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00010043APPJLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY 4. QQ JDO k� CITY OF CUPF.RTINO BUILDING - ELECTRICAL ^"N APPLICATION/PERMIT PLUMBING- NIECHANICAI. BUILDING DIVISION Sn001 - r,. t BUIIAING I 'ROJI ?CTiDF.N'ITNICAT' APPL ION' +.,', -'t BUILDING AINEIRMS: SANITARY NO. APPLICATION SUBMITTAL. Got /0 2 70 f� /'9iivP' Ale OFFICE ❑ Consultant fee's TA byA )Iwt InitisI) BLDG ELECI'r PLUMB MECII El ':. T-- o - �Wz X00 =UV -7�-W n7N j LICENSED CONTRACTORS DELI ARA110N 1 harehr.tlr.n that I licensed 1 provisions fChapter 9(cemmenc ng w s it nh Sea'on ptNNp o[D' un3 nftheltusim a dPmtasst is Cook and my lmmmis iearn an tied effect License Class 9/ h Lic.N Dam fci .�i%g- (2Ey r / ;'GLECT RIC PERMIT, _ _ ' FEE.• - '�.. r JOB DESCRIPTION RESIDENTIAL: _ [I SFDWL 0 KITCHEN RI;NODIiI' ❑AUDITION ❑ PLUMBING RI,-PTPR ❑MULTI -UNIT ❑STRUCTURAL - MOUTI'ICA'IION PIRMIIISSUANCE AT'PLIANCIiS- RF_SIDFNTIAL TS AHCHI'Ibe use DECLARATION , hlic ImdcrannJ my plans shell be used vs public rcnirdr PANELS =Z� p � - Llensed Mol'essionnl .- t1P TU 20nAMPS r 201- 10MAMPS ❑IN'I ERIOR ❑CHIMNEY REPAIR IMPROVEMENT El SWIMMING POOLS i J E � J 6 U WO y¢ OWNER- HU1LDER DECLARATION I hereby affirm that 1 ant exempt from din Ce drucmr's License Law for the following reason. (Section 7031.5. Business and I'mfessions CuJC Any city ar county which required a or I to conannc6 ..her, I ..ipnwe, demolish, or repair any snnewrc par,, to its iss ... re, sk. requiresda.,plicam forsuch permit to file asignedsmmment El BATH RI MODEIJREPAIR El DEMOLITION ❑ M HER OVER IOOOAMI'5 SIGNS ELGCfHICAI. - SPECIAL CIRCUIT /MISC. af y.4 �} GCO yea that he is licensed pursuant to the provivinr —I'lbc C.,cme,r's License Low(ChdaO9 americncing with Section TWO of Division 3 afthe Business and Professions Code) or IN, he i, exempt therel'mm and the basis for the alleged exemption. Any violntiun nl' TEMP. MR'IER OR IDLE INS I'. NP. BLDG /ADDITION El DBMOLIT[ON y Z Y =6 8 F-0 3 Section 71131.5 by any applicant for a Permit subjects the applicant to o civil penaltyy of net are than five hundred pall... ($510). [� I, as owner of the Progeny, or my employees with wages vs their sole <ompens:ni.n, will du the work, and Wesamentan is net intended oroffered lhruilc(So,.7044. Business and Professions Code: The Contractor's License Law does not apply In an comm, of POWER DEViCHS - nNANT ❑FOOD SERVICE ROV EMIiN'I' /C1 OTHER SWIM h1[NO POOL. ELECTRIC OUT LETS- SWITCHES- FIXTURES L progeny 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. IL however, the building., impmvemem is sold w,Wnorte year ofcoinpletion ,the NEW RESIDENTIAL ELECfR . SQ En SQ. FL FLOOR AREA $ /SQ. ET. ' owner-milder will have the burden of proving that he did not build or inipmve far our. pose of sole.). O 1, u, owner, of the ,,.,a, ant exclusively amvuedng with Beamed c..ntmaorc a+ " TOTAL: mnmcrtha project Igor. 7(W4. Ift,mess and Professions Code:) The Cmnmders Li- se haw does nth apPlymnniwner of Pr ipany woo nn ms Or nprevcs Etereaii and „ f QTY. '4 PLUMBINGPERMIT r r t FEE' who Contracts for such projects with a.omeamr(s) licensed pursuanc e the Contractors I'IiRMIT ISSIIANCIi License Law. Fl I nth exempt made See. . B & P C for thn oa...a + P-ner Date WORKER'S COMPENSATION DECLA RA PION ALTER - DRAIN A, VEIN 'I'- WAI'EIR U A) VAIAA'I'10� RACK FLOW PHC UCT. DEVICE 1 hereby affirm under penalty of Perjury one of the following declarations: DRAINS - FLOOR. HOOK AREA, COND. Ihavu and will maintain aCenifcrnc of Co... rom dl'- homalm Worker's Compem vntion, as provided (.r by Section 3700 of the Labor Code, for the Performance of the STORIES I'IO 'TYPE CONSTItUC P work for which this pvmrit is issued. I IXrFURES - PER 'I'RAP 1 have and will mvi main Worker's Compcnsntien happened, ns required by Section the Lab, F�nle,f ep omiance the work far which i GAS - EA. SYSfBM -I INC, 4OUTLETS 000. GROUP - MIN Ifflu My Worker' ,t nln iyNo.: r O C t POl cr No.: �`� /© ���"'YYY((( /// GAS - PA. SYSTEM OVIiR 4(BA) GREASIIINDUSTHh WASTE INl'EltCiil'f012 CEvri fFiCA 'rF,OFi7XEMITTONFROMWORKBRS' d� COMPENSATION INSURANCE BUILDING DIVISION PSIS (Ibis section need not he completed if We permit Is fm one hundral dollam 1511x) nr IessJ I GREASE 'I'RAP I'LANCHECK FEE -- Iren,fy that in the perfxonamen.fihe work forwhich this permit taloned, 1,h ad not employ any Person in any manner so as to become subject to the Workers Camper- SF. WER- SANITARY - S'IDRM EA. 200 F1'. ENERGY FEE WA'T'ER T TEAT ER W /VENrDIILECTR Z,z satins Lmxx of California . Da¢ Applicant \ GRADING FEE y a d Q �Z 4Uks NOTICE TO APPLICANT. If afar harking this Cernfi' ate of Exemption, you should bean.. subject m the Worker's Gmmpelesmion powi net the Labor Code, you mnnt fmnhwith comply with such pnn'iaonsor this permit shall be deemed revoked. CONSTRUCIION LENDING AGENCY I hereby affirm that .bent is v a d (Sec. 30lending agency fonhm perfomnmcenf Le wor k furwhich this permit is issue)(SW.JM], Civ. CJ Lender's Name WATER SYSTRMUREA'T'ING - SOILS FEE WATER SERVICE PAID Date Receipt# NEW RESIDCN'1'IALPLMB. "SQ. FI'. TOTAL: TOTAL : . , .., t „ I<ndcr' BUILDING FEE I certif sum that shove iws r is ,ail y that have read thirty andc h U z .nand and turn, wired. l agree to comply with all city and county ordinances t and sate lows resting a building amsimdinn, and M1erehy aothorire rcprcsenaiives of this city venter upon the IC QTY..,t MECHANICAL. PERM] 'F' Y. __ PE E SEISMIC PEE PERMIT ISSUANCE ELECTRIC FEE also.- meminned property fur inspection purpose. (WC) agree u+ save, indemnify and keep hamdess the City of Cupertino against ALTER OR ADD TO MECH. PLUMBING FEE Iiahiloiea,judgmems, costs and expenses which may in any way theme against said City in consequence of the 6raming of this permit. AIR HANDLING UNIT no IO,gO CFM) MECHANICAL LEE APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE. REGULATIONS. AIR CANDLING UNIT (OVER 111.0X10 CFM) CONSTIU1CHON'LAX - Signature of Applicano(Connactor Date HAZARDOUS MATERIALS DISCLOSURE EXI MUST HOOD(W/DUCT) HOUSING, MITIGATION FEE HEATING Cal T(,IO thama BTU) Will the applicant or future building occupant sere or handle hamnkax,nmeriul as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 255321a)! ❑Yes CI No HEATING UNIT (OVER 10 0000 B'IU) PAID Data Receipt d VENTILATION FAN BINGLE RESIDT BOILF:Ii- COMP(3HP OH 100,OOI18T11) Will Ibc applicant or on,m h refund th, he B y A equipment it Quality or Marna which emit hazarJOUS art conmmiwnts as JefineJ by the Bay Arm Air Quality Management IY)TAI� BOILER-COh1P (OVER IIq,1110 BTlll Convert ❑Yes DNA A IR CONDI'T'ION 1111 I have .call the haustal materials requirements under Chapter &M of the Col,- ISSUANCET)NIE, NEW RESIDENTIAL MECII. SQ. FT. forma ITealin & Smaly Cutler Suchom, 25505, 25533 and 25534.1 underxwnd fl nt it the building )des not currently have a tenant, mat it is my responsibility to notify the occuPunt of fiber bonbons which most he met Erin.........noval. Certifiaae el' Ore'a ..y. TOTAL: ISSUED BY: Owner r authorized agent - Date OFFICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO • BUILDING PERMIT INVOICE OPERATOR: christya Sec: Twp: Rng: Sub: Blk: Lot:32615106.00 INVOICE DATE......: 01/11/2000 REFERENCE ID # ...: 00010043 I C J 0 c 2 SITE ADDRESS .... 10270 ALPINE DR SUBDIVISION ....... ' CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: PAULSON DEVOTA E ADDRESS ..........: CITY /STATE /ZIP ...: CUPERTINO CA, CA 95014 -0909 CONTRACTOR .......: GILROY, JOHN LIC # 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 V•ID DESCRIPTION VOICE ID DESCRIPTION ........ ............................ 106 SEWER & WATER -------- ea.......................... 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB E OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING I C J 0 c 2 JAN.10.2000 10:10AM NETCLERK INC NO.893 P.12 L"i CITY OF CUPERTINO BUILDING PERMIT APPLICATION 10300 Torre Ave. Cupertino, Co. 95014 (408) 777 -3228 PROJECT ADDRESS: 10270 Alpine Oche BLDG # SUITE/APT >t PROPERTY OWNER GnklTtaeerTnta OWNERS NAME: Paulson, Devote NAME Just Water Wasters Inc MAILING ADDRESS:10270 Aping Drive MAILING ADDRESS: 1764Nalional Ave. CITYISTATEIZIP; Cupertino. CA 86014 CITYISTATE/ZIP: Hayward CA 84546.1722 PHONE 0.. ( 406)749.9058 FAX 0: ( ) PHONE N: ( 510)293.2012 FAX 8: ( ) E -MAIL ADDRESS: EMAIL ADDRESS: psrmlta®juetwaterhesters.net Q BUSINESS LICENSE e: 15128 EXPLAIN WORK TO BE PERFORMED: Water Hester Replacement 73 Gallon Gas BVILDINO: SLBCTRICAL: MECHANICAL' PLUMBING. RSROOF: HAZARDOUS FIRS ARE& YES, NO_ NUMBER OF BMTONG ROOF COVERINGS: 0 TYPE OF EXISTING ROOF COVERING: NUMBER OF EXISTING ROOF COVERINGS REMOVED: U NUMBER OF EXISTING ROOF COVERINGS RETAWED: I PROPOSED ROOF COVERING: PROVIDE LC.B.O. REPORT NO. VALUATION: 1249.00 pap IMPORTANT NOTICES NOTICE TO APPLICANT APPLICANTS C13FMPICATION I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE THAT IF A PERMIT IS IS. SUED FOR THE DEMOLITION DESCRIED IS THIS APPLICATION, ALL THE PROVISIONS OF THE PERMIT AND ALL LAWS AND ORDINANCES THSRTO WILL BE COMPLIED WITH. HOLD HARMLESS CLAUSE. The permkaa(s) by aaeptence of the permit . agro t(a) to Indemnify Ono hold harmless the City of Cuegninofrom and against any and all claims, demands and actions for damages resulting from operations under this permit regardless of negligence of the City of Cuperdno against all such claims. demands or actions, In conformity with the provisions of Section 3800 of the Labor Code of the Slate of CelHomle. the applicant shall have =vote a under (p, or (II) deelg- natod below or shall Indicate items (110, or (M, or A. whichever Is applicable. If however Item M Is chocked item (M must be checked es well. Mark the appropriate method of compliance. LICENSED CONTRACTORS DECLARATION l hNeby.m,ra that l am a domed under the prw een, m chow a foomne,dnsvta, !� 700%a(pN - 30!tha 9utl, yp and Rah e$bN Cade, and my aomN is In full fore one Lleenses 591328 ctao C36 B Ps: 03/31/2000 I hereby O15m1 under penalty of pm)ury one of the following declarations: I haw and well maintain a eatl8este of caneern to aes.lnsure fa workers' corn. pansellon, as provided by section 37W or the Labor Code, for the psna moneo Of the wok which this permit Is blouse. (✓) n. I have end will maintain workers' compenutlon insurance, as required by Sea bon 3100 of she Labor Code, for Me performance of the work for which Ihis permit is Issued. My worears' compensation Insurance carrier and policy num- p�' Clarendon Policy Number 02KR000101a ( 1 al The metal cyworkdons la Stoo orless. ( 1 N I oerttry that In the Performance of tM work for which this penult Is Issued, I $hall not employ any person in any mannsr so u to become subject to work. n' campenueon lawn of Callfdrnla. I funha ackrowlsdge that I understand chat In the event that I should bow" Subject to that worlrera' compensation providono of the Labor Code of California end tall to comply for8iwllh with provision$ of section 3800 of the Labor Code, that the permit herein appiled for shall be deemed r waked. ( I V. I "Nfy as Nita owner (of the agent for the owner) that In the performance of the work for wNch this permit Is Issued, I will employ a can tractor who complies well, the workers' compensation laws of California and who, prior to the cam. rnencement or any work, will To a camplatad copy of 8tia form with the Central Permit Buroau. PAYMENT ACCOUNTM i 6 E) FC DR CARD TYPE NAME ON CARD: 4 TURE: M - AMOUNTS: DEC 2 8 1999 Scott-Waterbury Signaturs o(Apptl4nl or ant DATA printed Name ofAppllcant JRN.10:2000 10 :09AM NETCLERK INC N0.893 P.11 ego Dubuque Avenue NetCleric; InC.: e- solutions forth® contracting Industry Sourb San Frendeoo, CA 94080 (868) as CLBRK Building Permit Application Fromr NetClerk Inc. Contact Name: Stott Waterbury Phone :. (650)624.0426 Fax Number: 1- (877)846 -5888 To: Building & Planning Department City: Cupertino Phone: (408) 777 -3228 Fax Number: (408) 777.3333 Permit Handling Instructions Please Fax Permit to: 1- (877)846.5888 Deliver to job site at first inspection I will pick permit up at the Building Department In 5 days X Please mail to Contractor address below Other: please emall permit to: permltsSnetclericcom Contractor Information Company: Just Water Heaters Inc. Worker's Comp #: 02KR0001018 Contractor Attn: Arnold State Contractor's License # 691329 C1assC -36 B Address: 1764 National Ave. City: Hayward; Ca. 94545 -1722 Phone: 510 -293 -2012 510.783 -6360 Gil: permits @justwaterheatersa Comments: Authorization forms: Credit Card Authorhation Rorm 9Iavw;4rW .JMr, u+wrma_t +roses hu yw ( raw: tSrad �i. rad$•Litia �jwm ,wAar,Uiwl�tM „i...uM taadgar ltde. �dbeed SYa @gjdoettre �, ® $'Yprlualelea;[�www:led4Ls mtdl���atllmraN abdrmr er[4Cl.em r®aeR ma a�.r:.dmr m au y�epe► erpfma �preadmc _ i Cemrot'rhLae pphgpr„+ ,•� Credit Card Information Credit Card Number 5474.6331- 7168 -6326 Name on Card: Expiration Date: Just Water Heaters Inc. 09102 MasterCard 'AgeM AdRharlratkaP- By compketng and warning the inrarmarlon below, you authorise NeWerk Ina to act as an agent on your behetrforthepunmse otwbmlteng permKappllatbm 7aM m1[AuyCansane Signature; Mr. CoRMWI