08090037 CITY OF CUPERTINO
BUILDING D!-VISION PERMIT CONTRACTQR+INFORMATIQt I x
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BUI I A KESS: PERMIT NO.
�l�f'3�� HENEY CREEK PL JUST WATER HEATERS INC 08090037
OWNER'S NAME: PERMIT ISSUE DATE
FRED & MICHELLE LACCABUE 3400 INVESTMENT BLVD 09/08/2008
)NE: (510) 293-9901 SANMARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT fNFO
BLDGELECT' PLUMB MUCH
t� 0 I� 0
30$ LICENSED CONTRACTOR'S DECLARATION
I hereby afnom wt 1 w licensed under provisions of Chapter 9(commeacdg Job Description
_z1 wishScake,]gKRofDiHaion)ofdieBusiessandTofectimuCode;andmylcerds,is REPLACE TANKLESS WATER HEATER
in full(ores and effect. -
Liet na:CI. Lie.t
Dao: Conuacwr -
eF^ ARCHITECTS DECLARATION
W U f understand my plansshall W umd as public rec-Na
bG t; Liarowd Professional
OWNER-BUILDER DECLARATION
1 bcmbY M.that I am exempt from the Conuamofa License Law for the
O o following rennin.(Sadon]ID 13,Bos;and Professions Code:Any city or county
3_ which reqt ulna permit m onosbmm.Aber,improve,drmolub,Of repair any structure
Prior to its issuance,aso require the applicant retouch permit to filcasigsed urcencnl
that he is licensed pursuant to the provisions of due Contractor's Liccnsc Law(chapter 9 Sq.Ft. Floor Area Valuation
(commenting with Section]OW)of Division 3 of th-R n.and!Pmfeuimu Code)or $3274
F 9 that W is exempt theelrom and the hands fm the a11Red exemption.Any violuion of
Section 7031.3 by any applicant fora permit subject he applicant or a civil prosily of Number Occupancy e
m,mare than five hundred dolum(g5M 34248028 . P yT'P
❑I.uowrcrofshe propmy,or mY eroPloyw with wagaanlhevsok compcaation,
and dothework andde aounuretrotintendedaraw do .1 in an wner..
And Rohahobu coat Th Contremseet Lf�•d ave sae ool,pply m an owner is Required Inspections
property wWWildamfmprowstivmove who am asuchwoh hiseUand fouugh his
now employee,progor i prsuch improvements itartnot su ofcmaeercd roe Mewl(,
however.Neawth Wilding or Mprowmentdssoldsdid Out
you dinmmovefortheowner-
Wilder will here the Wrdm of prvring NAI he did ml dull m improv far purpose of
tah.l.
❑1,an awns of the pmpen,am eaelmiwly amen ting with licamed contractoee to
mnSlNcl the Mica(Seca.7044.Buti.and Paramount Code:)The ContYW'S LI.
came law does not apply in an owner of property who Wilds or improves the mn,and
who contracts for such projects with a contacmr(s)licensed puuuant in the Contacmb
L.amen Law.
❑l art exempt under See ,B&PC for this won
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affrm under penalty of perjury cam:of the fallowing declarations
I ow am will maintain a Cenl6om of Come-so Ulf"Insure fm Worker'sCorepen-
radon,a provided for by Section 37m or the Labor code.for the performance of we
work for which this per ifl is isme.
❑I have and will maintain Worker's Compcnantian Insurance,an tequlmd by Sccaun
3700 ofthe Labor Code,fm de Performance ofdle wart fetwhich Nis Fermis is ianue,1 '
My Workcea Compcaauoa Inurtanm carrier and Policy number are:
Carie. Policy Nim ,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
erhds serum need Out he eompted if she permit is(mom hundred dollars(SIM)
or leu)
I certify that in the performance of Ne work fm which this Permit is Wood.l shall Out
-.-ploy any person in any m ome,.as m bmmoe subject N the Workers'Compensation
Laws of Califomit.Dat
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Eaemption,you sWuld
become subject N the Worker's Compclwlioo pmrisioru of the,labor Cod,you muds
.J z forthwith comply with such pmviuoa or tfu permit aloof be dremcd mmkcd.
OCONSTRUCTION LENDING AGENCY
[-� 1 hereby affirm that there is•coluwctiol landing agency far the prrforntAnm of
fk
the work for which this permit Is Wood(S c.3097,Cir,Q
W Q Lattices Name
Z) z Lenders Add
U O 1 comfy that 1 haw led was it"liadon and sura man de sinew inionat don I,
[T. F carreer.I apo to comply with all city and county on inure and auto laws mind,On
0 V Wilding construction.aod hemby mthoriU seputmludiwa or Nt city N mer upon the
aWU-mcnudgm judgments.
for ..per an purposes.
F y (We)agme to sow,indemnify and keep harmles the City of Cupertino so=
(n in COitie;stroCO dre Sinding expensru nit. may in any wyacerur agelanlsaid City
U z In PLICAence of thegranting of Nu per mit
2�(
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. '
Signuurt o(Applio!U ARaemr pads Re-roofs
HALUfDOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant or forum Wilding meupantuore or handle hautdoa mamriai
deby Nr CuCupertinoCupertinoMuni<ipal Code.Chapter 9.12,and the Heaith and Safety
Code.
Scam.255324)7
❑Ye ON. All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining inspection,I agree to remove
Will the applicant or(atom Wilding Occupant an,equipment or devices which g an P
andhaardmor ar contaminants a defined by the Bay Arta Air Qality Management all new materials for inspection.
❑Ye ON.
I have mal the hasolousmamriat requirements under Chapmr6.95 of Lhc Caiifor.
mu Health&Safety Cade,Seeuut25505.25533 aW 25534.I anticipated dm ifthe Wilding
does ma a molly have a IemaL the,it in my maptmibility in ondry de mapanl of On,
requirements which most be=1pormannounce,oracertificate oroccvpancy. Signature of Applicant Date
Owner or sutharveda em All roof coverings to be Class';W'
g Dam� g or better
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: pdtg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34248028. 00
DATE ISSUED. . . . . . . : 09/08/2008
RECEIPT # . . . . . . . . . : BS000006021
REFERENCE ID # . . . : 08090037
SITE ADDRESS . . . : 10359 HENEY CREEK PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : FRED & MICHELLE LACCABUE
ADDRESS . . . . . . . . . . : 10359 HENEY CREEK PL
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014
RECEIVED FROM . . . . : JUST WATER HEATERS
CONTRACTOR . . . . . . . : GILROY, JOHN LIC # 15128
COMPANY . . . . . . . . . . : JUST WATER HEATERS INC
ADDRESS . . . . . . . . . . : 3400 INVESTMENT BLVD
CITY/STATE/ZIP . . . : HAYWARD, CA 94545
TELEPHONE . . . . . . . . : (510) 293-9901
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 3, 274 . 00 0 . 50 0 . 00 0. 50 0 .00
IPPERMITFE FLAT RATE 1 . 00 : 40..79 0 . 00 40 .79 0 . 00
1PRWHEATR UNITS 1. 00 ..' 24 .48 0 . 00 24 . 48 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 106 . 56 0 . 00 106 . 56 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 106 . 56 VISA
---------------
TOTAL RECEIPT 106. 56
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
518 WATER HEATER
` City of Cupertino Building Permit Application
E-Mail
lobsite Address: 10359 Heney Creek PI. Date: September 8, 2008
Owner's Name:---Fred Laccabue
Phone No (408)967-5222 .
APN#: -4-� Project Valuation A 3,274
Building Permit Info: Bldg_—_ Elect__-- Plumb_—__X.—_ Mech
Job Description
Replace tankless water heater
Contractor Information
Company: lust Water Heaters Inc. Phone: (510)293-2012
Contact Name: Dulce Fax: (510)293-2022
• Address:3400 investment Blvd E-mail: permits®justwaterheaters.net
City,State and Zip: Hayward,CA. 94545
State Contractor's License# 591329 Exp. Date: 3/31/10
Worker's Comp#: 045096282 Carrier: ACE Exp. Date: 4/1/09
Credit Card Information
Credit Card #:
Name on Card: ,Just Water Heaters Inc.
Expiration Date: 6/11
Visa MasterCard
Comments
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT
10359 Hene Creek PI. 1 0037
OWNER'S NAME: Fred Laccabue PHONE # 408-967-5222
GENERAL CONTRACTOR: JustWater Heaters FAX # 510-783-6360
I am not using any subcontractors: .9-'As CO- t4uj-a_b� 09/08/08
Signature Date
Please check applicable subcontractors and complete the following information:
. 21 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
09/08/08
•
Owner/Contractor Signature Date
10/28/03