00120019 OF
c—BUILDINGuPERTNNo - CONTRACTOR INFORMATION:
_ PERMIT
BIn LDING ADDRESS`: _ ` I'IiRY1IT NO:
77 IFONG CT JUST *WATER .HEATERS' II IC 0012001.9
OWNER'S KAME: - APPLICATION SUB DATE:
RHYP TTtsj--RHENR AND TERESA 1764 ' NATIONAL AVE 12/05/2000
tlONli: - SANITARY NO. - . . CONTROL NO.
'..1 z Z ARCHI ITC-PENGINEEN, BUIIpING PERMIT INTO
be`u— - BLDG ...ELECT PLUMY , MECH
y
Z Ln,that ID CONTRACTOR'Snseuerprovision,
DECLARATION
5^_ Job_Descri tion
Z v_ 1 hereh amrm that 1 am licensed under n um.of Chapter 9(commencing
P - I
Z, Y pry p %
O( F� with all
c,"d,fDivisiunJ nfthe Buxincss and Pmtnsinns Codi,.anJ my license
ry Y is in full[lace mtd dTsl. _ , ' '
Diten,kcl t Lica P.EPALCE S@- GALLON GAS WATER HEATER
Dale Cnnlfaclur '
w 3 u y ARCHI'I'ECr'S DECLARATION -
a o"� 1 undemmrd my plans enpll w used as pnhlie accord. s '
ne O Llccmcd Prn&sdonul - - • -
fP OWNER-BUILDER DE6LARd'1'ION
u�= I hereby afllma that 1.,it cxempl form he Contractor's License taw for the -
F Z S following reason.(Section 7031.5.Business and Professions Cole:Any city or county _
S t O which require.,a permit to construct,alma Improve,denmlidt,u,repot,any morame
paintons marine.at... q ' .the ppls tf h'arriOn fl a'igw:llmenl '
dall he I,ticlosal pu:..an, the penwOmmofm C I t I Ease(Chir,acr9 Sq. Ft. Floor Area Valuation
(mmm.mmn,with See on 7000)of D v s on S ofthe Husmc s and Por4xsrons Coe)
or that he is excmnl the vrom and the bmiv Inrthc classed csc ruion.Any violation
of Section 7031.5 by any applicant for a Pemdt subjects miapplicanun a civil Penally - _.
offer roam man nechpnareddonars($500). _ APN Number Occupancy Type'
❑l.."wo r nl'Ihe prnperlr only c nithood,with waxes Or,tbd,snlc cnmpenxutinn. �r '
will do me work.and the swclum is not intended or.Bertad!for sale(Sec.70t, -- - `
Business and Professions Code. Me Contractors License Law does not apply to,an _ Required Inspections
ow a A ampuny WI amid,o,impmrea mefmn,and who docs inch work bine!(
r through his Own employees.provided that such nnprovnnems am not intended on 502 — FINAL PLUMBING ENERGY '
offered for sale.If,however.the building or improvement ix cold within one you of [� '
completion,the ow'nerhuildn will have the burden of proving that be did not builder 506 — GAS TEST - s
improve Our put3vrse of sale). z
507 FINAL PLUMBING
0l r of thepmisery,and I ly contracting with licensed commears u
construct th p'jec(scc7011B : aProfession,ca ) [ Court........
License Law docs not apply to as owner a I property she hard,or improsew thence..
and who contruns for such projects with a acmes)(teemed pursuant nr the
Cuntracmds Liccnze Law, - -
❑1 an a anpl under Sec. ,It&1'C or.thlx reason
0,Own Dam - •
WORKER S COMPENSATION DECLARATION
Ihereby affirm under penalty of perjury one of the following declarations: - - -
O 1 have call will ntainmin a Cetili,em of Consent m sear-i mune for Walker,,
Compensation, as provided for by Section 3701 of the Labor Code. for the '
performance of the work for which this permit is issued.
❑1 bra' and will mdinwin Worker's Campenvirou Insurance,as required by Section - -
37110 of the labia Cwe,for the perfomi n ce of the cork for which this permit is
wed.hay U'orkds Cnmcen3aion Insurance ami,, ad Policy number,arc:
Cartier: Psaicv No.: -
CERTIFICATION OF EKLMP'NON FROM WORKERS',
• - COMPLNSAI ION INSURA NCV
(This section need nm M complcml if the pennir is for one handled dollms
IT 100)or less.) -
I salify Ilml in the pednnaunce of the work for which this permit is issued.I-
shall nor employ any person in urs manner sen as to Manna wbjem h,the Wmkt, -
CompcmaionLav California bum
Applicant
NOTICLTOAPPLICAN'I:lf.nater makinx(his Ccnificmc of Exmnpliw.you.haul) - - '
become sabjeel m the Warkcr's Con,wasation provisions of the labor Code.you must
Q-Q mnhwlh ovuply wift such provision-m in,Icnnh shall he deemed related
z .
FCn CONSTRUCTION LENDING AGENCY -
C ' I hereby waffirmhich but moraiss av&I(So, Ponding nxaney for the perfnmmnce
Of the work fur whim this permit is isw¢A(Sec]Iya].Co.Cr , -
L lander'.Name
z - -
Ixmdcr'x Address '
l renily(hat I htrve read this application and.nam thus the above imhouratian is
rsr F career I agree m comply with all city and county ordinances and state laws relating
Q-z,)
to building construction,and hereby authorize mprcentmives ofthis city to enter upon -
(y the ultovermal red property l- n,pcctlun pun,...1, .-. ,.
F Iy (W'e)tgrccm rave.indemnify and keep hornless the City of Cupertino against _
VzA llabilitics,judgtncas.ensu and cnpemes which may in any way.,me agaimn said
City in con.etlacare of the xmming of Ihiv permit -
APPLICANTUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: DU(e"
SOURCE REGULATIONS. - it. y'
Signnum of ApnliCam/C(rartcmr Date Re-rOOI•s .
HAZARDOUS MAIL7RIALS DISCLOSURE -
Will the apphca.I or far..baddirg.cell rat.dowi Of haolle ba ardoas material Type of Roof ,
as defined by the Cupenino Munir,al Gude,Chapter 9.12,cad the Uealth and Safety
Code.Smdatt 25532(.)7 - .1
°Ya, ON. All rooks shall be inspected prior to any roofing material being'installed: .
Will ma,pplieattl ,,tri nnildlnxa.ratpi aseequi,irmat ,device.which If a roof is installed without first obtaining an inspection, I agree to remove
.it hazardous at ri'omamomnta as defined by the Bay Attu Air Quality Mnnam
gecnl
'grice all new materials for inspection. Applicant understands and will comply with
°Ya, 0N'o all non-point source'regulations.
1 have read the navalloas matelot:requirements under Chapter 6.95 of the
California Health&Safety Gude.Sections 25505,15533 and 25531 1 undcrstaml Thor .
Ifthc buildn"'Iart nut carcntly have atcmmt.that it is in,no,inoxihility ,,it ify the
accerional ill Tile reallicirlents which must be met prior sir uwanu nr a CCniticme'sit '
Occupancy. Signature of Applicant Date
Dwnef no,,,,aalnndzw agent Dam All roofcoverings to be Class "B', or better-
OFFICE J
• City of Cupertino Building Permit Application
E-Mail 001 a-00 I
jobsite Address: 7873 Leong Ct. Date: 11/28/00
Owner's Name:---Shyr T.
Phone No.(408)725-1835
APN#: 362-17-059-------------- Project Valuation: S 650.00-------
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#: 03KR0001018 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 MasterCard
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