03050051 ,) CITY OFCUPERTINO ' ' " ' ' 'tinea
BUILDING DIVISION PERMIT
lomN ACTCI lY `UX2M� aY(pN.
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BUILDING ADDRESS: JUST WATER HEATERS INC PERMITN003050051
565 20LT.TNr1RR Rn
' OWNER'S NAME: 1764 NATIONAL AVE PERMIT'RA/12 /2003 ROAJ1 2/2003
NG STANLEY H U�/ l
NE: (510) 293-9901 SANITARY NO. CONTROL NO.
ARCHI7ECTIENGINEER; BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�Oii LICENSED CONIRACIDWS DECLARATION Job Description
I hereby affirm that 1 am licensed under proo
visions of Chapter 9(commencing
with Salon 7WD)of Divided Sof the Buainea ash Pmfudnu Code,and my license is
immltmmeandefral. REPLACE WATER HEATER
j F 0�A L E®
z le Class, Lk.g
Z f— LiceDam Contractor (4 0 GALLON GAS)
ARCHITECTS DECLARATION
1 understand my place Mall be used u public records
MAY 2 8 2003
iLicensed Professional
OWNER-BUILDER DECLARATION
a� i hereby alrirm that I em exempt from Ne Communes License law for Ile BUILDING
i p o following mason.(Section 7031.5,Business and Proleadom Codb:Any city ser county
+�@ which requires a permit to Comrutt alter.improve,demolW,an repair any lon cted
poor In its issuance,also mquiras IM applieanl for such permit m file a signed statement
=zpF
that amI,llcemalpursaam1.NeprovidauaftheContractorsUaccdeiaw(Chapter9 Sq.Ft. Floor Area Valuation
5$ (commencing with Section 700M of Division 3 of the Business and Prorosiona Cade)or 600
�1 Nu has is exemptd N
therefrom and basis for the alleged exemptiaa W
My vloladem
Section
e mbw any
ndmdlicant far a Knit subjects lie applicant to a civil penalty of APN Number Occupancy Type
art Nen R
35922039 ' 00
0f,uawnerarthepmpmy,wmycmpioymwWwaguuNeirmlecompemdon,
willdothewodtand Nemumumtsnott.e .,offuWforaale(Sa.7044,Busims [���p����jpgQ
and Professions Cade:The Comencnes Liam Law dace tet apply m an owner of 502 — FINAL PLUMB I NCieC � RGY
property who builds ne important NaCon,arW who doessuch weak himselfor through his
own employees.provided Nal such improvements are not intended reoffered Imale.If. 506 — GAS TEST
however,the building or improvement u sold within arc year of comPlumn,the owmn
Wilder will have One burden of proving that ha did not build or improve for purpose of 507 - FINAL PLUMBING
We.).
0 1,as owner of the property,am exclusively contacting with licensed Contractors in
construct the project(Sec.7044.B"i=ash PrafeSfiam Cade:)The Conrames Li-
Com law des not apply to an owner of property who builds or Impmm shammed.and.
who Consumer for such projeaa withacanuantor(q Ilwmed Formal he the Cantnero'l
Licem Law.
0 lamuemptuddergea. ,B&PCfeathisrtasan
Ower Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of pe jory am of to following declaratem:
.Ir I have and will mainub•CeNEum of Camnua sel6lnsum feaWorker'a Camped
salon.as provided for by Section 3700 of the labor Code.for the performance of the
work for which this permit is issued.
0 1 have and will maintain Workers Compensation Immnce,as acquired by Sudan
3700 of Ne Lobar Code,for the performance of Ne work feawhult ala permit ts issued.
My Wmace.Compensate.Insunna carrier and Policy number sue:
Carder. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mles touched wed not W completed If Ne permit Is furore hundred dollar(SIM)
or leis)
1 certify that In the performance of the work for which this permit 4Issued,I MN not
employ any pared in say manner an as m haemo subject to she worker'Cmmpemdon
Law,of C'IifomiA.Dam
Applicant
NOTICE TO APPLICANT:If,after making NH Certificate of Exemption,you should
become subject an the Worker's Comocmton provisions of the late Code you muss
.7 Z forthwith comply with such Provisions or this permit shall be dwmcd mvoked.
zO CONSTRUCTION LENDING AGENCY
-[n I hereby affirm NU Nem is a Construction lending ageeoy for the perromume of
Ri � the work for which this Permit is issued(Sec.3097,Civ.C.) (�
a� lender,Name _
�z IanderaAdaR•• v Y
U O I ctrtlfy that 1 have dead this appliwion add mm Nat the shove mfm ratan Is
camtt 1 agree m comply with all sh l city acounty ordinances and sum laws(tiering N
O WlWing construction,and hereby mutation,representatives or thtschy to enter upon to
Lit muve-mentioned Property for Inspection purples.
(We)agree in save,indemnify and kap harmless Ne City of Cupertino against
rjj liabilities.judgment.eau and expenses which may In any way acenm again.said City
U7 In consequence of the pruning of this permit.
G APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOWPOINf Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signuu(t of ApplicardConramr Data Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will Ne applicant or future building occupant uom or handle hazardous mamrid
u darned by dw Cupertino Municipal Code.Chapter 9.13,and the Health and Safely
adc,Satan 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
0Yu ON.
Will the applicant ea future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mil haumnut air contaminants as abroad by the Bay Amt Air Quality Management all new materials for inspection.
D
istrict?
Yes ONo
I have mad the haukms materials requirements under Chapter 6.95 of the Califor.
.is Heal &Safety Cade,Sections 25505,25533 ane w
25534.1 unicrd that if Ne Wilding
w,out Currently have a tenant that It b my respoaaibirly m Eery to occupant or the
qulremcdts which tete,m met pilar m Issuance of a CArNate of Occupancy. Signature ofApplicant Date
or authoriscd agent Date I All roof coverings to be Class"B"or better
0 3
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 7565 Bollinger Rd. Date: 5- 12-03
Owner's Name:---Wong,Stanley
Phone No.(408)966-9468
APN#: 359-22-039 Project Valuation: $ 600.00
Building Permit Info: Bldg----------- Elect----------- Plumb------1L---- Mech-----------
Job Description
Replace 40 gallon gas water heater.
Contractor Information
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: 3/31/04
Worker's Comp#: 1626288-03 Carrier: State Compensation Insurance Fund Exp. Date: 4/1/04
Credit Card Information
Credit Card #: 5474-6390-0026-5679 ( $,3 0
Name on Card: just Water Heaters Inc.
Expiration Date: 9/05 6e.
Visa MasterCard X
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