04090268 CITY OF CUPERTINO `•'" ' -rn w '£"' `�' '
BUILDING DIVISION PERMIT CONTRACTORqNFORMATION I
BUILDINGADDRESS: JUST WATER HEATERS INC PERMIT NC,4090268
OWNER'S NAME: PERMIT IEBtfE DATE
ONE: SANITARY O. CONTROL NO.
ARCHMIC(ENGINEER: BUILDING PERM ITINPO
BLDG ELECT PLUMB MECH
0 0 0 0
°00 LICENSED Nu litt
CONfRACIOR'SDECON Job Description
u F 1 hereby affirm 1 am nwd under provisionsons of of Charter o
hapter 9(commencing
`�' Orion
with ' gpof D
ivison7of Ne Business and Pmfcuiona Code,end myliccvc is
_ infull from and effect.
LkenxaChaa
Lie.Or REPLACE WATER HEATER
F—O Dam Contractor (4 0 GAL GAS)
hJ ARCHITECT-S DECLARATION
m<I understand my plans shall be used u public records
DisU
u.G Licensed Pml
fcuiona
fl5 OWNER-BUILDER DECLARATION
M 1 hereby
affirm
Net I am exempt from Ne Conuacmfs License Law irides
00 fallowing reason.(Section 703 L.5,Bunions,and Pmfeuiuna Code:Any city or county
Km which reyuirrs a permit ,,emourra,alter,improve,demolish,or hepalr any swetum
FZ< pnonniu issumtt.alsu requires the applicam forsuchpermiuu51casigocdsummcnt
F WthcisliccnsedpursuannothcpmvisiomnfthcContranur'sLiccMcLaw(Chapmr9 Sq. Ft.Floor Area ValuatiR1819
SFO (commencing with Section 70M)of Division of leu Business and Professimu Cock)or
i
that he is exempt therefrom and the basis for the alleged exemption.Any violadon of
Section 7D3 L3 by arty applicant for a permit subjects the applicant to a civil penalty of ane ppN Number Occupancy
not mom than five hundred sallans(M). P Y Type
l.asawnn arthe n 36611088 . 00
❑ pmpc y,ormycmntended wiowagaM theirsolc7W,B udon.
will do Newark and the he Comisnor intendedw Law
fOutapplytDan v.of
and Professions Cock:The Cononaaon.and
Taw tlaea Out apply to rt owner of Required Inspections
ow.employ.,
who b,provirimpmvv ch improvements
and who aaasuch work himself edIhmugh his
own employees,p ing or improvement that such improscmenu are not ear of tl moBeretl for sale.IL
hunter Ne buildingoren ofpissoldwithinone year of completion,the owner
builder will have the burden of proving Net he did not build at improve for purpose of
sale.).
❑1,as owner of the pmpeny am cielujively contracting with licensed coronations to
come a dipmjea(Sec.?Dad,Businessand Professions Code:)Ther Comerson, Li-
whoeUwctsfnotapplyto jeanownerofpropcnywhobuildsorimprovesthereon,sols < '
who contracts for such pmjecu with a conuacmr(s)licensed pursuant In the CononadoYa /
n lam Law.
❑1 am"an exempt under See .B&P C for Nis reason /
wncr Data
WORKER'S COMPENSATION DECLARATION m
1 hereby affirm under penalty of perjury arse of the following declarations: V�
1 har:and will maintain a Certifhcam of Consent to self-insure for WorkefsCompcn-
ution,as provided for by Section 37M of dr Labor Code,for the Performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3710 of the Labor Code.for the performance of the work for which this permit is issued.
My Workees Compensation Insurance arricr and Policy number arc:
Cartier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('rniasection need not be complcred if the permit is forone boosted dollars(5100)
or las:) •-�-
1 eerdfy that in the performance of the work run which this permit is issued,l shall not
employ any person in any mannerso as to become subject to the,Workers'Compensation
Laws of California.Date
APPhemL
NOTICE TO APPLICANT.If,after making this ccad care of Facmption,you should
become subject to Ne Woher's Compensation previsions or the Labor code,you must
.JO forthwith comply with such provisions or this Permit Mtlecmcd invoked.'Z CONSTRUCTION LENDING AGENCY
[--�� I hereby affirm that them lax conjunction lendingagtncy for the permrin.of
IYthe.,it for which this permit is issued(Sec.3097,Civ.C.)
W Lender's Name
�z L.cnder's Add.
U p 1 ecnify thin 1 have read this application and sato don dhc above information is
If. P cornet.I agree in comply with all city and county ordinances and sum laws relating in
p V building eonnmefion,and hereby authodm representatives of this city to come upon one,
Y'a above-mnnioned pmperst for inspection which purposes
(We)agme to save,indemnify and keep harmless the City of Cupertino against
F"Z income,,judgments,
grauiand g Of this eawhitn may in any way aame agamn said cry
C..1? XMiL
APPLICANTPUN ERSTANDS AhND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS.
Re-roofs
Signature ofArdicarnsContractor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Willy t applicant or fumes building e,Chapter
or and ti hvudous material
u defined by the Cupertino Municipal Code.Chapmr 9.12.and the Health and Safety
M.Settlor 25532(x)? All roofs shall be inspected prior to an roofing material beim Installed.
❑Yej ON. P P � Y g g
Will the applicam or future building occupant use cyuipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit havardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
D aict?
❑Yes 0 N
1 have mal the hmaNtms materials requmcn ems under Chapter 6.95 of the Califor-
niaHcalth&SdCLyCodc,S=om25M5.25533am1255Ja.IurWcrn mifthe Wilding '
dors not cunconly have a soman,that itis my re.1.11131ity in rodfy IW occupant of the
reyaimmentawhich must xon,poor idismanotoraCertificate ofaapancy. Signature of Applicant Date
Owner or authorircd agent M. All roof coverings to be Class"B"or better
a40
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
F Fax(408) 777-3333
SCUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
1297 Aster Ln. U 0 2-6d
OWNER'S NAME: Drinkwater, Barbara I PHONE # 408-996-8405
GENERAL CONTRACTOR: Just Water Heaters I FAX # 510-783-6360
1 am not using any subcontractors: Q"'fo- 9/27/04
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
U'x&CQ. $� 9/27/04
Owner/Contractor Signature Date
10/28/03
6-7 O ��
Cit of Cupertino BuildingPermit Application [
E-Mail
Jobsite Address: 1297 Aster Ln. Date: 9-27-04
Owner's Name:---Drinkwater, Barbara
Phone No.(408)996-8405
APN#: 366-11-088 Project Valuation: S 819.00
Building Permit Info: Bldg---------- Elect--------- Plumb------1L---- Mech___________
Job Description
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: 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/l/05
Credit Card Information
Credit Card #: 5474-6390-0026-5679
Name on Card: just Water Heaters Inc. 11� Z 7 Z I
Expiration Date: 9/05 ' 1� O
p�/
Visa MasterCard ® 7
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