04060200CITY OF CUPERTINO
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BUILDING DIVISION PERMIT,CtUNTItAC'CO1tXX1Y'R�M
A.TIU1
BUILDING ADDRESS:
JUST WATER HEATERS INC
PERMIT "04060200
OWNER'S NAME:
PERMIT ISSUE DAM
BRUCE
ONE:
SANITARY 0. C NTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 0 0
j LICENSED CONTRACTOR'S DECLARATION
7bDescri tion
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1 am licensed under provisions of Chapter 9lm cmcing
1 thereby affirm Nu mm
Division7of the Businmand Profcssinu Code. end mylkensem
3 with Surm
and1o)of
in eneClassdefrtet.
REPLACE WATER HEATER
License Class sec. «
ic6
' Date ConmECLARATION
(THIS IS TO REPLACE #7772 SQUIREHILL CT.CONTRAC
ARCNT
Iundenundmyphummallloand As public recoNs
SENT THE WRONG ADDRESS --07/19/04)
e
Licensed Pmfcssional
DECLARATION
3 Oat
from
g I tire 1 am eacmpa from the Commcofa License law for the
I am exempt
me on Code:
moon. (Section 713 M. Buinm araC cat's car mum's
Lfollowing
are, dense
which require • ct a@n improve, demolish, or cp any tatucwm
m prior m its iazuaroc, ala m tM e a sig
e. AIM re quires
f such Grein La ed statement
Liman (Chapter 9
me, Ldtt
Sq. Ft. Floor Area
Valuation
vismout
fit to sears
(Miia
)o(Disloiun of Busi mfr
burlm ucingu dPuwan 7
Division of Nc B d Gni ) ser
9 (cat neem iN Suuon ]fang ext
th r ed a on. Mynvi n
. that he u exempt therefrom seri the hose far the alleged eumption. Any violation of
bees
81075
APN Number
Occupancy T
P Y YPe
Section 7071.5 by any, applicant for a Permit subjects the applicant to a civil penalty of
am ream anon five hundred dollars (S500).
❑ 1, u owner of the pmpmy, m my employm with wages u theirmlc c=Nnudon,
Required Iect
will do the work.and thesuuuum isnot intended oraQema forsale(Sec. 7044, Budmsns
and Professions Code: The ConuactofY LIRve Law dm nor apply m an owner of
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Internet, who Wilda or improves doe ntand whodoes such work himestforthmugh his
own employee. Provided that such improvements art not Intermed or of riew for uI .If,
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however, the building car improvement is sold within mm year of completion. Ne owner
®
builder will love the burden of proving Nat he did not build or improve for puryou of
oak'.
p ��
A A200
❑ I, a owner or do Pmpeny, am eacluiwlY contorting wilt licensed conusomn m
convect Ran pmica (Sec. 7041, Business and Pmfassions Cade:) The Conuacmis Li-
cave law dm not apply m an owner of property who builds or improves thereon, and
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who contracts for such pmjcm with a conations) licensed pursuant m the ConOactofs
®��
um.. law.
❑ 1 am exempt undo Su. . B A P C for Nis reazoa
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Nulty of perjury one of the following declensions:
-
1 have and will maintain a CerdOcate of Consent to satNa m for Worker's Compton.
,
talion, az provided for by Section 3700 of the Isbor Cade, for the perfo pr men of the
work for which this permit is issued.
❑ I have and will maintain Worker's Compensation luunnce, an required by Section
3700 of the Labor Code. for the performance of the work for which this permit is Issued.
My Worker's Compensation Inwnnce carrier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EJ(EMMON FROM WORKERS'
,
COMPENSATION INSURANCE
(This section need not becomplemd line permit la fnrone hundred dollars ($IN)
or Ions.)
1 certify that in the performance of the work for which this Permit is Issued. I shell not
employ any pawn in any mannerm az to become subject to the Workers' ComPenutlan
Laws of California Dam
Applicant
NOTICE To APPLICANT. If, after making this Ccmlliam of Exemption, you should
become subject the Waher'o Compensationsorthisprevisions of the Labor Code, you mon`—
v forthwith comply with such provisions orthea Permit shallOn, roomed node,'
y
'
iCONSTRUCTION LENDING AGENCY
1 hereby affirm that then is a comtmetion lending agency I'or the Performance of
the work for which this Pmmit is Issued (Sec. 7097, Civ, C.)
Landers NMe
Lcnder'a Addmu
1 cenify that 1 have read this application end state that the shove information is
correct. I agree in comply with all city and county ordinances and now laws relating an
building construction, and hereby aulhonat representatives of this city to enter upon the
Nw -n entioned properly for inspection purposes.
(We) agme m save, indemnify and keep handless the City of Cupcnino agaiul
liabilities, judgmcn s. costs and eapcnm which may in any way ace. against said City
r in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Sigawurc of ApplicaHU one
ARamor
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Willy applicant or (arum building now Oran Wk h
eardousdSafrmaterial
As refined by O Cupertino Municipal Code. Charter 9.13, and the Health and Safety
t e. Chart
elder, 6y. zss7z(a)7
All roofs shall be inspected prior to any roofing material being installed.
pYm ONO
If a roof is installed without first obtaining an inspection, I agree to remove
will the arrej ani or future building occupant am equipment or dcvim which
it harardnus air cconabriunu az cie0ncd by the Bay Am Air Quality Management
all new materials for inspection.
imlca7
❑Yu ON.
I hive mW the haurdmn materials requiremem s under CMPmr 6.95of Bre Califor-
nia thelth 6: Safety Code, Savma 35505, M333 amt ]5534,1 underataW here if the Wilding
does not currently haw a onand, mat is H my mNrooldlity w nod fy do occupant of the
myuirtments which most be met prior to trounce of a Ccnlficam of Occupancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner or aathariJcd agent Dam
DA 01
ICUPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
7771 S uirehill Ct.
PERMIT #
t9 6
OWNER'S NAME: Bailey, Bruce
PHONE # 408-253-9162
GENERAL CONTRACTOR: Just Water Heaters
FAX # 510-783-6360
I am not using any subcontractors: 6/19/04
Signature Date
Please check applicable subcontractors and complete the following informaHnn-
Owner/ Contractor Signature
6/19/04
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
Owner/ Contractor Signature
6/19/04
Date
10/28/03
I0
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City of Cupertino Building Permit Application
E -Mail
7 lu6 rto� 7n7.7 2
Jobsite Address: 7771 Squirehill Ct. Date: 7-19-04
Owner's Name: ---Bruce Bayle
Phone No.(408)285-71 71 U v s
APN#: 362-23-022 Project Valuation: $ 1,075.00
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)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: 3/31/06
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.
Expiration Date: 9/05
Visa ❑
NZ
MasterCard
mments
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