03040089 CITY OF CUPERTINO
BUILDING DIVISIONPERMIT CONTRACTORINFMRMATIONUA
Tff6V'T%NUBE DR JUST WATER HEATERS INC PERMIT NO.03040089
1 NF1 BRINE (BLDG E) 1764 NATIONAL AVE PERMIT SS6R7`l 6/2003
Adk
O (510) 293-9901
NE: SANITARY NlO1.Y CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BO ELECT PLUMS MEOCH
3Oo LICENSED CONTRACTOR'S DECLARATION
l F 1 Wreby OMI.Na 1 am licensed under provisions of Chapter 9(commencing Job Description
]2 wifellfrom 7IXM0of Diviq.nJO(Ne Busiocaand Profcamom Cade.and mylkcnuu
LLfull(once and cnett
License Coma Lk,0 REPLACE WATER HEATER �f •��E�
,an
Conan., (50. GALLON ELECTRIC)
f I untletwnd my pans shall he used as CHITECTS DECLARATION
bAR meet&
APR 2'2 X003
]6
taa� Licensed Pmfcui.nel
sN5 OWNER"BUILDERmDECLARATION 1
COO hereby affirm Nat 11. ,exempt from W Contractor's License Law for the BU'L D1R 1/;
p O following tenon.Section](131.5,Business and Professions Code:Any oily structure 3$ P60F t requires a Patent re cmauucL alter improve,demolish,ore a sig any saement
-iy pot hers itsissuance,pursuant
nt to thereS tM applicant for such Permit tokens)Law(Chapter
mem
(cothat he mmencing with
pursu.ol700)of Division
of of the Btnc70r'and PralaW sCode)
SCI. FL Floor Area Valuation
[F O (cat he is xempt t erafro]000)a e Imoui.n r the
the Dare..ess end exemption.
i Cade)or _
6�� Net he is exempt feertfrom and die bila for the alleged eumptlon.Any violation of 8800
Section 70]1.5 by any applicant for a Permit subjects Ne applicant l0.civil pcally of 'APN Number Occupancy Type
not more Nan five hundred dollars($500). P Y YP
oI.as owner or the propery,or my employees with wages u their sole compensation, 36949012 . 00
will d0 Newark and the atmctute is not intended or.Rental fonak(Sec.7041,Business
and Professions Code:The Comsat.,',License law dam not apply to an owner of Required Inspections
property who builds or improves thereaa and who does such work himself orthrough his 502 — FINAL PLUMBING ENERGY
commeplaya;provided Nmmchimprommenuvenottmmndedoro@red formle.IL S06 — GAS TEST
however,Ne building or improvement Is sold within ore year of completion,Ne Owner
builder will haw the burden of proving Nn W did not Wild or improve for purpose of 507 - FINAL PLUMBING
sale.),
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct fee project(Sec.7044.Business and Profession Code:)The Conuumr's Li"
come law docs not apply to an owner of property who Wilds or improves thereon,and '
who eamVacts for such Projects with a contractor(s)licensed pursuant to Ne Contractor's
License Law,
❑1 am exempt under Sec. .B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby sM m under penalty of Perjury,one of the following declarations:
I ban and will maintain a Certificate of Consent o uI(-insum for Workers ComPm.
sail..,a provided for by Section 3700 of Ne faWr Cade,for fee performance of fee
work far which this Permit is issued
❑I haw and will maintain Worker's Compenmllon Wurace,as required by Section
3700 of the Labor Code,fur Ne performance or Ne work for which this Permit is iced.
My Worker's Compema0.n onsunnce canner and Policy number are
Caller: Policy NO.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sedlon need not W completed if the permit a for CO.hundred dollart($100)
or lest)
I unity Nat in Ne Performance of the work for which this Permit it issad.I shall not
employ any person in any manner an as to Wcomc subject to tW Workeri Compcmation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.If.after making this Certificate of Exemption,you should
become subjat to the Workers compensation provisions of thc Labor Code,you muss
�p forthwith comply with such provisions or this permit shall W deemed revoked.
Zvy CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a convection lending agency,ter thc Performance of
Y, " thc work for which this permit Is issued(Sec.7097,Civ.C.)
Y Q Lender's Nurse
� z Ianderi Addmsa
C) I unify that I ban mad this application and sats Nm the show Information is
y correct 1 agree to comply with all city and county ordinances and exam laws relating to
V building convection,and hereby authaou rePreuntatives of Nis city to enter upon the
H U almvamcnuuned property for Inspection purposes.
ti G (We)agree to saw,indemnify and kap harmless the City of CMCnhm ag.iml
h Ifibolitlu.judSmcna,Coto and a.,.which may In any way aCcruc against a to City
in consequence of the granting of this Permit,
a7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
SigmWm of APPIica Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne pplicant m(seam Wal C g e.Chapter
Gore or handle Health
material
a dcnatl by dm Cupeninn Municipal Code.Chapter 9.11,and the HcaIN and Safety
Coda.Seefi..25532(.)7 All roofs shall be inspected prior to an roofing material bei. installed.
Elva 0N P P Y g 8
Will the applicant or future building occupant use equipment or dcviccs which If a roof is installed without first obtaining an inspection,I agree to remove
It hmardnus air c.nmminana as defined by the Bay Area Air Quality Management all new materials for inspection.
aria[
❑Yes No '
I have mad Ne hvaNuu..scrub requirements under Chapter 6.95 of the Califor.
nia HUM&Safety Cook,Secuom 25305,25577 and 25534.1 umlemind that if Me Wilding
does not currently han a tenant Nat it IS my MrOod hility m.Oul'y Ne OCCmmm of thc
requirements which must W met poor to issuance of a Ceruacato of Occupancy. Signature of Applicant Date
owner ar,.Noomd ag)m Dim All roof coverings to be Class "B"or better
City of Cupertino Building Permit Application
E-Mail
lobsite Address: 10208 Danube Dr., Bldg. E Date: 4-16-03
Owner's Name:--Brine,Cynthia
Phone No.408)257-5189
APN#: 369-49-012 Project Valuation: $ 800.00
Building Permit Info: Bldg---------_ Elect___________Plumb------k__— Mech----—_____
Job Description
Replace 50-gallon electric water heater.
Contractor Information
Company: lust Water Heaters Inc. Phone: (510) 293-2012
. Contact Name: Dulce Fax: (510) 293-2022
Address: 1764 National Ave. E-mail: permits®lustwaterheaters.net
City, State and Zip: Hayward,CA. 94545
State Contractor's License#591329 Exp. Date: 3/31/04
Worker's Camp#: 1626288-03 Carrier:State Compensation Insurance Fund Exp. Date: 4/1/04
Credit Card Information
Credit Card #: 5474-6390-0026-5679 2� l 2 sj
Name on Card: Just Water Heaters Inc. D "�
Expiration Date: 9/05
Visa MasterCard ® 73 0
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