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07080106 --7777777777.7777..77777777-7 CITY OF CUPERTINO PERMIT TeraMATI BUILDING DIVISION PiiA1Wi11 "P: 11 OR PERMIT NO. BUILDING ADDRESS: 10858 E ESTATES DR JUST WAr'ER HEATERS INC 07080106 PERMIT ISSUE DATE OWNER'S NAME: BLASQUEZ—GUERRA SHAREN ET AL 3400 INS SA i AR 0. CONTROL NO. E: (510) 29:1-9901 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description F I hereby affirm that I am licensed under provisions of Chapter 9(commencing - with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPLACE 40 GALLON GAS WATER HEATER p in full force and effect. License Class Lic.A Date Contractor _ ARCHITECTS DECLARATION I undcrseand my plans shall he used as public records F" Licensed Professional a OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the o following reason.(Section 7031.5.Business and Professions Code:Any city or county ti which requires a permit to construct,alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statementr'q-Ft.Floor Area Valuation ter 9 •t that he is licensed pursuant to the provisions of the Contractor's License Law(Chap o (commencing with Section 70D0)of Division 3 of the Business and Professions Code)or $908 ..' that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of ��}}Dh��T Number Occupancy Type not more than five hundred dollars(SM. 36922004: . U V 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner. builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractors Li- cense Law does not apply to an owner of property who builds or improves thereon,and• who contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law. 1 am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: (.]I have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 1 have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Polity number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION 114SURANCE (Kris section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must 0 forthwith comply with such provisions or this permit shall be deemed revoked. 0 CONSTRUCTION LENDING AGENCY w I hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(Sec.3097,Civ.C.) a Q Lender's Namc Lender's Address �z 0 1 certify that i have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorim representatives of this city to enter upon the y W above-mentioned property for inspection purposes_ Lir (We)agree to save,indemnify and keep harmless the City of Cupertino against y[� liabilities,judgments,costs and expenses which may in any way accrue against said City Z in consequence of the granting of this permit. Date .r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: _ SOURCE REGULATIONS. Re-roofs Signature of ApplicandContractor Dam Type of R oof HAZARDOUS MATERIALS DISCLOSURE yP Will the applicant or future building occupanlstore or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)7 All roofs ;hall be inspected prior to any roofing material being installed. ❑Yes ❑No Will the applicant or future building occupant use equipment or devices which If a roof i;installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes ❑No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Heal th&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a Certificate of Occupancy. Signature of Applicant Date All roof coverings to be Class"B" or better Owner or authorized agent Date -- City of Cupertino Building Permit Application E-Mail Jobsite Address: 10858 E. Estates Dr. Date: August 13, 2007 Owner's Name:---Guerra,Sharron Phone No (408)408-996-7473------ APN#: 369-22-004 -------------- Project Valuation $ 908.00 Building Permit Info: Bldg----- Elect—._--- Plumb-_—X--- Mech__�� fob Description Replace 40 gallon gas water heater. Contractor Information Company: just Water Heaters Inc. Phone: (510)293-2012 F, Contact Name: Fa):: (510)293-2022 V.2 Address:3400 Investment Blve. E-mail: permits@)justwaterheaters.net City,State and Zip: Hayward,CA. 94545 State Contractor's License# 591329 Exp. Date: 3/31/08 Worker's Comp#: 01 DKRM11001070 Carrier: Nelos Exp. Date: 4/11/08 Credit Card Information Credit Card #: Name on Card: Expiration Date: Visa* MasterCard Comments Community Development _ 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY Of Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: PERMIT # 10858 E. Estates Dr. OWNER'S NAME: Guerra Sharon PHONE # 408-996-7473 GENERAL CONTRACTOR: JustWater Heaters FAX # 510-783-6360 I am not using any subcontractors: . 4�yt 08/13/07 Signature Date Please check applicable subcontractors and complete the following information: 21 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 tQ-. V(-"Ja ..u-M ` 08,'13 07 Owner/Contractor Signature Late 10/28/03 INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMIT INVOICE OPERATOR: CathyS Sec: Twp: Rng: Sub: Blk: Lot: APN 365,22004 . 00 INVOICE DATE. . . . . . : 08 '13/2007 REFERENCE ID # . . . : 07080106 SITE ADDRESS 10858 E ESTATES DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : BLASQUEZ-GUERRA SHAREN ET AL ADDRESS . . . . . . . . . . : 10358 E ESTATES DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4534 CONTRACTOR . . . . . . . : GI],ROY, JOHN LIC # 15128 COMPANY JUST WATER HEATERS INC ADDRESS . . . . . . . . . . : 3400 INVESTMENT BLVD CITY/STATE/ZIP . . . : HK(WARD, CA 94545 TELEPHONE . . . . . . . . : (510)293-9901 FEE DESCRIPTION DUE FOR AMOUNT DUE PAID BALANCE --------------------------- --------- ------- ---------- ---------- -- ENERGY APPLICATION 34 .86 34 . 86 0.00 WATER HEATER/VENT PRINTING ?ERMIT 10.79 10.79 0.00 PLUMBNG PERMIT ISSUE PRINTING ?ERMIT 38.37 38.37 0. 00 ---------- ---------- ---------- 84 .02 84 . 02 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ------------------ 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING