05080042 (2) ' CITY OF CUPERTINO
BUILDING DIVISION PERMIT .�CONTRAGTORTN 'ORMATIO &'
}s,*%z�i ✓ K.i«.drf384.�•i,Ars. q� wT .•w.i�:aeN
BURRING ADDRESS: JUST WATER HEATERS INC PERMIT NO.
05080042
s 2
OWNER'S NAME: PERMIT ISSUE DATE
KIET NGUYEN 3400 INVESTMENT
NE: SANITARY NO. CONTROL NO.
(510) 293-9901
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
300 LICENSED CONTRACTOR'S DECLARATION JobDescrition
tJi C 1 Wean,allirm �
that l me licensed made,pmu of Chapter 9(rommencing - P
^t1 with Section 7000)of Division 3 of the Business mad Prolusions Code.sad my license is
In full to.andeffen. REPLACE WATER HEATER
HZ License ClassLic.11
J Date Container 50 GAL GAS
ARCHITECTS DECLARATION y�s�
I understand my plana"I M used as public mcorde �1 �� (�
k Licensed Professional IJ �vV3) y ,f+f}f_c+
OWNER-BUILDER
I hereby affirm the 1 am emptt from to Contractor's License Law for 1M r)
M o following moan.(Section 7031.5,Business and Professions Cale:Any city or county SEP/]-Q
$(L which requires a pmmlt m construct,after.improve.demolish,or minor any atmetum
-Zi prior m Its inuence,alsu requires lad applicant for Such Permit to file siigned wumonl ,_
Y .
�p that M la licensed pursuant on provisions of the Contractor's License law(Charter9 Sq. F[. Floor Area / Valuatif�)3181
E5 $ (comM is
with Section 7000)of Division 3 of tee Business and Profutsions Code)w 1 '{'
that esempt therefrom from and toe basis for alleged eaempd4 f den.My violation of d- .C!, :T.
Section 7031.5 by my applicant for a permit subjects te<applicant to a civil Penalty Of APN Number iV 9 %r ccupancy Type
not mom than fire hundred dollars($500). 36930010 . 00 -
0 1,as owner of Use property,or my employees with wars as their role compensation,
will do the week,and the awcurm Is not humbled or offered for aMe(Sax.7044,Businsas Required Inspections
and Professions Code:The ConuaemM1 License e Law dors not apply to an owner of 9 P
property who builds or i mprovvs thereon,end w ho does.tach work himself or through his
own employees,provided thalsuch improvements as notinunded a offered formula.ll,
however.Ne building or improvement is said within one your of completon.to owner-
builder will haw tm burden of paving test he did am Mild or Improve her purport of
sale.).
0 1,as Owner of the properly.am uclusively contracting with 0ansse convection to
coentrum the project(Sec.7044.Business and Pmfessm s Code*The Conmctol.LL
cense law des not apply to an owner of property who builds or improves themon.aad,
who contracts for such projects with aeanuutods)licensed purmanl to the Conuaetor's
License law.
0 1 am asempt under Sec. .B Q P C far this moon
Owner Dau
73011WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following decla limo:
I ham and will maintain a Cediftau of Consent to m16Wum fns Worker's Comport
M
ion,u provided for by Station 37M of the Labor Code.for tee performance of the
rk for which this permit is issued.
1 ham and will maintain Worh(s Compensation Insurance,as required by Section
of the labor Cale,for tad performance of tad work for which tem Permit u issued.
Worker's Compensation,Iastro ce grim and Policy number me:
ller. Policy No.:
CERTIFICATE OF FXEMVnON FROM WORKERS'
COMPENSATION INSURANCE
(Thtssatinn need notM completed KIM permit Is forone hundmddellan($100)
or less.)
I adify that in the performance of the work for which this permit is broad,l shall not q�J
employ any person ci.. any manncrSuutobttmmc subject m
llM Workers'Compenution
Lawsof Celifomla.Data f 1^
Applicant - 1
NOTICE TO APPLICANT:If.slur making this provisions
near the
Latuad you u mlW
Mame subject to sec Workers Compensation pmvit Ma mf tee labor vNe,you most
' 0 O forthwith comply with such provisions a this permit Mail M dametl mvotrtl.
Z 5; CONSTRUCTION LENDING AGENCY
h IMmby a(frtm that Own is a construction lending agency for the performer of
fY
the work for which this Permit is issued(Sts.3077.Civ.C.)
�W Q Lendefa Name
n7. z Lender'sAddreaa
U0 I cerfify that 1 basso read this application and sum that the above information Is
LL P correct.l agree to comply with all city and county ordinances and some laws mining to
CU building construction,and hereby auhodm representnives of this city to cmer upon tee
W ahoa•montoned property for inspection purposs.
LL (We)a&=to on,indemnify and ktap humblest Use City of Cupertino against
y
liabilities judgments.cam and expenses which may In any my ammo against said City
t„)7 In consequence of to grating or this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signalum of Applieaanm Dau
HAZAR
HAZARDOUS MATERIALS DISCLOSURE Type of Raaf
WIIIepCetnoforum buildingeauPantnomor handle haeandmasmatedai
as defined by the Cupertino Municipal Code•
Chapter 9.17.and the Health and Safety
.dlllllictme, Y"15533(x)7 ON.
All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or future Wilding occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It h4va does air conuminums as donned by IM Bay Area Air Quality Management all new materials for inspection.
❑Yes ❑Nu
I have mW the hasa dousm serials requirements under Chapter 6.95 of to Califod
nia HnithBSafmyCadc,Seaiam25305.15533u425534.IuMauand"iNr building
does tum cudemly haves moven thatR o my responsibility to testify toe acupanl df the
requirements which must MmetpdortuawnaofaCLd;ncalLofaLupaLy. Signature,of Applicant Date
Owner Or aumhorimd agent Dam All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
���=✓ Cupertino CA 95014
Telephone(408)777-3228
CITY OF
ICUPEI�TINO Fax(408)777-3333
Building Department
JOB ADDRESS: PERMIT#
20219 Somerset Dr. 65S� j- a- _
OWNER'S NAME: Nguyen, Met PHONE# 408-640-7945
GENERAL CONTRACTOR: Just Water Heaters FAX# 510-783-6360
I am not using any subcontractors: �� '�Q 7/05/05
Signature Date
Please check applicable subcontractors and complete the following information:
60 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
7/05/05
Owner/Contractor Signature Date
10/28/03
oJv 2-
City
Cit of Cupertino Building Permit Application
E-Mail
Jobslte Address: 20219 Somerset Dr. Date: 7-05-05
Owner's Name:---Nguyen,Klet
Phone No.(408)640-7945
APN#: 369-30-010 Project Valuation: S 1181.00
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: permitdept®sbcglobal.net
City, State and Zip: Hayward,CA. 94545
State Contractor's License* 591329 Exp.Date: 3/31/06
Worker's Comp#: 1626288-OS Carrier:State Compensation Insurance Fund Exp. Date: 4/l/06
Credit Card Information
Credit Card #: 5474-6390-0047-8660
Name on Card: Just Water Heaters Inc.
Expiration Date: 06/08 o�
Visa MasterCard
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