03110008'CITY OF CUPERTINO
CON TRACTOR INEORMt1TION
BUILDING DIVISION PERMIT
BUILDINGADDRESS:
a
JUST WATER HEATERS INC
PERMITNO.O311OOO8
F.R'S NAME:
1764 NATIONAL AVE
PERMIT ISSUE DATE
NE:
(510)293-9901
SANITARY N0. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT fNFO
BLDG ELECT PLO MB MECH
LICENSED CONTRACTOR'S DECLARATION
lob Description
1 hereby Affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section ]I%k)) of Division 3 of the Busincss and Professions Code, and my license is
in mu tome a ad effacdREPLACE
WATER HEATER
License Class Lim.A
Date Contractor
(5 0 GALLON GAS)
ARCHITECTS DECLARATION
I understand my plana shall be used As public rcemuda
Licensed Professional
OW NER-BUTLDER DECLARATION
1 hereby affirm that I am exempt from Ne Contractor's License Law for the
following mon. (Section ](131.5, Business and Professions Code: Any city or county
which mquir a permit to consmucl, alter, improve, demolish, Or repair any structure
prior 10 its issuance, also O%uims IM applicant for such permit to flea signed statement
Sq. Ft. Floor Area
Valuatio$75O
that he is licensed pursuant o the previsions of the Contractors Litems law Chapter
(co arcing with Section 7") of Division 3 of the B usiaess and Professions Code) or
Net he is exempt therefrom and the basis for the alleged exemption. Any violation of
,A Hh9DI Ti. ,,,,
36orrikkYyroo
Occupancy Type
Section ]031.5 by Any applicamfar Ape.i, subject the applicant to A civil penally of
not more than Eve hundred della. ($500).
❑ 1, m owner of the properly, or my employees with wages m their sole compensation,
Required Inspections
will do the work, and Ne structure is not intended or offered for sale (Sec. 7W, Business
and Professions CWe: The Committees License Law data not apply to an owner of
properly who builds or improves thereon, and who does such work himselfor through his
own employcea, provided that such improvements see not intended or offered for sats. If,
however. the building or improvement is sold within one year of completion, the owmm-
builder will have the burden of proving Nat he did not Wild or improve for purpose of
salt.).
1, as owner of the property, am exclusively contracting wit licensed commuters to
winnower the project (Sec.]044, Business and Professions Code:) The Convectors Li.
&L�D
tens law does not apply to an owner of property who builds or improves demon, and
�1N
who contracts for such projects with a convactor(s) licensed pursuant to the Contractor)
License Law.
Ca
lam exempt under Sea .B&PCfor this reason
pPR 1 v �oo�
r Data
w1■A. '
WORKER'S COMPENSATION DECLARATION
1 hereby alRrm under penally Of perjury one of the following declaration.
BUILDING
I have and will maintain a Cenificme of Consent to self -insure for Worker's Compere
cation, m provided for by Section 3]00 of the Labor Code. for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, m required by Section
3]00 of the Labor Code, for Ne performance of the work for which this permit is issued.
My Worker's Compensation Instmnce carrier And Policy number are:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if Ibe permit is foroac hundred dolla. (Slap
or less.)
1 comfy that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any mannerso as ms Weomc subject to the Workers Compensation
Laws of California. Data
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation previsions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION
Ihereby construction lending agency lithe performance of
Nat there issue
chrhi
Set. W7,Cing
Nc work fur which his pewit Is issued (Sats J09], Civ. C.)
Lenders Name
Lcnticr's Address
1 certify that 1 ban read this application and sum that the above information is
correct. I agree to comply with All city and county ordinances and slate laws relating to
building construction, and hereby ambonte representatives of this city to enter upon the
ahova-mentioned property for inspection purposes.
(We) agrte to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, cast and cxpcnecs which may in any way accred, agalnn said City
in consequence of the grand ng of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Signature of ApplicaData
HAZARDOUS
US MATERIALS DISCLOSURE
Type of Roof
Will thee handle
futureipal
Chaptnomof
Cupertser
Code.
the Cupertino Municipal Code. Chaplcr 9.12, and the HcelN AnJ Safety
fined Health and
io
Section 25532d)?
All roofs shall be inspected prior to any roofing material being
-7 Yes ❑NO
I Will the applicant or rulure building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
it havardous air contaminants As defncd by the Bay Arca Air Quality Management
all new materials for inspection.
lahlcl?
❑Yes [:1 No
1 have mad the handouts materials requirements under Chapter 6.95 of the Callum,
nia HmlNlk SarctyCodd,,Sccdom2505,25533ud25534.1undcmund Natifthe Wilding
does nil cunenlly haw a tenant, that it is my responsibility m norify the acupant of the
requirements which must the met prior it) issuance of aCcnifcamofOccupamy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner or authorivcd agent Dot
C
E -Mail
a 311b a a4
Of Cuaertino Buildina Permit ADDlication
Jobsite Address: 101 31 Linda Ann PI.
Owner's Name: ---Gills Manzur
Phone No.(408)859-9367
APN#: 369-43-014
Building Permit Info: Bldg -----------
Date: 11-03-03
Project Valuation: S 750.00
---------- Plumb ------ x----- Mech -----------
Job Description
Replace 50 gallon gas water heater.
Contractor Information
Company: Just Water Heaters Inc.
Contact Name: Dulce
Address: 1764 National Ave.
City, State and Zip: Hayward, CA. 94545
Phone: (510)293-2012
Fax: (510)293-2022
E-mail: permits@justwaterheaters.net
State Contractor's
License #
591329
Exp. Date: 3/31/04
Worker's Comp#:
1626288-03
Carrier:
State
Compensation Insurance
Fund
Exp. Date:
4/1/04
Credit Card Information
Credit Card #: 5474-6390-0026-5679
Name on Card: just Water Heaters Inc.
Expiration Date: 9/05
Visa ❑
MasterCard X
Comments
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