00120018 CITYOF
mvisRioNNO CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS: _ PERMIT NO. '
– -EATERS INC ' 00120018' `
OWNf?ft'S NAME - APPLICATION SUB DATE. '
FINNEGAN 1764 AI_•AVE 12/05f2000
fONF.: i. _ SANITARY NO. CONTROL NO.
!. P!33-991711 - .
COR
O ARCHITF;UUENGINEER: BUILDING PERMIT INFO
G
G_ `ta BLDG ELECT PLUMB MECH
Z H I.ICLNSEII CONTRACTOR'S DECLARATION - lob Descrl tion
OZ— Iheebyaf ntothat, I lwerrowd d p ,ion,of Chapter 9(....uttered, P
Fr3F wnh Salon TonadafDava,ion A I'theBu' slid P fissions Code andty license
- -
s to full force and effect
�O w a
to License Class - Llc.4 - REPALCE 40 GALLON GAS WATER HEATERto '
5 V Date Contractor .
u.O ARCHITECCS DECLARATION I
_ i undersand my plum droll be Listed as public re...us - L
w L o O Ltconsed Prolvswnnul
n bd l OW NCR BUILDER DECLARATION
fall n I hat li that I pn I Ih he C C.cIot 'L L r r he '
t�D wh g .1S t 703158 dP I :' CJ AY Iy .uny
CC q P I construct, p 1 f.I p y t dire ,
q tt II an In 11
i4m pro t tissuance, l applicant M1 ,g d:raten I
(Iain licensed p : II0p rd, ctoI L 1 (csma9 Sq. Ft. Floor Area Valuation'
'(cam g lnSw from andtev'v for
thelesinerrant]ion.Any
Code)
.What he s exempt therefrom mW the rosin for the integre a pliant In Any violation $ _• '
.f notSecco than
5 by uny rigid den for n yennil snnjene We applicant m a civil penury
nl not mare mon rvc nnoarril d.uat's rgslxp. - , APN Number Occup4 Type
°I,av no"it -f'he proplly,ornry employees wiles wages as their axle cnff'o'cion, r.- '
will do the work,and the slruclam is not intended or offered for sale(Sec:7044, :4 2 94 0
Business and Pmfe"imI,Cade:The C.nlracl°r'v License Law does not ayply I.on .III ford Required Inspections
crofn prtyWhob ds p 'he,, d h d such kh,nselr - -
orthrough his own enplY ,providedtht:nh inipboamentv are not'eadalOr
opened for.al .If how sr.thebulding or itaporsturienti.s, ldwio,noneyearOf . 50E — FINAL. PLUMBING ENERGY
idrpleti°n,the.caner-bailncrwin have thehnnienofprovingthatbeAldnotbaildor 506 — GAS CAS TEST
mprove lnrpum.ve ok.u.).- - .. _
❑1,ae owner afsha propenyl our exclmivaly contracting with beamed contract"1. 507 — FINAL PLUMBaI N,G
var a nt the indeed(Sit ,](144,Business ant Pmfcsait ns CodcU'Uoe Contractor's
License I.aw does not(,ply to an ownar.f property who bulld.v or improves thereon,
and who contracts for such prijea.s with it amlracfor(s) licensed pursuant to the
Connectors License Law. .
°I.tn exempl under Sec. p&P C or this ream"
Owner Do e
WORKER'S COMPENSATION DECLARATION s -
I punchy affirm under penalty nl peri,nY one of he fallowing deolmadore v
❑ 1 have and will nadnain a CeNtmue.f Consent in sell in sure for Workers - ' -
Compenmlio'n, ds provided fill by Seainn 3700 of the Lahor Code, for t1,0
perfbrmanem of the work for which this permit is issued. h
°I have and wall maintain Worker's Conhpemntion Insurance as royuireJ by Sedan - s
370p of the Labor Cod,,for the pcorermas,c of the work for'whlch this parmit is '
issued.My Workels Compensation Insumn[e currier and Policy number are
Carrier:- Policy No: - a
CERTIFICA'110N OF tiKEMPTION HR OM WORKERS'
COMPENSATION INSURANCE
(Oris secii°n need not be compaeed if Effort is for one hundred dollars
($Bxl)or less.)"
I ienify her in the performetce of the work for which this perch is issued,I - -
.shall nor emplay any perm"in any manner s.as,10 become_subject to the Workers r
Compausminn Laws of California.Dote
NOTICE TO APPLICANT.If offer-,king lhia Cour bales of Lxmnptfon,you should '
7-s became subjal to the Worker'sCoropensatnn provisions of the Labor Code,you nest _ -
Q Q forthwith comply wish aneb provisions nor this parmll dhoti be devoted revoked. "
CONSTRUCTION LENon len AGENCY
:l neebyfor waffloorhich this there is a umed(,get"lending agency for the perfnnnnnce
Ly of the is N for which this pennil ie issued(sec 309],Civ.C.1 + r
LL Lender's Name .
� z LenA Add rils
C.) 1 nfY nM1 nth Jlh ppl I dol IM1 ul h .onornadion' • .
F
Til Bey correct 1 agree in coal with oly J t}odinsuce,Aid once laws testing
OfQ tabu lov hg n efon, drorinspmei posentufves ofth ei tymemv upon
�y Try the abn(We)in boned property nu inspnd keep
purposesM.
E.t Ln (We)agree m xcost and concocts
kedep harely in the,way s cure ai against
nd _ -
tr !/� liabilities,judgments,rtc, Tac ing oofees ouch rely in an),way nmrue against suis - -
V City in consequenceUNDERSTANDS
of lho grunting D WILLCO. -
SOURAPPhICANTUNDERSTANDSANDWILLCOMPLYWITHALLNON-POIMr Issued by: Date
SOURCE REGULATIONS.
signamuc afApprcanucnmracmr Dn(a Re-roofs
HAZARDOUS MATERIALS DISCLOSURE - ,
Will he a,Pucam nor roture building continue store or handle bammat int Type of Roof s '
ae defined by the Cupertino Municipal Code,Chapter 9.12,and the Health"nod Safety
Cock,Seaton 255321ay1 s
°trod °NO All roofs shall be inspected prior to any roofing,material being installed.
\velma;hp,Bcomor(hture bulla'ng betapme me egn"I'll Ior de,acus which If a roof is installed without first obtainingan-ins inspection, 1,agree to remove. i
nit h:¢nNnuI at,mnendnanls as deOnad'by the Bay Area Air Gaal it,Managaurnin _ p g
aid''c'° - all new materials for ins eetion:Applicant understands and will comply with
°Y ❑Nn P PP
all non-point source regulations. «,
\1 1 have read the hazedom or
taphimeems under Chapter 6.95 of the
California Health&Safety Code Sections 25505,25533 and 25534.1 undersand that `
If the Noldingdoes nm colorfully have a'.air III(it is my responsibility to notify the
occupant of the"Parrenhems which nmol IN not prior a issuance A a Cenilicale or
.Occupancy _
'Signature of Applicant' _ Date -
Owneroraulhorreedagent _ Of - All roof coverings to be Class "B" or better
OFFICE
City of Cupertino Building Permit Application
E-Mail 0012�0018
jobsite Address: 21135 Hazelbrood Dr. Date: 11/28/00
Owner's Name:---Finnegan Sandy
Phone No.(408)257-6648
APN#: 326-28-051-------------- Project Valuation: 5 979.00--------
Building Permit Info: Bldg_---_- Elect----_ Plumb----X-- Mech--__--
Job Description
Replace 40 gallon gas water heater.
a
Contractor Information
Company: just Water Heaters Inc. Phone: (510)293-2012 .-
Contact Name: 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: 3/31/02
Worker's Comp#: 03KR0001018 Carrier: Clarendon Exp. Date: 4/1/01
Credit Card Information
Credit Card #: 5474-6331 -7168-6326
Name on Card: just Water Heaters Inc.
Expiration Date: 9/02
Visa MasterCard
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