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05080038 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTORINFORMATION :: BUILDING ADDRESS: JUST WATER HEATERS INC PE"MRNO05080038 21094 MARCY CT OWNER'S NAME: PERMIT MUE DATE JOHN TSING 3400 INVESTMENT BLVD 08/05/2005 NE: SANITARY NO. CONTROL NO. (510) 293-9901 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH j00 LICENSED CONTRACTOR'S DECLARATION O O O edF I hemby grim that I am licensed under Provinces of Chapter 9(commencing - Job Description £zu`$ with Section 7=1)of Division 3 ofthe Business and Professions Code,and my licemo is 3�y in fell mmradd errea REPLACE WATER HEATER 1 z License Class Lk,g c g c Dale Convenor 50 GAL GAS £ dy ARCHITECTS N DECLARATIO 1 understand my Plans shall be used as public DECLARATION >yV a u. dia Licensed Professional `903 OWNER-BUILDER DECLARATION B a E I booby affirm on 11. exempt from the Contractors d Liccnx Law for the T 3 O O following mason.uncut m co s r Business and va,Professions Code:Any city or manly �! $ which its ism a Permit re ennswe4 altec i t forsu,demolish,or repair ed structure Pr(af 111 its issuance,also requires the applicant forsuch permit las filcasUw(summcm ss0 thmlmecmved pursuant to the pmvivoruor lhecomacmrauttls¢how(Chaplcr9 Sq. FL Floor Area V i 4087 yF$ 'at(cohe t mute with Section Tang of Divisi for of the Busaged exe pt Proroacon.M i vi Code)of — that he a escmpt therefrom and the bases for bj alleged exception.Any violation of Out. hate five anyapplicantdont puts permit Subjects the applionl m a civil penalty of p 4 8 2 7 . Occupancy not mon man eve banana dollar(g5110). 32654027 . 00 p y Type ❑1.as own.of theproperty,ar my employed with wages as their role compensation, will do the work end the structure Is not intended or offend for sale(Sm.7044,Business and Propositions Code:The Contractor's License Law dues not apply to an owner of Required Inspections progeny who bas ilds a r improves Inereon,a red who does such wart himse If or through his own employers,provided that such improvements an not intended oro@red for sae.If. however,the building or improvement IS xld within one year of completion,the owner Wilder will have the border of proving that he did not build or improve rd purpose of Sale.). ❑1,as owner or to propcny,am exclusively conducting with licensed contractors to construct the pmjca(sec.7W,Business and Professions Cade:)The Co osers's U. cons,law docs not apply m an owner of property who builds or improv Ihmnon,and who contracts for such projects wits a contractor(s)licensed pursuant m the Conuactoes License law. I am exempt under Sec. ,B&PC for thB mazon Owner Data WORKER'S COMPENSATION DECLARATION 1 hccoby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a Certifinx of Consent to self-insum fm WoracesCompen- satum,as provided for by Secuon 3100 of the IaW,Code,for the peAarmaneu of the work for which this permit is issued. ❑1 bare mW will maintain Worleas Compensation Insurance,as recruited by Section 3100 of the labor Code.for the perfmmenee of the work for which this permit is issued, My Worker's Compensation Insurance candor odd Policy number an: Carrier: Polity No.: CERTIFICATE OF EXEMMON FROM WORKERS' COMPENSATION INSURANCE (This inion reed notbecmnplcted life,permit is for one hundred dolled(SIM) or less.) 1 crnlfy that in the pertmoranee of the work for which Ibis Permit is issued,l shall not employ any person in any mender On as In become subject to me Workcri Compermdon Laws of California.Date Applicant NOTICE TO APPLICANT.If,after making this CcniOdte of Exemption,you ahou d become subject m the Worker's Compematiun previsions of to Labra Code,you most .J ,Z forthwith comply with such provisions or this permit shall IN deemed revoked. z O CONSTRUCTION LENDING AGENCY [—h I hereby from that mere is a ematrvctior ending agency for me performance of IY 7 the.,it fur real this perms,u issued(sec.309'!,Co.CJ WM Q Lender's Name 7z lander!Addmu fJ C) I ttnify our I have read this application and sate mat the aW,infometion is IL cmecL 1 agree to comply with all city and county ordinances and sue laws elating to OV building construction.and hereby aumomnx e mpnuv diof this city to cow upon ft above-mentioned property for impection purposes. H 1 (we)agree to save,indemnify and keep harmless the City of Cupertino against H incoiuesmence fthe cmtsand eapenses which maY in any way uamme agaimdaid City V zs Permit. APPLIC NTeUNDERSTANDS Aractfing of hND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. s4te� Signature of ApplicanUConvxmr Dam Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building necupant am at handle Num us material as dcrined by the Cupertino Municipal Cob.Chapter 9.12,and tM HdIN and Safety We.Sectionzss3z(a)1 Yens ON. All roofs shall be inspected prior to any roofing material being installed. Will the APPridnt ar future wilding occupant use equipment or devices when If a roof is installed without first obtaining an inspection,I agree to remove 'Vorh havardous air contaminants as defined by the Ray Area Air Quality Management all new materiap materials for inspection. Duukt7 ❑Yes ON. I have coed the hvardaus mamrials equimncros under Chapter 6.95 ofthc Califor- niaHolub&Safety Cade,Secuores 25505,25533 and 25534,1 undemsend the if the Witding does not control,hmc•coram that it is my mapomihili y or notify da a cupant of the nquiemcnu which mus be mel prior to issuance ofa Cmrcate of Occur, Signature Of Applicant Date Owner Oraudoriardagent Irate All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue Q( -� Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -UPEkTINO Building Department JOB ADDRESS: PERM bT#� 21094 Marc C1 Ct. " vo3 OWNER'S NAME: Tsin ,John PHONE# 408-253-5095 GENERAL CONTRACTOR: Just Water Heaters FAX# 510-783-6360 I am not using any subcontractors: �� 4"-+a.0CJv--) 7/05/05 Signature Date Please check applicable subcontractors and complete the followinginformation: 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 7/05/05 Owner/Contractor Signature Date 10/28/03 City of Cupertino Building Permit Application E-Mail Jobslte Address: 21094 Marcy ct. Date:-05-05 Owner's Name:---Tsing,John 11 Phone No.(408)253-5095 APN#: 326-54-027 Project Valuation: $ 1087.00 Building Permit Info: Bldg___ Elect Plumb—____X_ Mech Job Description Replace 50 gal gas water heater. Contractor Information Company: Just Water Heaters Inc. Phone: (510)293-2012 Contact Name: Dulce Fax: (510)783-6360 Address:3400 Investment Blvd. E-mail: permltdept®sbcglobal.net City, State and Zip: Hayward,CA. 94545 State Contractor's License# 591329 Exp. Date: 3/31/06 Worker's Comp#: 1626288-05 Carrier:State Compensation Insurance Fund Exp. Date: 4/1/06 Credit Card Information Credit Card #: 5474-6390-0047-8660 Name on Card: Just Water Heaters Inc. Expiration Date: 06/08 Visa MasterCard LiN Comments