04040122 CI'T'Y OF CUPEWHNO
BUILDING DIVISION PERMIT C0NTI2ACT012INk'0RMAI'ION
BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT N004040122
- 10776; TA RMA DR
OWNER'S NAME: PERMIT ISSUE DATE
talk JOAN MARASCHIN 1764 N 2004
ONE: SANITARY NO. CONTROL NO.
(510) 293-9901
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�OpZ LICENSED CONTRACTOR'S DECLARATION Job Description
L� O O O
¢F 1 hereby affirm @sl 1 em licensed under provisions of Chapter 9(commencing p
.<n with Senion](lfN)),if Division Sof Oc Business and Professions Cum.and my license is
in full force and effect.
Vin, Z Dole Class Lic.N
REPLACE WATER HEATER
Dam Contractor (4 0 GAL) ,
44 ARCUFFECTS DECLARATION .�� L WRD
K 1 understand my plans shall be used as public records
�Deuf;
01 Ucenud Pmfcssional S L P p 2004
,3 Oat I UM"ILDtfr DECLARATION J !r"- O L
Z 2 0V. I Masa afrirm that I am cxcmpt from he fesmrns Co License Law lit he
Z2 o which following reason.(Section](131.5,Business and improve.
demolish.
Code:Any city nr ectomy
m
which mquirns a Permit to ennnrucL aper,improve,Jemnlish.Or repairanyxuunum81#01
poor m its issuance,also requires the applicant for such Permit to rile a signed statement
�< thamt he is licensed pursuant the previsions of the Contractor's License law(Chapter 9 Sq. Ft. Floor Area 'a uatit ggg
(comencing with Section 700D)of Division 3 of the Business and Partisans Code)or
Nat he is exempt dumfound and the basis for the alleged exemption.Any violation of
Section]831.5 by any applicant fon pump subjects Ne applicant to a civil penalty of APN Number
not more than Eve hundred dollars($50o), Occupancy Type
01,as owner of the property,or my employees with wages u their sole compensation, 36934038 . 00
will do he work,and he Immune is no,intended or offered for sale(Sec.7844,Business
and Professions Code:The Contractor's License raw does not apply to an owner of Required Inspections
Property who builds or improves thereon,and who doessuch work himself or through his
own employees,provided that such improvements ere not intended oroffered for sale.If.
however,Ne building or improvement is sold within one year ofcompletion.due owner-
builder will have she burden of Proving that he did not Wild or improve for purpose of
salt.).
❑1,as Owner of the property,em exclusively contracting with licensed convectors to
Co nsvoct the ymject(Sec.7804,Business and Professions Cade:)The Contractor's U.
Crowe Law does not apply to an owner of property who Wilda or improves hereon,and
who contracts for such pmjecm with a Contractors)licensed pursuant to the Comreclorl
License Law.
❑I am exempt under See, ,B A,P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hem'y affirm andty er Pear of pe j.,one Of the following deduniona:
hoveandiv8l mainainaCcniticateofConemnmuB.tnsummrWorkescompcn-
aation,as provided for by Section 37OB of the Labor Code,for he Performance of the
work for which this Permit I,issued.
❑1 have and will maintain Worker's Compensation Insurance,u required by Section
37W of he labor Code,for the performance of he work for which this Permit is issued.
My Worker's Compensation Inaaaane,Cartier and Policy number art:
Carrier: Pal icy No, _
CERTIFICATE OF EKEkl MON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed If the permit is formic hundred dollars(31(X1)
less)
1 certify that in the performanee or the work for which this Permit is issued,I shall not
employ any Person 1n any manner suss to become subjecuo the Wofkeri Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Ceni scam of Exemption,you should
became subject to the Worker's Compensation provisions of the labor Code,you must
.J O forthwith comply with such provisions orthis Permit shall he deemed revoked.
Z y CONSTRUCTION LENDING AGENCY
P I hereby affirm hat there is a construction lending agency he the pnfurmance of
!Yi he work fur which this permit is issued(Sec,309],Civ.C.)
a Q Leader's Name
Lc /^) \
der's Address /
U O 1 certify that 1 have read this application and Hatt that he above Information is `
t]. correct 1 agree to comply with all city and county ordinances and list,laws relating to
oUbuilding construction,and hereby auhnt;m representatives Of this city to enter upon the
yahovc-mentioned property for inspection purposes.
(We)agree to cavo,indemnify and keep harmless the City of Cupertino egilnsl
N incoisequenc of its,the grauindofPemcamit, may in ony wry accrue against said City '
t„)z A consequence of the granting of this Permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by: Date
SOURCE REGULATIONS.
Signature of ApplicanVCommctor Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle haeodous material
u defined by he Cupenmo Municipal Code,Chapter 9.12,and the Health and Safety
Alllll�de.
osc❑cties 25532(a)3
Pow 0N All roofs shall be inspected prior to any roofing material being installed,
If a roof is installed without first obtaining an inspection, I agree to remove
WiII the applicant or future building accupam use equipment or devices which p
u hvamous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
J7dws
tiet]
❑Yes 0N
I have mad the horamous materials requirements under Chapter 6.93 of the CalifnP
Health K Safety Cale,Sectors 25505,25533 as 25534,1 understood that if the Wilding ..
not currently have a tenant,that it is my resrynsihility m nouly he Occupant of the
lrements which most W met game to issuance of CemEcam of O,co,bou, Signature of Applicant Date
Owner or authorised agent Ww All roof coverings to be Class "B" or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
ISCITY 0 Fax(408)777-3333
UPEkTINO
Buildin De artment
JOB ADDRESS: PERMIT #
10776 La Roda Dr. 6 �{ " Z -L�
OWNER'S NAME: Maraschin,Joan PHONE #408-253-7213
GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360
I am not using any subcontractors: �.a. .. R'{�� 4/19/04
Signature Date
Please check applicable subcontractors and complete the followin information:
Vj 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
• (T'ille Ua.� 4 s�r2^^ 4/19/04
Owner/Contractor Signature Date
10/28/03
r
2-
City of Cupertino Building Permit Application
E-Mail
Jobslte Address: 10776 La Roda Dr. Date: 4-19-04
Owner's Name:---Joan Maraschln
Phone No.(408)253-7213
APN#: 369-34-038 Project Valuation: $ 698.00
Building Permit Info: Bldg__—_-- Elect_ Plumb`—X----- Mech_------
Job Description
Replace 40 gal 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# 591329 Exp. Date: 3/31/04
Worker's Comp#: 1626288-03 . Carrier:State Compensation Insurance Fund Exp. Date: 4/l/04
Credit Card Information
Credit Card #: 5474-6390-0026-5679 v�� z3s'
Name on Card: Just Water Heaters Inc.
Expiration Date: 9/05
Visa MasterCard X
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