03040088 CITY OF CUPEIZTINO
BUILDING DIVISION PERMIT CONTRACTORANFOR,MATION '
aYlffifDMNUBE DR JUST WATER HEATERS INC PERMIT NO,03040088
LLW6,VY"ftS SALLY A ET AL (BLDG E 1764 NATIONAL AVE ""64'1`16/2003
Adk
NE: (510) 293-9901 SANITARY NO. CONTROL NO.
ARCIi1TECf/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 o
loo LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under prevision of Chapter 9(commencing lob Description
az1 K4
with
nlarle DiWion3afNe Business and Professions Code,and my license is sa�'��sy, �`
O,rt in fuesc Claand ellen. yF� •4rFa a(ayaA�
Liccnu Class Lk.g REPLACE WATER HEATER
Dam Contractor (42 GALLON ELECTRIC)
ARCHITECTS DECLARATION /„a� C 41 ra ra8�
f I understand my plain shall he used u public recnrN � N-`P `ua (Lt t'jj
SyU
.O Licensed Profenkmal .
y OWNER-BUILDER DECLARATION
i F 1 hereby affirm Nal I am exempt from the CemrKtol l License Law fettle,
D 0 following moon.(Section 7031.5,Business and Profession Code:My city or county
S$ which requires a permit m construct,alter,improve,demolish,m repair any structure
.Zr prions its issuance.also requires the applicant for such permit to fl to a signed pLement
ma< thot he is licensed pursuant to list provisions of list Comracmr's U..Law(Chapter 9 Sq. Ft.Floor Area Valuation
�FO (commencing with S.tion7gp)nf Division 3o NC Business and Prafessinm Chem).
$ Nat he Is exempt therefrom and the basis for the alleged exemption.Any violation of 8800
Section 7031,5 by any applicant for a permit subjects the applicant o a civil penalty Of APN Number Occupancy Type
not mere than rive hundred dollars(5500). P Y YP
01.as oven.or the property,or my employees with wages as their.1.compensation, 36949010 . 00
will do the welt,and she atrVcwm is not intended or offered fora.(.(SK.7014,Business
and Professions Cade:The Comosctor's Llceme Law docs net apply to an owner of Required Inspections
progeny who buildserimprovu Hereon.and who does auchwark himself orNrou,h his 502 — FINAL PLUMBING ENERGY
own cmployees,provided Nn such improvements art not intended eroBemd for We.IL 506. — GAS TEST
however,Ne builEing or improwmenl is seld within ane year of complmion.Nc owner- '
builder will have the burden of proving Nat he did not Wild or improve for purpose of 507 — FINAL PLUMBING
ole.).
0 1,a owner of the propeny,am exclusively contracting with licensed contrea.Yors to
construct the project(Sec.7044,Business and Professions Cade:)The Contractor's Li-
come Law docs not apply to an owner of property who builds or Improves Merton,and
who commets for such pmjecb with a cownscror(s)licensed pursuant w Our ConuactoM1
License Law,
0 1 am exempt under Sec. .B&P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I haw and will..Irwin a Certificate of Consent to ulf-insum for Worlaee9Cumpem
cation,as provided fm by Section 37M of the Labor Cade.for the,Performance of OR,
work for which this permit is inwd.
0 1 have and will maintain Worker's Compensation Insurance,as required by Section '
3700 of the Labor Code,f.the performance of the work for which this Permit is Wood.
My Wmke'.Compensation[a.m.cam.and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Iris section need not bacompletd If the Pem,it is foronc huMmd dellrrs(SIMI
or Mss.)
1 emify that in Ne performance of tiw work for which this parmlt Is issued,I shall not
employ any person in any manver an as m become subject to the Worked'ComPensnion
Laws
t
of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Canons o of Exemption,you should
"
becomesubject
coy it Worker's provisions of Ne LaMrCMc,you muss
�p forthwith comply with such provisions of this permiuhall be dcemcd revoked. -
�'1
.N., CONST,it aC0NLENDINGAOENCY
I hor which
Nat Nem isaed(Sec.3D97.lending geneyfor list performance of '
3i Ne duh for which Nla Permit Is issued(Sec.J09i,Co,C.)
QLandch Namc
34
,Z Lender's Address
a 0 I modify that I haw read this application and rete that the show inf.matiun is '
y^ correct.I agree to comply with all city and county ondinances and state laws relating to
building construction.and hereby authorize rcprescnttives of Nis city to enter upon the
LU 'hove-mentioned properly for impaction purposes.
y h (We)agree to Saw.indemnify and lamp harmless Nc City of Cupertino against
fA liabilities,judgments.costs and expenses which may in any soy Kcme against cold City
J7 incoueguenee of the grafin,of this permit
rr77- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS,
Re-roofs
Signature of ApplinDataHAZAR
HAZARDOUS
S MATERIALS DISCLOSURE Type of Roof
Will these Cupertino
or future building e.Chapter
Branthandle NUNouo metrial
u defined by Ne Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
Code.Slion 25532(&)l 0No All roofs shall be inspected prior to any roofing material being installed.
❑
8 Yes
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it h,tardnus air contaminants as defined by the Bay Arta Air Quality Management all new materials for inspection.
vicR
❑Yes ❑Nu
I have meat the huardousm'tedals requirements under Chapter 6.95 of the Califor.
7dms
Health&Safety Code.Sectium 25505,35533 and 255341 understand Natif the building
not currently how a tenant.that it is my responsibility re notify tax Occup.,of tat
uiromous which mop be mel prior w issuance of a CcNficam of Occupancy. Signature of Applicant Date
eer er.umnrired ascot Dale All roof coverings to be Class "B"or better.
1
• City of Cupertino Building Permit Application
E-Mail
jobslte Address: 10212 Danube Dr., Bldg. E Date: 4-16-03
Owner's Name: --Colpitts,Sally
Phone No. (408) 255-2403
APN#: 369-49-010 Project Valuatlon: S 800.00
Building Permit Info: Bldg_-------— Elect___________ Plumb____x_____ Mech-----_--_
Job Description
Replace 42-gallon electric 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: perm Its®J ustwaterheaters.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
Name on Card: Just Water Heaters Inc. Z�
Expiration Date: 9/056 a 6/
Visa MasterCard ® o
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