04080151CITY OF CUPERTINO
$' °'7 `
'U 'NATION.
.,
BUILDING DIVISION PERMIT
CC►1�iTRA TQR IN .
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BUILDING ADDRESS:
JUST WATER HEATERS INC
PERMIT N004080151
OWNER'S NAME:
PERMIT ISSUE DATE
ONE:
(53.0) 293-9901
SANITARY OL NO.
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
DECLARATION
LICENSED CONTRACTOR'S DECLARATION
Job Descn
I hereby efLIC bum 1 am h=osed under provision 9 (commencing
P
H NAL E
with Section 70M)) of Division 3of due Business and Pmfcasiun Code, end my license is
In LicenlseC sndeffe= Lie a
REPLACE WATER HEATER
(4 0 GAL GAS)
SEP $ 2004
Dam Contractor
ARCHnECTS DECLARATION
I understand my plans shall be used as public records
Licensed professional
OWNER-BUILDER DECLARATION
BUILDING
hereby affirm mm I am exempt from due Convector's Law for the
1 hereby
e: Any c
following reason. . (Sce Business and Professions Code: Any city or county
it ](onstru
permit alley. improve, or repair any swctum
requires a pmmit sea t,
h Perlin
pdarm itsissuance. also nt to the the applicant far suchpactur s ice ssignedhapter statement
prior sires; the
wit pursuant lathe previsions thee (Chapter9
Sq. Ft. Floor Area
Valuati1882
sion(
(commencing with Section 7120) of Businessand Professions Cade) or
( commecing MDiasis 3th al Business and
Nat he u exempt Nemfrom and the beau far dte alleged eumption. Any violation of
and f rm. Any
Section 7031.5 by any applicant fora permit subjects the applicam to a civil penalty of
APN Number
Occupancy e
P Y GYP
Out mom Nan Eve hundred dollars (SSW).
❑I. as owner ofthe property, ormy employees with wages a their sole compensation,
37514033.00
will do the work mad the awctum is notimencied oroffered forsale (Sm. 7044, Business
Required Inspections
and Professions Coda: The Co moucwr's License law dose not apply to an owner of
'
property, who buildsorimpmvex mete nand who doessuch workhims elforthmugh his
own employees, provided dimsuch improwmenu arc not intended oraRered formic. if,
however. the building or improvement is mid within one year of eamplcfion, the owner.
builder will hew the burden of proving that he did not build or improve for purpose of
Sate.).
❑ 1, as owmr of the propert, am exclusively contracting with licensed conuecmrs w
=nstmet the project (Sec. 7054, Business and Profession Cade:) The Contractors Li
=rise Law don not apply in an owner of properly who builds or improves busmen, and
who contracts for ouch projects wit a conuactor(s) licensed pursuant to the Convector's
License Law.
I Un exempt under See. , B & P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury om of the following declarations:
1 haw and will maintain a Certificate of Consent to self -insure for Womer'sCompen-
ad a, ss provided for by Section 37W of me labor Code. for the pcRartname of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, far me performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Cartier: Polity Na.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu amount need not he completed if the permit Is foram hundred dollars ($I W)
or less.)
1 certify that in one performance of the work for which this permit is issued. I shell not
employ any person in any manner= as m become subject to the Workers' Compensation
Laws of Califuntia. Date
Applicant
NOTICE TO APPLICANT: IL after making C of of Exemption. you should
become subject Workers provisions of the Labor Cod e, you nun
'Compensation
forthwith Comply With such Provisions Or this permitshall be deemed rewkcd.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that them is a convection lending agency far the performance of
me work for which this permit is issued (Sec. 3097, Civ. C.)
Lenders Name
Landers Address
I certify that I have mad this application and state mat the Show information is
-
correct. 1 agree to comply with all city and county ordinances and sum laws relating w
building construction, and hereby aulhmise representatives of this 0. ity to enter upon thc
alpve-mentioned properly for inspection purposes.
(We) agree 0 saw, indemnify and keep harmless the City of Cupertino against
liabilities, judgments. toss and expenses which may in any way seems against Said City
6i
in comet cram of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date '
SOURCE REGULATIONS.
Re -roofs
'
Type of Roof
Signature of Applica pa
HAZA RDODO w
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant tar future building Occupant stow or handle
Health and as defined by the Cupertino Municipal Cade, Chapter 9.13, and the Hulth and Safety
ode. Section 25532(a)?
All roofs shall be inspected to any roofing material being installed.
❑I&S ❑No
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment at devices which
nit hammous air conmmin ots as defined by the Bay Area Air Quality Management
all new materials for inspection.
❑Yes ❑No
Idm
I have mad the hanNaus materials requirements under Chapter6.95 of Ne Califon
ice HC.] &SafctyCade,g U..25505.35533and25534. 1 trdersund Natifmc building
not currently haw a tensest that it is my responsibility w notify me meopant of the
quiremeeawhichmostbemetpoorto issuance ofaCertficate o fOccvpancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner r mthamcd agent
Dam
•
is
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777 -3228
Fax (408) 777 -3333
Building Department
JOB ADDRESS:
10310 Stern Ave.
PERMIT
OWNER'S NAME: Radhakrishnan, Yoshie
PHONE # 408 -544 -7671
GENERAL CONTRACTOR: Just Water Heaters
FAX # 510 - 783 -6360
I am not using any subcontractors: -X 8/17/04
Signature Date
Please check applicable subcontractors and complete the following informs+inn-
Owner/ Contractor Signature
8/17/04
Date
10/28/03
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
Owner/ Contractor Signature
8/17/04
Date
10/28/03
u
•
C
E -Mail
of Cupertino Buildinq Permit
Jobsite Address: 10310 Stern Ave.
Owner's Name: --- Radhakrishnan, Yoshie
Phone No.(408)544 -7671
APN #: 375 -14 -033
Date: 8 -17 -04
Project Valuation: 5 882.00
Job Description
Replace 40 gal gas water heater.
Contractor Information
6� °S2 C.) SCI
lication
Company: Just Water Heaters Inc. Phone: (510)293 -2012
Contact Name: Dulce 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: 3/31/06
Worker's Comp #: 1626288 -04 Carrier: State Compensation Insurance Fund Exp. Date: 4/1 /05
Credit Card Information
Credit Card #: 5474 - 6390 - 0026 -5679
Name on Card: Just Water Heaters Inc. 2 6 73
Expiration Date: 9/05 Q o Z
Visa MasterCard ® U
mments