06060146 CITY OF CUPERTINO ✓ r 9�(�r.*.�yxa��q,.aj
BUILDING DIVISION PERMIT 1��11?J:iLL"11:�a �"^ ^y
BUIL
DINC ADDRESS: WATER HEATERS INC PERM"N0.06060146
1625 JAMES TOWN DR
OWNER'S NAME: PERMIT ISSUE DATE
RENWALD JUDITH T 3400 INVESTMENT BLVD 06/16/2006
NE: SANITARY NO. CONTROL NO.
(510) 293-9901
ARC HITECr/ENGINEER: BUILDING PERMIT INFO
BLDG ELER PLUMB MECH
0
Sop LICENSED CONTRACTOR'S DECLARATION Ib Description
�u 1 hereby affirm that 1 am licensed under pmvisioru of ChapteO
r 9(commencing p
with Section 7000)of Division 3 of the Business and ns ProfessmCade.and my licenseu
+� imOfbmeandefrect. REPLACE 50 GAL GAS WATER HEATER
4 License Clan Lk.0
Dam Contrxmr
ARCHITECTS use DECLARATION FINAL
I understand my plans shall he used u public reenrdt
D C�
led Licensed Profcnianal
`,� OWNER-BUILDER mDECLARATIONtheCano
Za I naso .(rimeSect that 11. exempt from the Cssions o Liccnso taw for the JUL
_
ct o following reason.(Section 703 construct.
Business and are,de fans Cade:Any city or roomy Jll ,7 5
S$ which rtguima a Permit re wren the alcor.hnprow,demolish.w mash any structure
_ZSa
prior mlLLknsed pYm mgolma the vision of for achpermiuofnlea,Law([ummem
<
that eensod Setiontotheprovisionsa.1' CamrmmhU¢nsolaw(Clmpmr9 Sq.Ft.Floor Area aluation
3I
(commendingaI,exempt
pth Section and
tof he Division 3.1'the BuatnessarW PmfAWnN Coda)on
3
that io k exempt any applicant
li and or per it 0m allm the esempnt n.in Any l violation of
JIM odek
Section 7031.3 by any redliant rte a peamit objects the applicant m•rival penslty of r
vel more mm fins hundred dollen(SSW).
O 1,as owner of the property.or my employer Who raga as thele sole compensation,
willd0 the work.and W suuclum knot intended moQered fw[ate(See 7044,Business
and Proresslons Cade:The Conbacmes License law don not apply m an owner of Required Inspections
property who builds m l mpreves therwn,and who does such work himself w lWoagh his
awnemployces,pmvided Wl=bimprmemauartnotin'P woEeedfmsak.if.
however,dm building or improvement is mid within am year of completion,the awner-
bullder .will haw the burden of proving that M did cot build er improve for purpose of
sold.).
❑1,as never of the property,am exclusively contracting with licensed wntramn to
wnswct the project(Sex.7044.Business and Prolmadom Cade:)The Conlramw's U.
cense law done not apply to an owner of property who builds or Improwa durtan,ad,
who demuecta for such projects what a convanor(s)licensed Featured as the Commences
License Law.
❑l am exempt undo Set .B i P C for this mason
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby aRma under penalty of perjury nor,o(Ne following declarations:
1 have and will madman.CrsdEam of Cousem ed self-insure for Wo lacesCompm-
tiw.as provided for by Section 3700 of the labor Code,for that performance of the
work for which this permit is named.
O 1 haw and will maintain Worker's Compensation Itsoranw,as required by Section
3700 of the Labw Code,for the perfarmawe or ma wort fwwhkh this permit is issned.
My Worker's Compensation:Immmnce artier ad Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tisk section need not be camp icted If the Permit Is for one hundred dollars($100)
nr ksa.)
1 certify that in the performance of the work for which this Permit Is Issued,l shall not
employ any person in my mammrm as to become subject in the Wmkeas'Comp meadon
Laws of California.Dam
APpllam
NOTICE TO APPLICANT:If,after making this CerdOwe of Exemption,you should
become abject to the Worker[Compensation provisions of the labor Code,you most
C)Z foMwith comply with such provision or this permit[hall be darned reeked.
OCONSTRUC ION LENDING AGENCY
[—t I hereby afrum that there k a construction lending agency for the performance of
ai
the work for which this permit Is issued(Sec.3097,Civ.C.) ,
W�Q Lender's Name
a z LcmicesAddmn
U O 1 certify,that 1 have mad this application W Yam dol Lou above information k
Iy F corms I agree to comply with ill city and county ordinances and state laws relating to
OU building construction,and hereby authorise mprescnmives of this city to enter upon the
[TJ above-mentioned property for inspection purposes
g), (We)agree to save,indemnify and kap harmkas the City of Cupertino against
0 Ilabilitia,juegmems,costs ared expenses which may in my way accrue against aid City
U,'Z in comequmee of the grating of this permit.
^" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature ofAppOwHAZAR Data
HAZARDOUS
S MATERIAuS DISCLOSURE Type of Roof
WilldoeCupertno(Muni building eceupatatarew handle Health
sd Safety ss defined by the Cupertino Municipal Cade.Chapter 9.11.and the Hcilth and Safety
Code,Section 15531(a)7 All roofs shall be inspected prior to any roofing material being installed.
OYa Otho
Wme applicant or future building Occupant use equipment or devices which
ill If a roof lS installed without firs[obtaining an inspection,I agree to remove
It haratdnus air contaminants a defnned by the Bay Ara Air Quality Management all new materials for inspection.
smiict7
OYus ONO
1 have read the hadatdous materials requirements underchaper 6.95 or Led Califor-
nia Heath At Safety,Cede,Sections 15505.35533 and 35534.1 untlemmnd mat ifde building
does out currently haw a nen w.that It Y my mspommity in entry the m:cupat of the
requirements which mus M met prior to issuance of a Certificate of Occupancy. Signature Of Applicant Date
Owner maumasuted agent Dam All roof coverings to be Class„B„or better
Community Development
10300 Torre Avenue
ac,
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
•CUPEkTINO
Building Department
JOB ADDRESS: PERMIT#
1625 James Town Dr.
OWNER'S NAME: Renwald,Judith PHONE # 408-253-2804
GENERAL CONTRACTOR:Just Water FAX# 510-783-6360
Heaters
I am not using any subcontractors: ��` �aw�O Qx�R^ti� 06/13/06_
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
• 4..��Qea 4-�o }CAQ��zR^� � 06/13/06
10/28/03
CITY OF CUPERTINO
m 1 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36610101. 00
DATE ISSUED. . . . . . . : 06/16/2006
RECEIPT #• . . . . . . . • : 34897
REFERENCE ID # . . . : 06060146
SITE ADDRESS . . . . . : 1625 JAMES TOWN DR
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : RENWALD JUDITH T
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : JUST WATER HEATERS
CONTRACTOR . . . . . . . : GILROY, JOHN LIC # 15128
COMPANY . . . . . . . . . . : JUST WATER HEATERS INC
ADDRESS . . . . . . . . . . : 3400 INVESTMENT BLVD
CITY/STATE/ZIP . . . : HAYWARD, CA 94545
TELEPHONE . . . . . . . . : (510) 293-9901
�EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BPWHEATER PER HEATER . 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 84 . 02 0 . 00 84 . 02 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
c�Co�Pbi�-(o
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 1625 James Town Dr. Date: 06-13-06
Owner's Name:---Renwald,Judith
Phone No.(408)253-2804
APN#: 366-10-101 Project Valuation: $1,075.00
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: Dulce Fax: (510)293-2022
• Address:3400 Investment Blvd. E-mail: permitdept®sbcglobal.net
City,State and Zip: Hayward,CA. 94545
State Contractor's License# 591329 Exp.Date: 3/31/08
Worker's Comp#: C44510091 Carrler:ACE Exp. Date: 4/1/07
Credit Card Information
Credit Card #: 5474-6390-0047-8660
Name on Card: Just Water Heaters Inc.
Expiration Date: 06/08
Visa El MasterCard
Comments