040801521
i
CITY OF CUPERTINO
BUILDING Dlvlslory PERMIT
CONTRACTOR YNVUMAON
Ru1LDINGADDRESS:
JUST WATER HEATERS INC
PERMIT NO. 04080152
OWNER'S NAME:
PERMITISSUEDATE
ONE:
SANITARY @0401. NO.
ARCHITEC (ENGINEER:
BUILDING PERMITINFO
BLDG ELECT' PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
ONTRAunderprovisionsof IOper9(commencing
fff������
Job DESC�t�L
1hereby.(firmthat1am licensed
with Section 70(X1) al'Division 3 of Me Business and Professions Code. and my license is
E D
in .(fact _
REPLACE WATER HEATER
Licenlse Cleats Llc a
Dam Contractor
ARCHITECTS DECLARATION
(4 0 GAL GAS)
SCP ' 2MOA
20
1 undashall ersnd my plans all he useas public and.
JL
TTd
Licensed
OWNER -BUILDER DECLARATION
I hereby a1Erm Not 1 em exempt from the Contractors License Law for the
hereby tris
BUILDING
following mason. (Saturn 7031.5, Business and Proftemons Cade: Any city m e. my
which requires a Permit in convect, alma improve, demolish, or repair any sio ctum
prior to its issuance, atm ba,mmaa be applicant for such pernil to file a signed statement
mat he is licensed pursuant to the provision of the Chummier' License Law (Chapter 9
Sq. Ft. Floor Area
Valuatio®810
(commencing with Section 70M) of Division 3 of me Business and Professions Code) or
4
that he is exempt therefrom and the basis forthe alleged exemption. Any violation of
APN Number
Occupancy e
p y �p
Section 7031.5 by any applicant for a permit subjects the applkanuo a civil penalty of
not marc than rive hundred dollars ($500).
35618004.00
0 1, as owner of the property, or my employees wish wages as their sole compensation,
- Required Inspections
will do the work. and Restructure is not intended mortared formal. (Sec. 7044, Business
and Pmfeumns Cudc: The Conrncwrt Licanse Law docs nal apply a. an owner of
property w ho builds rr improves thereon, and wha does sorb work himse If or though his
own cmployres, provided that such improveme assn not intended or offered Image. if.
however, the building or improvement is said within one year of completion. the owner.
builder will have me burden of moving that he did not build or Improve for purpose of
sale.).
❑ 1, m manner of the p .part , am exclusively contracting with licensed contractors to
construct the project (SCC. 7844, Business and Professions Cade:) Tax Cantracmre Li.
came Law dos not apply to an owner of progeny who Wilds or improves shaman, and
who convects for such projects with aconwctor(s) licensed pumuml to the Contractor's
License Law.
0 lammemptundm Sec. ,Bk PCWthiammon
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury am of the following declarations:
I haw and will maintain a Cenifieas, of Consent to self -insure for Worker'sCompen-
smian, as provided for by Section 3700 of me labor Code. far she performance of the
work for which this permit is ounce.
❑ IW. and will maintain Worker's Compensation Insurance, as required by Section
3700 of Ne labor Coda, for tie performance of the work for which this Permit is issued.
My Worker. Compensation Imursmc carie and Policy number are:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This action need not he completed if the Permit isforone hundred dollars (SIM)
nr ICss.)
1 certify that in me performance of Ne work for which this permit is issued. I shall not
employ any Person in any manner so as m become subject o the Workers' Compemadon
Laws of California. Data
Applicant
NOTICE TO APPLICANT: IE arm, making this Ccnificae of Exemption, you should
become subject to Worker's Compensation me,r Code, you shun
provision of the
Compor
l
forthwith comply with such and revoked.
it Nis Permitshelf he
or this
CONSTRUCTION LENDING AGENCY
I hereby affirm she there is a convection lending agency for me performance of
Me work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lenders Address
1 cenify Met 1 have read this application and sae Nat me show information is
correct. I agree to comply with all city and county on inances and sate laws mating to
building convection, and hereby authonm cpm mmmuca of this city to enter upon me
,
aMve-.. . ..cd popery for inpectian purposes
(We) agree to save, indemnify and keep humleu the City of Cala move against
liabilities. Judgments. costs and expenses which may in any way accme against mid City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Type Of ROOF
Signature or ApplicaDae
HAZARDOUS
S MATERIALS DISCLOSURE
Will the applicant mfuture buildinge. handle
m Chaptstoreor
the Cupertino Municipal Code. Chapter 9.13, and rim Health and Safety
Health and
cad ic,See .
es 25532(a)?
All roofs shall be inspected to any roofing material being installed.
❑Yes ON.
n
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
mit heasrdous air contaminants as defined by tee Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes 0 N
In= mad meWardousmaarialsmquimmenmundcr Chaper6.95ofthe Califor-
,
nia Health&SdetyCodc,Sccdms35505,3 533md35534. lunderand N.tiflhc Wilding
docs nut currently have a tenant, met it 4 my responsibility to noul'y the occupant of the
requirements which muss m met prior a issuance of a Cerulicam of Occupancy.
Signature Of Applicant Date
All roof coverings to be Class "B" or better
Owner
or aamrnaed agent Daa
is
7t --r
SUPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
10980 Maria Rosa Way
PERMIT #
o t 2 --
OWNER'S NAME: Beccia, AnthonyPHONE
# 408-253-0428
GENERAL CONTRACTOR: Just Water Heaters
FAX # 510-783-6360
I am not using any subcontractors:
�.x+.�ee. 1--�av�..t`Cs✓Q.e.7c2n�._�
8/11/04
Signature Date
Please check applicable subcontractors and complete the following information:
LJ.a� �Jc�-M O-UXLPv- 8/11/04
Owner/ Contractor Signature Date
10/28/03
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
LJ.a� �Jc�-M O-UXLPv- 8/11/04
Owner/ Contractor Signature Date
10/28/03
•
•
City of Cupertino Building Permit
E -Mail
Jobsite Address: 10980 Maria Rosa Way Date: 8-11-04
Owner's Name: --- Beccia, Anthony
Phone No.(408)253-0428
APN#: 356-18-004 Project Valuation: 5 810.00
Building Permit Info: Bldg ------ _--- Elect ----------- Plumb ------ X_
Job Description
Replace 40 gal gas water heater.
\.UI III QI LLJI 1111 U11fIcLLIUlI
lication
Company: Just Water Heaters Inc. Phone: (510)293-2012
Contact Name: Dulce Fax: (510)293-2022
Address: 1764 National Ave. E-mail: permitsg)justwaterheaters.net
City, State and Zip: Hayward, CA. 94545
State Contractor's License # 591329 Exp. Date: 3/31/06
Worker's Comp#: 1626288-04 Carrier: State Compensation Insurance Fund Exp. Date: 4/1/05
Credit Card Information
Credit Card #: 5474-6390-0026-5679
Name on Card: just Water Heaters Inc, r J 2673
Expiration Date: 9/05 i �� 1 d
Visa ❑ MasterCard X Q `�
Comments