05090079 CITY OF CUPERTINO . err y �,T2!z5' d
sulLowc Drvlston PERMIT Yl,NT
BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT N005090079
OWNER'S NAME: PERMIT ISSUE DATE
VINAY CHANDRA 3400 INVESTMENT BLVD 09/13/2005
NE: SANITARY NO. CONTROL NO.
(510) 293-9901
ARCHMIC(ENGINEER: BUILDING PERMIT INFO
BLDG� O ECH
PE M�
30o LICENSED CONRACIORS DECLARATION Job Description
I he affirm Nu 1 em licensed under provisions of Chapter 9(commencing
with Section 70(N)of Division Sof the Business and Profcuium Code.and my license is
in full to. REPLACE WATER HEATER
i g? Dano Clic Lk.N
FFFF Dam Licr 40 GAL GAS
3 ARCHITECTS DECLARATION
icy I understand my pWs"I M mind as public records
qua Licensed Pmfcuianel ))
contr
OWNER-BUILDER DECLARATION
gm 1 Meshy sRrm dial I am esempt(rosem ftConuacrofs License Law for tM
E:00 following moon.(Section 70313,Business and Professions Code:Any city or county
n$M which mguima a permit in common.alter,improv,demolish,or repair any structure
s,Z12 prior to its issuance.alto requires the applicant for such permit in rile.signed statement
FF WtMislicensedpursuanttoftprovisionsofdwConmebo'sLicenrelaw(Chapter9 Sq.Ft.Floor Area Val
C $ (commencing with Section 7000)of Division 3 of the Business and Proksoma Code)or
3 that he is exempt therefrom and du Was for the alleged exemption.Any violation of
Section 7031.3 by arty applicant(m a permit subjects that applicant in a civil penalty of APN Number Oeeu tin
not came than five bundmd dollars(M). 32345002 . 00
Y Type
❑1,as owner alibis property,or my employees with wages as their sole compensation,
will do the work and theshumurt Is notdnunded oroRe ad far We(Sec.7011,Besineu
and Profeulons Cade:The Commences License Law don Out apply in an owner of Required Inspections
property who bu Ild1 m improv thereon,and who does tach work himalf m through his
own employee,provided that such Improvements am ret intended oraRartd fmule.if,
however,the building or improvement is sold within one year of mrepledm.die Owner.
builder will have the Wooden of preving that bu did not build in improv for purpose of
ale.),
❑I.as weer of the property.am exelusivly contracting with licensed contracmn w
conshmt the project(Sec.70ad,Business and Professions Code:)The Contracsefa U.
cave Law docs not apply w an owner of Finnerty who builds or improv demon,and,
who conuacu for such projects withacontracmr(s)liamed pursuma w the Conuactofs
License Law.
❑I am eempt under Sec. .B d P C for this recon -
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby slBrm under penalty,of perjury one of the following decho tionse
1 Waw and will maintain eCeNOau ofCanum w self-Wort for Wartets Campers-
adon,as provided for by Smdon 37M of the Labor,code,for the performance of f
work for which this permit is issued.
❑I have and will maintain Workers CompemaUan Iruwance,as required by Section
3700 of die Labor Cads.for the performaree of&w wort fmwhieh this permit is issued.
My Workers compensation,Laurance carrier and Policy number art:
Cartier: Policy No.:
CERTIFICATE OF EXEM MON FROM WORKERS
COMPENSATION INSURANCE
(This section need not becompleud if the permit Is fmooe hundred clulus(51010
or lest)
I Unify that in the performance Of the work for which this permit Is issued.I shall not
employ any persen in any manner w as in become abject to tion Workers'CompcaWon
Laws of CWHOMIL Data
Applicant
NOTICE TO APPLICANT..If.aper making this Cenifieaw of Exemption.you should
became abject w the Worker Compenudon provisions of f labor Code,you muse
.,O foMwith cemply with such provisions or this permit sball be doemed unwed.
?� CONSTRUCTION LENDING AGENCY
F+ IMmby aRnm slut Vert iso Wood
.nn , agency fortheperformarrce of
a's,7 the work for which this permit u iuoed(Sec,3t19'i,Co.Civ.CJ
LendNuns,
=z
sander's
Address
V Q 1 certify dial 1 haw mad this application and sore that the above information is
G4 cermet.I agv to comply with all city and county ordinances and sou laws relining w
O building construction.and hereby adhodm representative of this city in enter upon the
W ebovementiaoed Property rot imRposes
cdon purposes.
LL (Win)agree to un,indemnify and keep humus the City of Cupertino agaimt
cn liebllitiesjudgmcm,com and expenses which may in anywayxecrue agamosaid Cly
C)7 in consequence of the granting of this MMIL . .
•^'r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
HAZARDOUS
Signuum of ApplleDateHAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will ft applicant or forum boacupantatortor Modic aodousmaterial
u defined by the Cupertino Municipal Code.Chapter 9.13,and theHeHealth and Safety
cads.Station zss33(a)7 All roofs shall be inspected prior to an roofing material being Installed.
❑Yea C]No P P Y g g
Will the applicant or round building occupant use equipment m&-vias,which If a roof is installed without first obtaining an inspection.I agree to remove
7io
t hayaodous air commitments u defined by die Bay Area Air Quality Management all new materials for inspection.
i ❑Yes ❑No
I have mud die Murdws maurisisminflo mcnts underChamer6.93ofthe CeliforHealth&SsfctyCodc,Sections37N13,33333uW2353d.IundsnuM thatifdic building
s not currently haw s wnan4 that it u my repomibility w notify the occupant of silo
eiremcnts which mum be mel pdorm issuance Ora Cereficate a(Occapincy. Signature of Applicant Date
ner or an......
ad ed agent Dow All roof coverings to be Class"B"or better
f Community Development
10300 Torre Avenue
a Cupertino CA 95014
Telephone(408)777-3228
lCITY OF Fax(408)777-3333
'UPER,TINO
Building De artment
JOB ADDRESS: PERMIT#
11082 Firethorne Dr.. ojS` c --> 7
OWNER'S NAME: Chandra, Vinay PHONE # 408-737-1687
GENERAL CONTRACTOR: Just Water. FAX # 510-783-6360
Heaters (�
I am not using any subcontractors: v `� 9/12/05
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
9/12/05
10/28/03
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 11082 Firethorne Dr. Date: 9-12-05
Owner's Name:---Chandra,Vinay
Phone No.(408)737-1687
APN#: 323-45-002 Project Valuation: $ 657.00
Building Permit Info: Bldg— Elect Plumb____x_ Mech_
Job bescri tion
Replace 40 gal gas water heater.
Contractor Information
Company: Just Water Heaters Inc. Phone: (510)293-2012
• Contact Name: Dulce Fax: (510)783-6360
Address:3400 Investment Blvd. E-mail: permitdept®sbcglobal.net
City,State and Zip: Hayward,CA. 94545
State Contractor's Ucense# 591329 Exp. Date: 3/31/06
Worker's Comp#: 1626288-05 Carrier:State Compensation Insurance Fund Exp. Date: 4/l/06
Credit Card Information
Credit Card #: 5474-6390-0047-8660 O
Name on Card: Just Water Heaters Inc.
Expiration Date: 06/08 (, v,;�,
Visa MasterCard ® �' I
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