03060172CITY OF CUPEwrINO
BUILDING DIVISION PERMIT
CONTR 'C�'TnR1INFORMATION:q�'
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B UILDING ADDRESS:
JUST WATER HEATERS INC
PERMIT NO 03060172
OWNER'S NAME:
1764 NATIONAL AVE
PERMIT ISSUE DATE
NE' -
(510) 293-9901
SANITARY NO. CONTROL NO.
ARCIi1TECT/ENGINEER:
BUILDING PERMIT INFO
FILED ELECT PLUMB MBCH
0
LICENSED CONTRACTOR'S DECLARATION
lb Description
o
1 haffirm arm Nal 1 am liaved under provisions of Chapter 9 (commencing
P
with Sermon Division]of Ne BuxinvSand Professions Code. rod myliceveis
andefof
Lfeumreaandefhn
REPLACE WATER HEATER FUNA E93
License Class Lic.g
Data Cmi.ler
(4 0. GALLON GAS)
ARCHITECTS DECLARATION
I understand my plans shall he used as public records
JUL 0 7 2003
Licensed Professional
OWNER -BUILDER DECLARATION
I hemhy affirm that I am exempt from the Contractor's License Law for tw
BUILDING
following reason. (Section 71171.5, Business and Pmfessiom Crol Any City or County
which recut., a Permit ,, construct, alter, improve, demolish, or repair any structure
poor m its issuance, also requires the applicant for such permit to rile a signed statement
that he is licensed puna. In the provisions of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuat�)11099
(commencing with Section 7") of Division 3 of the Business and Professions Code) or
Nat he is exempt therefrom and the basis for the alleged exemption. Any vlaladon of
39919&Di1T@er 00
- Occupancy Type
Section 7871.5 by any applicant for a permit subjects the applicant lo a civil penalty of
not mom than five hundred della. ($588).
❑ 1, as.., of the prepeny, or Any employ. with wag. u Heir sole Cempenssenn.
Required Inspections
will do the work and me structure is net intended or Aircraft forsale (Sa. 7044. Business
and Prefessiov Code: The ConnectorsLittve law d= not apply to m owner Of
502 FINAL PLUMB I NT3 ENERGY
property who builds or improves thereon,and who does such work himself or through his
-
own employees, prodded Unit such improvements are not Intended oronered for aide. If.
506 — GAS TEST
however, Ne building or improvement is sold within one year of completion. Ne owner.
builder will have the burden of proving that he did not build or improve for purirose of
507 - F I NAL PLUMBING
.ICJ.
1, as Owner of the property. am exclusively contracting with licensed conuacrors to
construct the pmject (Sec. 7044, Business and Pmfessiom Code:) The Constar's Li.
cave taw does not apply to an owner of property who build, or improv Ilemon, and
who contracts for such projects with acontrator(s) licensed pursuant to to Contractors
License Law.
❑ I am exempt under Sec. B k P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one Of the following CI Claallefts:
I haw and will maintain a Ceniricam of Consent no self -insure for WOrker'aComPCn-
aation, u provided for by Section 7700 of Ne Lobar Code. fm Ne Performance of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
37IX1 of NC labor Code, for Ne performance of the work for which this permit is Issued.
My Worker's Compensation Insurance carrier and Policy number am:
Cartier. Polity No.:
CERTIFICATE OF E%EM MON FROM WORKERS'
COMPENSATION INSURANCE
(This section need nm bccompleted if the Permit isformm hundred dollars(Slp)
or IeuJ
1 certify that in the performance Of the work far which this permit is issued, I shot l Out
employ any permn in any manner m As las hccomc Subject to the Wdden' Compensation
Laws of California. Data
Applicant
,
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker a Compensation previsions of Iw labor Cnde, you must
forthwith comply with such provisions or this Permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that them is a consuucenn lending agency fur the performance of
the work for which this permit Is issued (Sec. 3097, CO, C.)
Lemons Name
^�
tleh Address
I<nAdd
I canary that I have read this application aM suite Nat the above information i,
contact. 1 agree. comply with all city and county oolimence, and sum laws relating to
building construction, and hereby amomin representatives of this city to enter upon me
ahove-mentioned property for inspection purrroaes.
(We) agree to save, indemnify and keep harmitsa the City of Cupertino against
liublI tim,judgments, costs and expcnsv which may in any way accrue against aid City
'
I. consequence of the 6Oantiq of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONPOINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Type of Roof
Signature ol'ApplicanUtComaxeclor Data
HAZARDOA2ARDOUS MATERIALS DISCLOSURE
Will NeeCuApplicant or future building ac strand
haptstore
v darned by the Cupertino Municipal Code, Chapter 9.12. and rite Hca1lM1 mJ Safety
the Health And
oda Section 25532(a)?
All roofs shall be inspected prior to an roofing material bei. Installed.
P P Y 8
71 No
e
I❑Yes
If a roof is installed without first obtaining an inspection, I agree to remove
Will me applicant O, return wildmgoccapaim. equipment nuc dcviee, which
ii hanrdous air Contaminants az ticfmcd by NC Bay Area Air Quality Mavgcmcm
all new materials for inspection.
uuiaT
El Yea ❑Nn
1 have mad Ne havallous materials requiremenos under Chapter 6.95 of the Califon
tie Net On 6 Safety Cook, Sector 25505,25533 And 25534.1 moorstand Nm if me wilding
Joe, not currently haw a tenant, thin it is my respomibility m notify the oecup., of the
Acquirements which must be met poor At issuance Of a Cm50cam of Occupancy.
Signature of Applicant Date -
All roof coverings to be Class "B" or better -
Owner or autheoved agent Data
t
L
C
E -Mail
of Cupertino Buildinq Permit A
jobsite Address: 20171 Suisun Dr
Owner's Name: ---English, Sharon
Phone No.(408)255-4823
APN#: 369-28-012
Building Permit Info: Bldg ---------.
Date: 6-26-03
o 3,--' C v( 7L-
)plication L -
)plication
Project Valuation: S 1,099.00
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 # 591 329 Exp. Date: 3/31/04
Worker's Comp#: 1626288-03 Carrier: State Compensation Insurance Fund Exp. Date: 4/1/04
C.reait Cara Intormation
Credit Card #: 5474-6390-0026-5679 9
Name on Card: Just Water Heaters Inc.
Expiration Date: 9/05NZ
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Visa MasterCard
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