BLD-2021-01506BUILDING PERMIT
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10850 JOHNSON AVE Cupertino APN: 375 30 023 PERMIT NO: BLD-2021-01506
OWNER'S NAME: GOODMAN GRANT R AND ALANA J TRUSTEE OWNER'S PHONE: Not Provided
CONTRACTOR: SAN JOSE PLUMBING INC, 19970 MC KEAN RD SAN JOSE CONTRACTOR PHONE: 4082961820
DATE ISSUED 8/4/2021 12:06:08 PM ISSUED BY:VALUATION: $3795.00
JOB DESCRIPTION
1.Provide and install a Bradford and White, 50 gallon, natural gas, 10 year warranty with 40,000 BTU rating (model # URG250T6N plus 4 year extended warranty certificate). Will
provide a new shut off valve , new hot and cold flex lines, gas flex line with sediment trap, a new pan with drain and redo the relief line to code with a union. Will also make sure
the water heater is grounded from the cold to the hot and to the gas line with clams and bonding wire. 2. Provide and install a Grundfos pump with 1/2" copper pipe and fittings
LICENSED CONTRACTOR INFORMATION
CONTRACTOR: SAN JOSE PLUMBING INC
LICENSED CLASS: C36 PLUMBING
LICENSED NO: 615156
EXP DATE: 09/30/2021
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
force and effect.
I hereby affirm under penatly of perjury one of the following three declarations:
1 I 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 performance of the
work for which this permit is issued.
2 I 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 permit is
issued.
3 I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, l must forthwith
comply with such provisions or this permit shall be deemed revoked.
I understand and agree that I am electronically signing and filing this application and that checking the box below has the same legal effect as manual signature. I also
understand that I have the option of filing a paper copy of this application with a manual signature but have chosen instead to file this application electronically.