00110006 CITY OF CUPERTINo
EIiu.DING 1)!VISto , PERMIT - CONTRACTOR INFORMATION: _
BUIIDING A7)DRPSS � PERMIT NO.
— JUST. H .ATERF . • _ _ ..
OWNER's NAME I -. - APPLICATIONSUB DATE '
1 l I1/01/2000
DONE: _ SANITARY NO. CONTROL NO.
9"7
Pee
Z4 ARCHITEC rENGINEER: - — - - BUILDING PERMIT INFO
w- .. s BLDG EI.ECr PLUMB MECH
F a —I IJ• -1 IJ
LICENSED CONTRACIOR S DECLARATION
Z 5 = .. men . Job Description
Oz ,� Iherebyatt nn thatlwn lensed nd p sof Chpf 91 cing - P
l-al isith Section 7")of Division 3 of the Hu d Itofessio.Cod J qty license
Fa5 J isinruu lass demeL REPLACE 50 GALLON GAS WRIER HEATER
of p ) Liccnsa Class Lic.p t
X 3 a tc Ute Cnnmmhsr
ce u.O ARCHITECT'S DECLARATION
`] 1 unde,dind my pbenz shall he used as public rearms .
Y
w O O Licensed Pro!sionul -
a a Oat I am BUILDER m the RATION c
u v�. 1 hereby affirm on 1 1. exempt from the Cession, oc Licn y c Law for the
fohnswce? 1hich ing Han n.(Section 7 construct,
Business oil ve,dnions Code:Any city lir county.
W F O which requires a permit 1.re am.s the lifter.applicant
for cu demolish+lir repair by structure
c. poo t t:' I. requires ap0lc ff chile 'n is g JCh mem
mwhe :r ship fttnp rmeef Business L<e: l IChmm9 Sq. FLFIoorArea Valuation
(usm n1w,eem Secinn 7(c B of lotthe baion sisaom bel ,, evand
plion. ny,'Cade)
onl lit l -:exempt th f I o b farm,c II I d pt Any v airman _ �...
. a ofnot tion reiiunSliive bLoy
I III I)'Ban($W0 tat subjects the applicant ua'I penalty _ APN Number ' Occupancy'Type.
D 1,as owner of the property,lit my ampinyees with wages as their tole compensation.
x;R do the owk. d the oractme is of imedded ,,ldfidedl sale(see.704
Business and Required Inspections
professions:i, Code ThContractors L La dt apply eat an
x net of property Who Wilds or mpnwe-thembil,and who does such%ork himself
or through his own cmployoz.pow ided that such improvements are not intended erSO2 — F I PIAL 'PLUMBING ENERGY%
offered for sale.if,hillthe building or improvement is sold within one year of _
ample ion,the owner-bldlder will have the burden of moving that he did nm hails or _506 — GAS TEST
improve far purpra ui'sulu.). 1 s a
D L a of the pmpery. .elusively contracting with licensed cunlracons m 507 — FINAL PLUMBING
conswcnt they project ISoc.]p,4.Nus and Process s Codc:)no Contractor's
License law does oaf apply to an owucr of properly who W ods or improaca then n.
and who contracts for such projects with a contrrctims)licensed pursuant,.the - -
Comractofs License Use - ,
❑I am exempt under See. .B&P C for this mason
Owner Date .
WORKER S COMPP.NSA'I)ON DI;
CLAIZA'rION ,
I hereby aftinot tinder penalty ofp,J the follow g deelaricam,
I l have mad will maintain Certificate f Consent to off' I.,Worker', -
:open f n a1 provided far by Section 3700 of the t boli Cade. for the
performance of the work for which this permit is iswexi,
❑1 have and will maintain W(;rkcrs Compensation Insurance,as required by section
37110 of the Labor Code.hr the performance of the work for which this permit is
ucd.My Work,,,Cmnl'<nmaion Inacomwe earlier and Poll,number a¢: -
C'arier: Policy No: s
CERTIFICATION OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE. -This seainrt need not he completed B the permit is for one hundred dollar '
DIOD)or lescl
1 certify that in the perEwmance mf the work for which this permit is issued.I
shall not emplov any sero n in any mu r so as au become subject to the Worker%
ConCenswion Lawsof CaliRsmin.Date
nn
Applicant
NOTICE"FO APPLICAN'1:11.alter making anis Cuniticute of Exenlpdo,you should
second subject o the Worker s Compensation pnrviaiartiol he Labor Code.yon nn¢t -
Z tlmhwifh comply with such provisions or this permit shall be deemed,evoked.
^F CONSTRUCTION LENDING AGENCY -
a ] 1 hereby w�Tw that err iss construction Igoe.
0st?lending 1,C.) for the pcdisnnan¢ -
W fitLethe work for which this permit is issued(Sec.JIF)].Civ.C.)
d z Lender'.'Name
- r7 z Lendn'x Addie, -
V 0 1 evndy lha l base read this'pplicaf l)nand state hat the bo -t s .
correct,I agree to comply ant all city and county ordinaries and state laws refining
U lir buildin8eonstmetion.and hereby author lac rapmwmadvemfth,city,.toleration
} 4x1 the ahn'e-mentioned property for inspection paryoses.
,L C IW'eyagree,.saveJndecrnify and keep harmless the City meat<nhn against -.
fn liabilitie,judgments,costs and expenses which may in any way accrue against said -
V L_ City in consequence of the granting of this permit.
APPLICANT
UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT ULATIONS Issued by: Di1IC
'Sigawmaof AppreamtCanwctar, . Dela Re-roofsHAZARDOUS MATERIALS DISCLOSURE -
Will the applicant lir lmore building¢eupant score or handle hazardous material Type of Roof
as defined be the Cupertino,Municipal Cole.Chapter 9.12.and the health and Safety
Cole.Section 25532(x)'!
D yO1 ON. - - All roofs shall be inspected prior to anyroofing material being installed.
Will m 'villi f t t b Id' g n' t : q n f d rt rn If a roof is installed without first obtaining an inspection, I agree to remove
%;:nh hazardous f t.-:defined by theBay A \ Q hti M gentcm
" t all new materials for inspection.'Appl(cant understands and will comply with: -
DY- 0Nall non-point source regulations.
1 have read the M1 d,a z materials q u u tt'under Chapter 6.95 of the - h
L
in Health&Safety Code.Sections 25505.25533 and 25531.1 understand that
uilding does not mmently have a tenum.that it is my responsibility to notify thent of the mquiremnnt,which must be met pdo,lit%nuance of a Certificate ofney Signature of Applicant Date
or amhoimd agent Date All roof coverings to be Class `•Br" or better -
OFFICE
City of Cupertino Building Permit Application
E-Mail O(MoO®4
Jobsite Address: 20090 La Roda Ct.
Owner's Name:---Cramb Dale .
Phone No.(408)253-5591
APN#: 369-34-033 ---------- Project Valuation: S 989.04----------
Building Permit Info: Bldg----------- Elect-_------_. Plumb------X----- Mech--_-----
Job Description
Replace 50 gallon gas water heater.
Contractor Information
Company: Just Water Heaters Inc. Phone: (510)293-2012
• Contact Name: Fax: (510)293-2022
Address: 1764 National Ave. E-mail: permits@justwaterheaters.net
City, State,and Zip: Hayward,CA. 94545
State Contractor's License# 591329 Exp. Date: 3/31/02
Worker's Comp#: 031<110001018 Carrier: Clarendon Exp. Date: 4/1/01
Credit Card Information
Credit Card #: 5474-6331 -7168-6326
Name on Card: just Water Heaters Inc.
Expiration Date: 9/02
Visa E] MasterCard X
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