05010135 CITY OF CUPEWrINO
BUILDING DIVISION PERMIT CONTRAC./TOR INFORMATION
BUILDING ADDRESS: JUST WATER HEATERS INC PERMIT N(O 5010135
OWNER'S NAME: PERMIT L6UE DATE
TAO GUAN 3400 INVESTMENT BLVD 01/25/2005
ONE: , SANITARY NO, CONTROL NO.
510) 293-9901
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
100 LICENSED CONTRACTOR'S DECLARATION O O O
fW I hereby arfirm that I am licensed ander previsions or Chapter 9(commencing Job Description
6� witb Secti)n?(XaB of Division 3af me Basins., nd Proressinm Code,and my license is
I. aufo lass affect.
REPLACE WATER HEATER
j = Liccnm Class Contractor )
�r Da¢ Cmtractor 50 GAL GAS
ARCHITECTS DECLARATION
f w U
61 undersand my plans shall Ise used as public records
e o N Lk:..d Professional j
3 OWNER-BUILDER DECLARATION O
<y 1 hereby affirm that I um exempt from me Contractor's License Law for the 1\
p O following reason.(Section 7(01.5.Business and Professions Calc:Any city or county V
5 m tai which«quires a permit to conswct,alter,improve,demolish,or repair any ewcture
prior in is issuance,also requires the applicant for such Permit to file a signed statement
reap that he is licensed porsmminthe provisionsofthe Contractor's LimnuLaw(Chapter 9 Sq.Ft. Floor Area Valuati($1$00
[t— (commencing with Section 2000)of Division 3 of the Business and Professions Cork)or
u�$ Nat he is exempt therefrom and the basis for da alleged exemption.Any violation of
Seen.7031.5 by any applicant for a permit subjects the applicant to a civil penalty or
Out.)« APN Number Occupancy T e
man five hundreddollars(SSW). 35623019 . 00 p y yp
❑1,u)wncr of the property,m my cmploycu with wage u tkir sole wmpemation,
will do the work,and me structure is not intended or offered for sale(Sec.7U44,Business
and Professions Cmc The Conmctor's License Law does not apply to an owner of Required Inspections
Own eny who builds or ed thavu improvements
mpr and who docssmM1 work h r offered
bis
Own the uip building
or improvement
such fit is Sxmcnaarenot intendedor)Bernd for vie. r-
however.thebuilding arimprovementishat within one year of completion,the ase of
builder will breve do burden of proving that he did not build or improve far purpose of
tile.).
1,as Owner of the property,am exclusively contracting with licensed contractors to
consBact the project(sec.7044,Business and Profusions Code:)The Contractor's Li.
cense Law docs not apply to an owner of pmpcny who builds or improver demon,and.
who commca for such projects with a eonuactor(s)licenud pursuant to the Convenor's
License Law.
I am exempt under Sec. ,B A PC for this«axon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one Of the following deeikations: .
I have and will maintain a Cerdficam of Consent o vlf-insure for Worker,Compcn-
sation,Or provided fm by Section 37M of me labor Crude,for But,perfann...of the
work for which this permit is issued.
❑1 ban and will maintain Workers Cmula m ttwo Insurance,as«qui«d by Section
3700 of Ne labor Cme,for the peeformanee or the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number arc:
Cartier. Polity No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
CITU amen neeA not be completed if the pemrit is for one hundred dollars IS IUD)
or Irv.)
1 mnify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner As as in become subject to the WorkersCompensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Ceni fieaw of Exemption,you should _
become subject to the Worker,Compensation Provisions of the Labor Cade,you mum
�Z forthwith comply with meh provisions or this permiuhall he deemed revoked.
ZO CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency I'nr the performance of
x the work for which this permit is issued(Sce.3097,Civ,C.)
1 Q Lenders Name
3. z Lcndcr's Add«as
J C) I certify that 1 lave«ad this application and ser«that de above information is
y comect.I agree to comply with all city and county ordinances and state laws relating to
'U building construction.and hereby suthmi««presenatives of this city to enmr upon the
amvomemianed propertycosts
for inspection expenses
purposes.
Ow (We)agree to save,indemnify and keep harmless the City of Cupertino against
Z in COsespiiac afthe casaantl cxpmaaswhich may in anyway accuse against Said City
JZ, in of UNDERSTANDS
of cotspermit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONPOINT Issued by: Date
SOURCE REGULATIONS.
Srgnaarcof Applm.nUConoacmr Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or furore building acapant a,..or handle havmdaus moterial
as defined by the Cupenino Municipal Cmc.Chapter 9.12.and the Health and Safety
,gliWotic.Section 25512(.)?
❑rex 0N All roofs shall be inspected prior to any roofing material being installed.
Wilt the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
sit hazardous air contaminants U defncd by the Bay Arca Air Quality Management
District? ,all new materials for IHSPCCtIOn.
❑Yes ON.
I hate mad the h.vaNnus materials requirements under Chapter 6.95 ofde Calif.,
out Health&SafnyCme,Smut.25505,25533 and 25534.1 undersand mot if the building
does not currently haze a tenant,that it is my«spomi hil ity w mn61y the accoput of the
requirements which most Iz at on,to issuance of a Ccoiricate of Occupanry.
Signature of Applicant Date
Owner or authorized agcm D,w All roof coverings to be Class"B" or better
t� Community Development
-Cf 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
SCITY'OF Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRESS: PERMIT # /
21536 Monrovia St. o-S o I D(3S
OWNER'S NAME: Guan, Tao PHONE # 408-253-7895
GENERAL CONTRACTOR: Just Water Heaters FAX # 510-783-6360
I am not using any subcontractors: 1/20/05
Signature Date
Please check applicable subcontractors and complete the following information:
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
�4 1/20/05
Owner/Contractor Signature Date
10/28/03
City of Cupertino Building Permit Application
E-Mail
Jobsite Address: 21 536 Monrovia St. Date: 1-20-05
Owner's Name:---Guan,Tao
Phone No.(408)253-7895
APN#: 356-23-019 Project Valuation: $ 800.00
Building Permit Info: Bldg—-------— Elect_________ Plumb___ _X__-__ Mech_________--
Job Description
Replace 50 gal gas water heater.
Contractor Information
Company: Just Water Heaters Inc. Phone: (510)293-2012
Contact Name: Dulce Fax: (510)783-6360
Address:3400 Investment Blvd. E-mail: permits@justwaterheaters.net
City,State and Zip: Hayward,CA. 94545
State Contractor's License# 591 329 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 ,13
Name on Card: just Water Heaters Inc. 0 5
Expiration Date: 9/05 d `i
Visa MasterCard
Comments