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07060270 7777777777 CITY OF CUPERTINO tie h BUILDING DIVISION PERMIT C `RAQ IUTIQN* PERMIT NO. BUILT Iy,lG�WT'bANTA TERESA DR JUST WATER HEATERS INC 07060270 (J PERMIT ISSUE DATE OWNER'S NAME: SMITH WARREN E AND SUE L 3400 INVESTMENT BLVD 06/29/2007 SANITARY NO. CONTROL NO. VE: (510) 293-9901 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH p p LICENSED CONTRACTOR'S DECLARATION Job Description V" 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing :Z U3 with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPLACE 40 GAL WATER HEATER. ? y t in full force and effec t v�Z License Class Le•# E-q Dam Contractor ARCHITECTS DECLARATION JI understand my plans shall be used as public records >a.0 U.l- Licensed Professional o a OWNER-BUILDER DECLARATION >- 1 hereby affirm that 1 am exempt from the Contractors License Law for the jn C following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure z r prior to its issuance,also requires the applicant for such permit to file a signed statement c q-Ft.Floor Area Valuation a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $1080 c t=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 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 35617024 �Number Occupancy Type not more than five hundred dollars(5500). 0 I,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.). 0 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. 0 1 am exempt under Sec B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: (]I have and will maintain a Certificate of Consent to self-insure for Workces Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I 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 Workers Compensation Insurance carrier and Policy number ate: Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars(E 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 ,J. ,Z forthwith comply with such provisions or this permit shall be deemed revoked. Z OCONSTRUCTION LENDING AGENCY F.a 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.) W Q Lender's Name Z Lender's Address (� 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 Jbuilding construction,and hereby authorize representatives of this city to toter upon the ahovc-mentioocd property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City Ca Z in consequence of the granting of this permit. Date APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. Re-roofs Signature of ApplicanUComractor DateT Of Roof HAZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs:hall be inspected prior to any roofing material being installed. 0 Yes 0 No 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 emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? C]Yes ONo I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.f understand that if the building docs 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 A Applicant Date All roof coverings to be Class"B"or better Owner or authorized agent Date - -- CITY OF 2UPERTINO 3 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35617024 .00 DATE ISSUED. . . . . . . : 06/29/2007 RECEIPT #. . . . . . . . . : BS000001850 REFERENCE ID # . . . : 07060270 SITE ADDRESS . . . . . : 11150 SANTA TERESA DR SUBDIVISION . . . . . . CITY . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SMITH WARREN E AND SUE L ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4767 RECEIVED FROM . . . . : JUST WATER HEATER CONTRACTOR . . . . . . . : GILROY, JOHN LIC # 15128 COMPANY . . . . . . . . . . : JUST WATER HEATERS INC ADDRESS . . . . . . . . . . : 3400 INVESTMENT BLVD CITY/STATE/ZIP . . . : HAYWARD, CA 94545 TELEPHONE . . . . . . . . : (510)293-9901 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1. 00 34.86 0. 00 34.86 0. 00 BPWHEATER PER HEATER 1.00 10.79 0. 00 10.79 0. 00 PPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 84 .02 0. 00 84 .02 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING CITY OF CUPERTINO C)7u Z-7 v WATER HEATER OF CUPEkTINO PERMIT APPLICATION FORM J Date: Buildin ddress: Owner's Name: I,1+ Wv4y'v-eK1 Phone#: Z-,2 Contractor: Phone License#: IU5T �-�41�' �lti[ �vZ ` cl ��I Z Contact: Phone: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect ®/� Plumb Mech ❑� Job Description: Residential A Commercial ❑ Cost of Project: ( (D60 ' I--- Strapped -F:--I' On Platform.a Bonded New Location ❑ Replacement Qty. if Applicable Fee ID Fee Description Fee Group -� BPWHEATER Water Heater/Vent BUILDING PPE FEE Plumbin Permit Issuance PLUMBING BENERGY Ener BUILDING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 tt a Telephone(408)777-3228 CITY OF Fax(408)777-3333 f-WEkTINO Building Department JOB/ / I Sb DRESS:54j-,d4 4- Q PERMIT# 00&5-i-27�c� OWNER'S NAME: IqJ4. W PHONE # 4000 Z S D 3 I GENERAL CONTRACTOR: �'v ' (.�v�;. � FAX # I am not using any subcontractors: �'�' 4 ,rw C- 7 Signature Date Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSYNESS 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 Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ ontr r Signa at