00010046APPLICA14TTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY O/�Q�Qd "J
CITY OF CUPERTINO PLUMBING - ELECTRICAL EHA ICA �RM11 N°
BUILDINGDIVISION APPLICATIONtPERMIT rrrn. PLUMBING -MECHANICAL ,50001
nrvr s.un n:cr uaa rtvs(`aTHW i
CONTACT: PHONE:
S/o A9-3 lo I °
azz
,+IOp
wo,
t- 1=
<UU
yaa
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm the I am licensed under powlsions of Chapter 9 lcommcndng
with Seaion]1XNB of Division3oflleBwinex and Professions Gdc. and my license is
in full force and flL`
License Clms p �A ^
QTY.
I, '. 'ELECTRIC PERM iT
t - s
JOB DESCRIPTION
RESIDENTIAL'
❑SIUWE ❑ KIT Cl IEN REMODEL
El ADDITION C1 PLUM BING RE -PI PIE
❑M OUT I -UNIT []STRUCTURAL
MODIFICATION
❑I SIT HR I OR ❑ Cl IIMN17Y REPAIR
I M PROVEMIEN'T [2 SW IMM ING POOLS
❑ BATH REMODF:UREPAIR ❑ DEMOLITION
❑ Of HER
PERMIT ISSUANCE
API'LIANCIS - RESIDENTAAI.
e emnm De - --
F- D 0
o Z,4O
ARCHITECTS DECLARATION
I understand my plane shall Ire dose as public records
PANELS
lll'TO200AMPS
I-•4tM
�X'.
C � 6
x1,x
0i U
W 3 c y
Fq�OQ
W<�that
LiwnsW Pmferaionul
OWNER - BUILDER DECLARATION
. I hereby affirm that 1 am exempt trop the Contractor's License Law for the
following reason. (Section 10]1,5, Business and Professions Code: Any city nr county
which ma ui is a permit to construct, alter, improve, demolish, or repair ally umcmre
prior to its issuance. also require•he applicant for such permit or file a signedxm¢mem
he is licensed pursuant to the provisions of the Contractors License Law (Chapter9
COMMERCIA
❑ NEW BI.DGIADDITION ❑DIEMOLI RON
0 TIENAN'I' ❑TOO[) SERVICE
IMpItOVEMHNT
❑ OTHER
201- 1000AMPS
OVER 1111X1AMPS
SIGNS ELECTRICAL
SPECIAL CIRCUUMISC.
d o p
(cammencing with Section 700(6 of Division Sot the Business and Plnfessinns Code) or
shot he is exetnpl nleretmat and the bads for the alleged reamptinn. Any vich I of
See 7031.5 by wry nppl t,aml for dpennit subjects lire upplleant ma civil penally of
TIEM It METER OR POLE INS'('.
POWER UIEVICES
�C
C e
a3
n more(hun five hmrdred dollars ($501).
E] own %of lhepmpeny,onny cmpinyees wile wages as NCirsolernlnpenottio .,
will do the work, and the slmcmm is not intended ortaicmd for sale(Sce. IDTL Business
and Profesions Code Tic Contractors License Law does not apply m an owner of
property whe builds or improves thereon, and who doss such work himself or through
his own employees, provided that such improvements are not intended or offered for
SWIMMING POOL EI- EC'I'RIC
OIL '1'LFTS- SWITCtI &S- PI%TURIS
NEW RESIDENTIAL ELECTR Q
sale. IT however, the building or impressment is sold within one year of completion, the
owner,hailder will have the burden of proving thal he dhl not build or impmvc for put-
TOTA
-
Pone of sale.).
❑ L w ownef of the pmpany, am exclusively collou in, with licensed colournrs a
consumer the pnrLeft (Sec. 70414, Business and I'rufcusions Castle:) The Crianni rs Li-
ccuse Lawdessnul apply to an owner ofpropeny who builds orimproves thereon, and
who contracts for such projects with a cotvractor(s) licensed pursuanuo the Contractor's
m ,• „- - -s i'
QTY,' ,(PLUMBING PERMIT
PERMIT ISSUANCE
l.ioerve low.
E) I am exempt under Sec. . B & P C for this reason
AI:1'ER - GRAIN &VENT'- WATER (EA)
r Dam
WOR KER'S COMPENSATION DECLARATION
BACK PLOW PROTECT DEVICE
11 Nina under penalty of perjury one of the following dacbmn inns:
❑ (have and will noncom a Certificate of Comcnraa of f -insur for Worker's Compel-
DRAINS - FLOOR, ROOF, AREA. COND.
satian, as provided for by Section 37W of the "hot Code, for the performance of the
work for which this permit is issued.
FIX 'IURPS - PER TRAP
1 have and will maintain Workers CourNawition Insurance, as require) by Section
37W ofthe lrMr ode, BUlhe pe/l'�nnancee the work for which this permit is Issued.
GAS - IEA. SYSTEM -) INC. q OUTLETS
CAS - EA. SYSTEM-OVER J(HAI
My Works' i)aene tlnn/nsm�ncec er and Policy ryytYeVJ2 ODp/
Carries: ENV a Policy No l�L/VC
CITOIPICAI'E OF EXEMPTION FROM WORKERS' p'G
COMPENSATION INSURANCE !/ o
GItlEAS1YINDIIS1'1U, WAS1131M1'ERCEPPOR v
ORF.SEIRAP
('nissectinnnmJ not io comple¢d if the permit inf one M1Undrul Jnllursl$110)
orlcss.)
SEWER - SANITARY -S DIRM EA. 200 FIT.
Icerify that in the performance of he work far which this permit is issued l elnll
nut employ any Penn in my manner so as to become subject ,o the Workers Compen-
WAI'IiR I IRATE R WNENTBLEC 14
Z
C)
satian Laws of California. Date
Applicant I
i..l .N.
a'
L1-I
0
V O
D. f•-'
WLender's
y
FN
U�
NOTICE TO APPLICANT: If, after making this Certificate of Haemption, you should
humne subject um the Workers Compensation previsions of be Labor Code, you into,
fanhveim comply will sash,ru,kum, or link,rmi, shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
(hereby affirm that hem is a coneramion lending agency for the performance of
the work for at hichthis permit is issued (Sec. 3091. Cit, C.)
Lender's Name
WATER SYS rEM/BHATING
WAILER SERVICE -
NEW I(ESIDLNTIAL PLMII. SQ. FIT.
TOTAL:
Address
Icertfy that I have read th. ppl [ and state that the above automation
Correll I agree to comply with all city -ne county ordimance, and state lawxdating n
nmdm ne�mertela a -nram' I tr; nnl'aaityt rnermy nme
.QTY,, MECHANICAL. PERMIT
-
rhovo-menooned Property tart mspectmn purposes,
(Wet agree in nvo, indemnify and keep bubble,,, the City of Cupertino against
liuhilitics, judgments, costs and expenses %Inch may in any way accrac against said City
in nsequence of the Smiting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE REGULATIONS.
I IAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building oceupant store or handle hazardous laaa rial
us refined by loo Culaalino Municipal Code, Chapter 9.12, and the H.111, and Safety
Code, Stalin 255321•)'1
I❑Yes E] No
Will the applicant urn future building oecttpant use equipment or devices which
emit hazdnlnus air nmhmdnams as defined by the Buy Area Air Qualhy Management
Dialrict^
❑ Yes ❑ No
1 M1ave mad the hsrsNnus meermix rgmrsonenls under Chaper, 695 of Inc CA-
fnmia Health & Solely Code, Sections 25505, 25531 and 19534. 1 malma.ad that if Ilse
building does not currently have a enanl, that it is my responsibility to notify the oecupant
of the Icquimmenu which must be reel prior to issuance of a Certificate of Ovc ipab,
FERMI 'I ISSUANCE
ALL HR OR ADD TO MECH,
AIR HANDLING UNIT IT 10,00 CFM)
AIR HANDLING ON[ '1' (OVER 10,0(1) CFM)
EXI IA11S'f HOOD (W4)UC'If
HIEAfING UNIT (TO I00,WI) 11'1'U)
HUAI'ING UNIT (OVER 100,000 ETU)
VENT 'ILAI'[ON FAN (SINGLE RFMD)
BOILER - COMP OHPOR 100,000 BTU)
UOILIEIt- COMP(OVER 100,00011111)
AIR CONDI'T'IONER
NEW RESIDENTIAL MECH. SQ, ET.
TOTAL:
OFFICE
SQ. PI'. FLOOR AREA
S'IYlN1ES 'f'
1136?z000)
BUILDING DIVISION FEES
PLANCHIiCK FEE
ENERGY FEE
GRADING FEE
SOILS 113E
PAID
Due Re eipt W
BUILDING THE
FEE 11':
-s. -1• SEISMIC FIB(
ELECT RIC ITH
PLUMBING ILE
MECHANICAL PEE
CONS I ROCTION TAX
HOUSING NIHIGNI'ION ITHE
PAID
Dote ReeeiptX
'HyrA1.: 4a4�5
I
'
JOB DESCRIPTION
RESIDENTIAL'
❑SIUWE ❑ KIT Cl IEN REMODEL
El ADDITION C1 PLUM BING RE -PI PIE
❑M OUT I -UNIT []STRUCTURAL
MODIFICATION
❑I SIT HR I OR ❑ Cl IIMN17Y REPAIR
I M PROVEMIEN'T [2 SW IMM ING POOLS
❑ BATH REMODF:UREPAIR ❑ DEMOLITION
❑ Of HER
COMMERCIA
❑ NEW BI.DGIADDITION ❑DIEMOLI RON
0 TIENAN'I' ❑TOO[) SERVICE
IMpItOVEMHNT
❑ OTHER
SQ. PI'. FLOOR AREA
S'IYlN1ES 'f'
1136?z000)
BUILDING DIVISION FEES
PLANCHIiCK FEE
ENERGY FEE
GRADING FEE
SOILS 113E
PAID
Due Re eipt W
BUILDING THE
FEE 11':
-s. -1• SEISMIC FIB(
ELECT RIC ITH
PLUMBING ILE
MECHANICAL PEE
CONS I ROCTION TAX
HOUSING NIHIGNI'ION ITHE
PAID
Dote ReeeiptX
'HyrA1.: 4a4�5
I
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY'OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: christya
Sec: Twp: Rng: Sub: Blk: Lot:36920001.00
INVOICE DATE......: 01/11/2000 -
REFERENCE IO $ ...: 00010046
SITE ADDRESS : .... : 847 ALDERBROOK LA
SUBDIVISION .......
CITY CUPERTINO
IMPACT AREA .......
OWNER ............: LEE LESLIE AND JIMMY
ADDRESS ..........:
CITY /STATE /ZIP ...: LOS ALTOS CA, CA 94023-
CONTRACTOR .......: GILROY, JOHN LIC.N 15128
COMPANY ..........: JUST WATER HEATERS INC
ADDRESS ..........: 1764 NATIONAL AVE
CITY /STATE /ZIP ...: HAYWARD, CA. 94545
TELEPHONE ........: (510)293 -9901
FEE DESCRIPTION CHK TOTAL FEE PAID -TO -DATE BALANCE DUE
--------- - - - - -- - -- --- - - - - -- ------ - - - - -- ----- - - - - --
BPWHEATER P 9.99 0.00 9.99
PPERMITFEE P 35.52 0.00 35.52
--- - - - - -- ------ - - - - -- ----- - - - - --
45.51 0.00 45.51
1 ID 'DESCRIPTION- i6 -a = - -- VOICE ID DESCRIPTION
c 106 SEWER a& WATER = =202vav UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB & OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
j,JF1N,10.2000 10:90RM IIVETCLERK INC IN0.897 P/5
CITY OF CUI PERT INO
BUILDING PERMITi APPLICATION
10300 Torre Ave, Q06MI'106 Co. 96014
(406) 7773226
PROJECT ADDRESS. 847AIdectimictLane BLDG #..---_ 3U1TE/APT#
PROPERTY OWNER I CONTRACTOR
OWNERS ren
NAME: Lee, Jby
NAME Ju&t~ Hectare Ins -
"MUNG ADORESS:047 Aldwbroek lane
"LINO ADDRESS: 17114 Netlonel Ave,
enYBTATEMP: Cupertino Ics , OW14
CITr /5TAT0ZP: Normand CO Oe6y6
PH ONSAb(408A4.803o PAX ik ( )
PHONE4:(81N2)3-201I FAX* ( )
14ML ADDRESS:
E"L ADDRESS:
t1USiNESS LICENSE Y. 15129
E2LA N WORK TO BE PSUORMED: water heater iep)eoemerrt40 gallon gas
elILll1N0+- SLICTRLCAt: AISCiANICALt_ PLSINEma. if
RHRDOP: 1rAZAY= T=AR3A. YE6_ NOS. NUD®&LOF DD9T(NO ROD? OOVSR`31":
TYPE OFEXISTWQ ROOF COVRR0dd 0 PROPORBD ROOF COvBRIIiO:
N0bmu OP.wa fm ROOF COvaRMEASMOVgp1 0 .
NUMM OF IXISTTLNGROOT CovMuwA WrARAEDr
PROVIDE LC3A. RRPORT N0, vALQA7tONs
IMPORTANT NOTICES NOTIC[70 APPLICANT
APPLIOANTra CrJkrFW r4N
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE
ABOVE INFORMATION IS CORRECT. I AGREE THAT If A PERMIT IS k,r.
SUED FOR THE OEMOLITION DESCRIED 18 THIS APPLICATION, ALL THE
PROVISIONS OF THE PERMITANDALL LAWS AND ORDINANCES
THERTO WILL BE COMPURD WITH.
HOLD HARMLESS CLAUSE The pstmkWe) by aooeplanee et the permit .
sgroa(a) Ie Indemnify and hold toml lcw the Oy d Cupertino kom and
agalnal cry and all claims, demands and adions for damages msul5ny from
eperadorla under this pomdt regardless of negligence of me CILy of Cuparrrno
agalnn all such claims, demende or oa ona.
In osrdm* vAdt ac prmislena of Scol)on 3800 of Ilia Labor Code Atha
fthl Of C&IMerrd4 Ills appasrrt &hall have coverega under a or (In dwlpr
noted below or shop Indicate Game (III), or (M, or M. whltdcvsr in applicable,
If hewwer RIM M 4 checked ham (M mm he checked as waLL Mart the
appropriate merhed of comprianwr
UCENIRO CONTRACTORS oemA ITION
I hereby Stara under pendb of pe&fy one of the falksrkrp dederoonr,
(3 L l have one vm moniker, a wqg=% d Danboro ro "hang is igwabnr of
e/ �rhl oadbyS heuad. aVre Lelia Code, for the periamaw
V), a I APO old w6mahralnworlum 'mnpenuconrnsurenowwralukbobysec.
liar 3100 ofaw IabcrCoda, IbP me wFormanae d as wedtlbrv,lllch ode
Fwmlllebbod MYrrahes'oomperaellar yaraenae bomltlMdpplt4rnYeF
her Ckrendgn
pft Nuidr 02KR00010/8
r) R The coat dfec wwkdorayftea arises
f I N I aenVY dot In M pMamarae ortMwak a whlGr drY pennn M ibouoa, l
' Wlrellrotrmnp link, person In enr menrwwsea become auwtto worh.
as' revnpem n It I o arC.mowne Subject to OW WMNW Owpomadono
MIbtale of Let Iepode of CavaanhJan v (he Ytnf11M�Dampe+%a
pra+Lnlabo err alelaba Cade or CaOemle errs sate aemplylMtlwAWl Yolk,
neaalara of Section tea, of On Lobar Coda col err oermll rereln a*lod tar
shelf be deerned rwelpd.
INAMllea Mowlepiatlr0ale~and pr�aiorA04Wadpw rnY+efeanlwda/wN r i I" ION* wma awner(a meiaamaaxi ownl that Inft podermanal at ft
OW,rrrene esiwn Vkrad teseN wak faw'Nah Oe permit 4 Neued, I vAll em p
airs wet ea woud Orel a nmeadorwo Dam pbo
eanpmbodan lewd er GsaNe one Maio, pnfw to the Cenc
Lkrnee t Se1S28 C96B �'03191R00 � B cry wmk. ram eN a aemgerd mps a Dale team with as eamral
PAYMENT
ACCOUNT,: 5474.6331- 71684326 2WIRATION DATE
�DRCARD TYPe MA8TER CytD_ NAME ON 0411D: JUST WATER HEATERS INC.
AMOUNTS:
EEC S 1d� SdOTTWATERBURY
DATi wkrtea Hem.OrApplltlaro
1JRN _10 _2000 10:_ 3AM Ps7s LpR INC fNO. E97 d .. 4
690 Dubuque AVenYe
°NstClerk, Inc.: e- solutions for the contracting Industry South 99TV Pnnereao, CA 64000
(960),08 cLeSx
Buildin
From: NetClerk•Inc.
Contact Namw Sam Waterbury
Pboaw (650)624 -0426
Fax Number.
Permit Application
Permit
Please Fes Permit to:1- (877)846 5888
I will pick permit up at the DaUdin8 Department In 3 days
Other. please email permit to: parmitsQuetclerk com .
?o: Building & Planning Department
City:
Phone:
Fax Number.
Cupertino
(408)777.3228
(408) 777 -3333
Instructions
job site at first inspection
Please mall to Contractor addraw below
Contractor Information
Company: run water Heaters Inc. workers Comp Of 02EM001018
Contractor:
A= Amold
Address:
1764 National Ave.
City:
Hayward, Ca. %S4S -1772
Phoaw_
SIO- 293 -2012
510. 783.6360
etb
pertabsSiustwatorheaters.m
Comments:
Authorization forms:
0100 OWAUL%wL dcrnRoam
nsr�at°r�.'
antiGkrNAlSrs .miYla�lb��q�dedaMeteia
elm+�dlreal e W istlar JMi�e. e[aeea
a .
State Contractor's Idcaow O 531329 ClusC46 D
Credit Card Information
Credit Card Nnimber: S474a331- 7168.6326
Name on Card;
RvIration Dates
Just water Heaters Inc.
09/02
MasterCard
44WAemobatlele- 11rmmpuian3end wwm9gtha rafeenmion bdom
Jaw oeaReCOi9domtlomaSaanaaantenPoorbeh9rf fweuympma
sat►wanaWV�mda