05120054 CITY OF CUPERTINO
BUILDINGDIVISION PERMIT CONTRACTOR INFORMATIQN
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BUILDING ADDRESS; JUST WATER HEATERS INC PP"M"N0 05120054
10710 N BLANEY AV
OWNER'S NAME FERMrr ISSUE DATE
Alk DOROTHY ZESZUTEK 3400 INVESTME
NE SANITARY NO. CONIAOL NO.
(510) 293-9901
ARCHRECT/FNC'INEER: BUILDING PERMfr INFO
BLDG EIFLT PLUMB MECH
loo LICENSED COPRRALIORS DECVrRAnON � Job DeSCT'yuy/'� ��O E®
c m b/a firm Wal l w OWIRA undo DECL RAnON 9(a.omxN{ tl7 �el dial L
l E wiW Sectlm TUOO)aDividdn]aate Budrm oval Rvfo,im,Cadc.ad myliensh
± � mrduraamdiert« REPLACE WATER HEATER
Dina onic ciao N 40 GAL GAS
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f U Iun4manamF' %yplus"iInu,cduNWcn=erd, /
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03 OWNER-BUILDER DE CLARAnON BUILDING
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I bcmby M.Wu I R—eump R D the RArIONr,ldcrnc Law for We IN!9`Y'p�7�/
C o f.O.wint nuen(Sccdm 1D]u.Budoras and Pmfodum Calc:Any 61 a Camay .
$e which rtquao a parrot an cnwrct alla,knprmo,dcm.Nb.or repair my maean
-iy prior m d,iumnm.simaquita lit apple fa a,ch "it Lid LUn.fi{rsd Llllentm
pp o ,wKI,B�maawnaanlmuKpra.:,una�rurcadra.mr•,ua�l..(oral.ar9 Sq.Ft. Floor Area Valuatio 960
2�9 (chromatdn{widi Seedm 700O)of Owns.7 of We 9adnn,Lodi Pmf�ima Coae)ha
aul he a a¢mP,Limchm oand de tuh fa ttrUged earampdo..Any v-Lfdsh a
Swim INDM by Lay appliom fa a"emit month Ibe Applicant m a clvO�M1y ar � P� Y Type
ml mac Won floe h.adtd aah,a WWI, 3T1 30O8r OO u e
❑L u.woe or We popery.a my ervpbyca wdW r.p u thew mit caopvtodo0.
soc! ° armrk.Conj=T Coausc o s Loccous:I dons a sXIY W"•.a Required Inspections
ad Pmfraloo code The CmucmYt I.iccas law aaa apt appy m ao mvaj of eq .
p.perly omni huBd,a irvprneaavmn.and whodouwcb work him,eJf a thmu{h hl,
aw mPliheim Idmg or tWu.achanprortmevuineatinv of oladna Lan
V,
hm.e,v.theallium{a improlanm haat kiwnno year or kn p fd.dxaam-
bdhe wN Nom tW burdut a PeHn{that he ad nm miW a kopm=for povport a
,akd.
O L u owns a We Km nyl w uavd"Jy Raclin NW 1,--a mew.trn n
ma,a.a We".Jett(Soso 1 'B..Led Pmfeadaaa Code)ILe Cmtranne,Li-
1.2-
ilaw dors oast apply m as ori W'LXv,+tr"bd baW w unpnwa tbemm.Land.
whd co.vana fa a>b"..Jests riW amarcmt(L)Bewea pte,tunt m the CorwaearL
Li ve aro
�Iwucmp udeSec .BdvPCfa Wia rtaam
Ownv Da¢
WORxzitS COMPENSATION DEC'L TION
I l,ertby ifum tinder peony of pejmy.do of We f.11c, {dhdsMi0rcc
1lcieand wi0 codons.a Chad.a Cuoza in of-ia,am for V oa $canpea
slim,u pmvihil fa by Sent.37W of We labor Code,fa Inn Lmrf.om of the
what for which this pcmft is iwcd.
❑1 haw red ma mdmain W.W,Comp d..lasur .u ntltdr d by Seedm .
]'n10 or dho labor Codc.fa the perforarmcn of We wo,k fa wEld dad prnit is imed.
My Werkaes canpeawlm In oars ce aaier and Policy,numbs art:
Caorier. PoBcy No:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(iLox nnN.ho cmipktcd Vain p arat I,fame haddiod aWan($IOD)
ab )
1 gray thu u We porfamaae a the wool,for winch Wit pmeil h i I,hal has,
emplq any penin in any mai u n bec.rm hubjem in aha Waters'Compemadm
Laws of CYiforois.Duo
NanCE
NOfICETOARPIJC.wonl e.artamasici this Cmins,a a Eccmptioayou ah.ud '
become=object m We Watch Cao"orthis".rind^,a d c nnod Coac yin muv
.JO faWwiW comply wab mcL providetna this permaahWl be dmmtd mvNea.
z� CONSTRUCTION LENDING AGENCY
F— Ibertby aDam WU Wham laa camru'Ihn kndle{atmry far We"amnion¢a
(Y,> dm w=ok fa which W,"Walt 6 Wood(Sac.309T,Civ.G) /)
1 Q lenhYL Num
= z I<drYL Ad6ela
U0 I amdfy Wat I ba.=rtaa Wit appii ah ad Lar dou We abo.e"mfcma as U
mrtav I a{rce m maplY wait all ally anal comely dranartm,and sure hi rtlahnt n
O huddia$cmwoclim.Lm hertby awhonm cparntsi.e,of Wi,city,in mrnmr upon ft
r 4 above-meadacd popsy fa irupectim purpo¢a
(Wk)a{rte to-w,indemnify Lea keep I units We Cay ofCepcnino ataiau
VNlikie.lud{mcou.caas wall eapmsc,which avy In my my am .smear sW City
u In e.n ,,an=of Lin,t,uaat of W,pramil.
^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
SI{emum of ApylionVCawamdr Due
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WH aha appV®t a fuwe hadd t o¢upaaaort mbaeale hmrdw,macrW
mBnm hr aloe cdpenm Mtadapn eale,maae 9.I1.ad me HcdW area=acre
Cade.Sxdm n$]x(a)± All roofs shall be inspected prior to any roofing material being installed.
❑Yo ON.
WOI We appliaat or fu=bdildint o=u ma uac egtlpmcnl as tivim which If a roof is installed without first obtaining an inspection,I agree to remove
d wara,n all dmumiounu a dermm fly doe B.y,w Air adhr M,n.tcmea all new materials for inspection.
Div ?
❑Ya ON.
1 hate nod the WnNdu,towc+uh rtrpacntcw undo Chpam 695 of We Calira
ma HcalWh WnyCodq Sccd.ru IddOd.255J]ad 27dN.1 udcrvad Watlf Ik btdlddt
Joe rm cuorcalY m W.u,.nt.thu IL h my teapatdbilay Ia raxifY do daupm er aha
madacmen0 which a=an meL"rear in md,nm as eel;mm of amparcy. Signature of Applicant Date
owaar or acft. . Data. . All roof coverings to be Class"B"or better