Phone: (510)293-2012
Contact Name: Dulce Fax: (510)293-2022
Address:3400 Investment Blvd _-mail: perm itsg)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 #: 5474-6390-0047--8660
Name on Card: ,Just Water Heaters Inc.
Expiration Date: 6/11
Visa MasterCard X
Comments
Community Development
10300 Torre Avenue
Cupertino CA 95014
alo Telephone(408)777-3228
CUPF�TINO Fax(408)777-3333
Building Department
JOB ADDRESS: PERMIT p
1123 Scotland Dr. o D 0 U
OWNER'S NAME: Michael Yukelson PHONE # 408-264-1166
GENERAL CONTRACTOR just Water Heate:-s FAX # 510-783-6360
I am not using any subcontractors: 08/07/09
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
/07/09
Owner/Contractor Signature Date
10/28/03