00010045 CITYOF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO. �
10619;;$v.BLANEY' AV, ." , r. JUST WATER HEATERS,.INC , r„•q ; . 0,0,01:0,045
e- AME: ”" - ""' APPLICATION SUBDATF -
0
" IM JOEL''B 1764 NATIONAL AVE 01/11/2000
rJ
IIII-IONE: SANITARY NO. CONTROL NO.
1 (510) 293-9901
T
OVO ARCHITECT/ENGINEER: BUILDING PERMIT INFO# BLDG ELECT PLUMB MECH
6
�?z
Z LICENSED"disk1CONTRACTOR 5 DECLARATION Job Description
�Z „� - "ylIµs lAerob 4fTlrry tlle(I ant llcGOSed and proslpni of Chopter:9(commencing .
LLppCp 9n o Droson3o(NeBusiness and Profession Code ndmylicense REPLACE,'WATERHEATERt I+
yF�.YF�.J :151
1YllyfQraet�tt1
z .6a :Liem"i Coca, "Lic.M
xO a u Date ' :'., .,r •: Contractor .. .
m 3 a y ARCHITECT'S DECLARATION
1 understand my plans shall he used as public records
Sue se Lice
6 p'O Licensed Professional
a.— n ;� OWNER-BUILDER DECLARATION
F < T `'ii hereby dfrm that 1am Burin from the Contrns Cc Limns law for the
allowing reason.ISenion 7031.5.Business and Professions Code:Any city or county $1
E F O which"'ons°perms! I I stmt,Improve.demoLsh or upur eny strucwrc
a3�"pyo mit uumr'dalso regmieathe ePPitamfw mchpennnmilees
'Ir(m l¢ypr„Pimyurz drg collie vsours. the Cmummr's Ltecnx law(Chapter 9' ,. , W11,W,QIIy�s���sc/�gfx6. �.eh r Valuation _.. . . .-
,(comtpenPng,wnhSecu ]000 of Division Sof Ne Bmmesx.md Profeaxiom Cdel 3 liw1i.3_YC;a'+.-"lYo:O J\s.jt�..t t��.'•:
I
Nm he's ezEmpl Memfrom dnd the born for the.Ileged eampdon.Any v olouon p�,,,nv1a.,�
of S,an.TU31 3 by eny vpplie.,for.permiI subject,Ne eppliwm to a civil prnolry l 10 6 .YC�"n'G'iC & WATER. . .
often moreman fl.hundred dollen(3500). APN P_a5n+—.'. Occupancy Type
-L•v -: -
ml,uowilcr of the popenY•or mY employees with•ma8uutheir sole mmpenation„
-'will da We work(mld Ae swcmrc is'...Intended or'oQered for ale(Sec riHa,'
I B uirst wN Professions Crude The Cmumcmr'a License law does not apply to at 3
luwner of property Who Wilds or Improves thereon,end who dues such work hi If I I
F or through his own employees ar
Provided that such Improvement,mcnot Intended r 3 0 2 TUB;
].Reid for eel, ICIuFw& the ti-ld s or improovemem t,sold withinone y f -C, I DDDT, f�QT ERG i•' „n �:
't t completion the ewuer budder will haveflu,burden of proving that he did not build
imPo fwprpai sale) ,A/p— AS
—
[ .m uctmer pfthe (Sm.
7 vin Business and
Cadens The Co cmnto - 'i•`( \`•D
Lfuwn Ne Prefect(Sic.]0aa,owner or and arty who
Code:)The Conlrmar's — Y i f.CI' Y!.i •�b. sit
and
License law does ,f apply m an owner of property who builds seimproves therms- _ I
and who emtmet,,fa such Prolan with.cont tw(al lamed pursuant mthe-
.Conlan t x.law
a. ,m lam exempt under$ec : ' ' I "`xB A'PCfor this reason
y;aa Y N a' if 'HxBj — i _ r
:r ,:Owller4 o-^:S!•' s _%'.Date
5;e_p�' F`),'r`,�YE I;�;+ss':WORKER'S COMPENSATION DECLARATION
.1hereEYeffimunder.pendry.o(pcilpry dile ii followingdMrations:
=:rr' — ❑ i have and w;Chounnum a'Cmificace of&Lm to rel[-+nam for Worker's
_ — - Compensation, ..provider for by Section 3100 of the-Labor Cade, for the
performam,of be work,for which this is issued...,
(31 have aad will ma man Wo L r Cgritpetaidnii I E.'a required by Smuoa /J
3700 of the Labor Code far the pert f[be w rk'for which this permit Is y/L�
'bound-My Wodrt2s Compensation Insance
urcam r and Policy numberam; u h l/r✓ ;.•:r�_,,,�„�„_
'Caro r 11.js sit l [ t-v nl'y,PobcyN ”! }.I.. r. 0e. at' a
CER ICATIONOF EXEMPTION FROM WORKERS '
"F01'I`�' P ” COMPENSATION INSURANCE'''a'"' •" --------------------
�'I"Vit"lThis'ienroa need
not be cdmylcte'd if the permit is for one hundred dellen ;+i'\ ,, }'_i:ii' , - .✓rl
_ 1 ni[X that th performance of th,work for which thii pemin n Issnd.
'Hal not employ any Person in my manner x as to become vublect to the Worker"
ppil
Compenaiion Law's fCahforni fJaie - "' -
'NOTICE TO to
Ilk Wdrk If bf ipich6ti rbne n lcate of Caber!on,you main
0 Z becameh mimlifo the Work,/r Cisionssaun pmtins of thelabor Code,you,must '
'7.-.1,h,omply with such provt,ion - - .- tshallWdeemedresulted. _-- -
C+ !f� )•ZCONSTRUCTION LENDING AGENCY 3 '
t 1 hereby flim that dome s e con uunma lending agency for the perform From, tel I _
of the wbrk for which this parent is Isau d(Sec 309]C v C.)
w'0 Ledas Nems - uw .0 . ..- ...-_. _. ._ ... ... -. .. .__ . ...._..- .__...___..._._ __.. ..._..... . . . . .. ...._. _.
.iD
p" 4 :Ucvddrs Add,'a
`n•.
I r n Fy than dale coed the 9ty.atd ton and anti that es a above stat maws irlon is
[T+.[r <oerkn l.gree tp comply d hi pll pity end authorizeFount,rept ordinances and amts laws relating
;to builtling comWdtionoperty for
impaction
reposametives of th!edty to enter upon
r� :Ih2 abavememioneJ property for inslzPion puipsrxs..,•, -
.0. es,j dgreem,cos ndemmpenses hihmay inth Ci ay Cupeninima said f4 'City mss,judgments costs end expenses which may,in any way - e again;t said
Cuymcbnulluence (theg tingg (this permit
AYPUCA.NT UNDERSTANDS AN�W!LLCOMPLY WITH ALL NON-POINT ISsuedb Date
'SCSURCEREGL}3.,iTfONS y
;SigSarura of AppluminfCmtradlor,;';' -. t ' ', poq .• ' Re-roofs
to It HAZARDOUS MATERIALS DISCLOSURE
Fru WIII Ne dppl cml or future building occuPm[smrt o hu die haamdous matcnel Type of Roof _ - - •-- '•'_-^'_^ _^
u defined by th C,p,ai o Muntnpal.Cde Ch per 9 13 end the He Ith and Safety
.Cde Swim 2553:{pl , t -' ., „ .''. T;,y lfi rrlj�1�1 ,.
All.roofs shall be inspected pnor,to any.roofing matenal.being installed..__..-
r ,, i ,..�,. '-, '
Wel ttie,aipphc nt riot re Wiiding«ctpant use equipment m devices which If a roof is in'slalfed'without first obtaining an inspection,tI'agree to:remove
mal hiazinims an,conwimmus s defined by the Biy Area Air Qmllty Monagemem
Otrthn[^ ___all new materials for inspection.,Applicant understands and will,comply with ._.....
r:1 all non-point
❑Yes, r i c c , ,i source re U1flI101[-6•.•
g
I
C.I(i,l have read ISa M1a.C.dc'Lm t,..,,r 505,requirements under.Chapter 6,93'd that
+ omit Hee!tfi l a.,tay,Codeave ac 255115,25533 and 853J.l ity to nmd that -_........ ...._....__._ ..._.
'I>; sent , .10i pone hliny 6 notify the ._ . . ._. . ._ . ... _ _.. _ .
! t sum a 1. of a Cenifiwt'of '
Ocwpancy 9 S mnet He
met Pnon° Signflture of Applicant Date
i [ Ido doesn I urnnl aveamnanl that,it is `
s
l occu M of the ie mxm nYe'wbl<h'
, f
4., t,;. )Ownero nth g Dote .
All roof coverings to be Class B or better .
.....OFFICE. .. . .. .._ . . . . _ _ . .... . . ... .. _.
._ .. ..
41 •:Lt 11: '" 'I:u .i ..rL - ,..6,.. .... PP, .i • 'rID'I, II
APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL
PUILllING PROJECT IDEN'1'IFICATIUN S0001
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL
io di e �
WNER'S NA My / N NE: COME 'SN G LIC NO
NIC CONTROL#
CHITECPENGINEER. LI O: ADDRESS
CONTACT: pyflNE:
/Uanna _/ �7 //J�//��// BUILDING PERMIT INFO
S /d z73 0/y ❑ Consu 8 tt -9 MAip aant(Initial) BLDG ELECT PL�U7"M7/B MECH
LICENSED CONT'RACTOR'S DECLARATION ❑ ❑ Ve ❑
I hereby off me'hct I um licensed under pnwisinnc of Chapmr 9(commencing QTY' ELECTRIC PERMIT FEE
,OC with Sedior II100)ofDivislonJofthc Business and Rofessions Gxle,and mylicenceis JOB DESCRIPTION
F�� a fiallforceandefiCCL n PERMIT ISSUANCE RESIDENTIAL
ODU License Class It" 9 1e f9 Lie,# ✓n / + `J ❑SFUWL ❑KITCHEN REMODEL
r ZW Dote �77pZ�C°ntrn`"' # APPLIANCES-RESIDENTIAL ❑ADDITION ED PLUMBING RB-PIPE
ARCHITECT'S DECLARATION
F" IunJemmnd my plans slmll he used as public rccPANELS El MULTI-UNIT El urdc MODIFICATION
ZOy„
O14;{Ay Lnznsed Professional UP TO 200 AMPS ❑INTI3RIOR ❑CHIMNEY REPAIR
�1 „'j OWNER-BUILDER DECLARATION 201-IOMAMPS IMPROVEMENT SWIMMING POOLS
yy C 04 G I hereby affirmthat I atn exempt from the Conlmetnr's Ll cense Law for the OVER IOW AMPS El BATH REMODEUREPAIR rl DEMOLITION
p(3 F following reason.(Section 7031.5,Business and Profeasionx Codc:Any airy nr county SIGNS ELECTRICAL ❑OTHER
which requires a permit roconstruct,al's'improve,demolish,or repan any swewre -
0J priorto ill isvrance,alsorequiresrhe applicant forech Perini[ o file a signed statement
that he is licensed pursuant to the provisions of the Contractors License Low(Chapter 9 SPECIAL CIRCUIT/MISC.
O CO (commencing with Section 700p of Division 3 oflhe Business and Professions Codo)nr TEMP.METER OR POLE INST. COMMERCIAL '
d 0.a rL met he is exempt therefrom and the basis for the alleged exemprinn.Any violation of El NEW BLDG/ADDITION
m Section 9031.5 by any applicant for a permit subjects the applicant m a civil penalty or POWER DEVICES ❑DEMOLITION
E. not..'I'ban five hundred dollars($50% ElENANT ❑FOOD SERVICE,
I.as—act'Ifthe prnfamy,army employees with wages a,theirsole cnmpen.cation, SWIMMING POOL ELECT RIC IMPROVEMENT
~ willdo'hewnrdai
k,and maximum. milaale(See.9044,Hulloes DUFFER
w
L ce and Prolecsions Code:The Contractors License Law dues oar apply m as owner of OUTLETS-SWITCHES-FIXTURE
psopeny who builds or improves thereon,and who does such work himself or through
his own employees,provided that arch improvements are nor minded or offered for NEW RESIDENTIAL ELECfR
sale.If,however the building or improvement is sold within oneyearofcssmpletion,the SQ.FT,FLOOR AREA $/SQ.Ef
owneolhoulder will have the burden of proving act he did no'build or improve Iia no /1
Plant of sale). V
❑ 1,as owner of the property, in exclusively cormeTing with licensed cmucacmrs to TOTAL:
common,The pmjcer(Sec.7044,Business and Professions Codc)The Contractors Li-
cense Law does not ripply to an owner of property who builds or improves thereon,and QTY. PLUMBING PERMIT FEE
who contracts for such projects with a:ontmc'm(.c)licensed pursuant to the Contractors
License Law. -
❑I am exempt under Sea. ,B&P C for this rearm PF.RMI'I'ISSUANCE
wrier Date ALTER-DRAIN&VENT-WATER THAT VALUATION
WORKER'SCOMPENrjoy on DECLARATION BACK FLOW PROTECT.DEVICE �[G�
(hereby moral WORKanderperally COMPE Ary N ECL following declarations: JV7
I have and will mummin a CenificamufConsomm self-insure for Workcr'.c Compcn- DRAINS-FLOOR,ROOK AREA,COND.
action,m provided for by Section 3700 of the Labor Code,For the performance of the STORIES TYPE CONS'I'RUCTION
work far which this permit is issued. FIXTURES-PER TRAP
❑I have and will maintain Workers Compensation Insurance,as required by Section
3700of'he Labor nde.for'hrperfr ranee of the work for which this permi'ic issued. CAS-EA.SYSTEM-]INC.4 OUTLETS
My Warkcr6 ten•F n Incur�p�/I i and Policy 2p OCC.GROUP APN
Carncc y Y c Policy N( __% �O� GAS-EA.SYSTEM-OVER 4(EA) 6g,3,3ov6
CERTIFICATE OF EXEMPTION FROM WORKERSep/ O
COMPENSATION INSURANCE O GREASFJINDUSTRL WASTE INTERCEPTOR
caIescJ
(This seconr need not becnmplGed If'he pecon is fo onehundreddrllarsSIWGREASE TRAP
) BUILDING DIVISION FEES
the
perfo
ce
ffic
I certify that am anyramnr,.as t work
mewubject 1. ria issued.I shall PLANCIIGCK FEE
pert SIURM EA. FT
not einVl%any person in any manncrrousto become subject tM1e Workeri Compcn- SEWER-SANITARY- ' ENERGY PGG
O ,Z cation Laws of Colimmla Unre
O Applicant f WATER HEATER W/VENT/ELECTft
GRADING PEE
NOTICE TO APPLICANT:If,after making this Cisions of
Exemption,you should WATER SYSTEM/1'REATING
UJ become h leobject o'be Worker's Compensation provisions b the Labor Cade,you must SOILS FEE
forthwith cnmplY with tach provisions or this panni'chat l be deemed revoked.
I W Q WATER SERVICE
:D z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ Er. PAID
I herebyoffina
n that thea is a mmuctirn lending agency for the perfomram,of Mute Receptis
LLthe work for which this permit is cents!(Sec.3097,Civ.C.)
0 U Leacka,No. 'TOTAL:
W Lender's Address 'TOTAL:
pT 1 ecnify that 1 have read this application and.crate that the above information i.v BUILDING FEE
rn corms"Iagree to comply with all city and county hinicancec and state laws relating to QTY MECHANICAL PERMIT FEE
L) z building construction,and hereby authorise representatives ofthis city mentor upon the SEISMIC FEE
above-mentioned propcny for inspection propres.
PERMIT ISSUANCE
(We)agmen to save,indemnify and keep harmless the City of mCupertino against ELECTRIC FEE
in dgments,
granting of this stent. may in any way accrue against laid City ALTER OR ADDTOMECH.
in aonsegocnce of the granting of this permit. PLUMBING PEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT'(TO 10,000 CFM)
SOURCE REGULATIONS. MECHANICAL FEE
AIR HANDLING ON['I'(OVER IU.WU CFM) CONST SECTION TAX
f
Signature ofApPbcaHAZAR O Date EXHAUST HOOD UYDUC) /
HAZARDOUS MATERIALS occupant
DISCLOSURE HOUSING MI"I'IGATION FEE F
Will
ytheCuapplicant
ertino futurebuildingCode,
Chapter 9.12,
handle HeaMOuemareeal HEATING UNIT(Tb IW,IIW H'fUJ
C defined ion 25 Cupertino Municipal Gale,Chapter 9.12,and the Health mrd Safety
Cade,Section 25532(n)'! HEATING UNIT(OVER 1110,000 BTU) -
❑Yes 7 N
VENTILATION FAN(SINGLERESID) PAID
Will the applicant or future building occupant use equipment or devices which Data Receipt If
emit hazardous air conterminous ac defined by The Bay Area Air Quality Management BOILER-COMP OHPOR 11X,000BTU)
District
MAI,:
❑Yet EINo HOLLER-COMP(OVER IW,UUII BTU)
1-ii oo ti !-
IhavcmaJthehaeaMousmuterialsrequiremenks under Chapter 6.95 of the Cnli- AB CONDIT'IONLR �a5
fomla Health&Sanity Code,Sgguons 25505,25533 and 25534.I undersamod that if the ISSUANCE DATE
buildingdoolleacunend,have a'nnaal.that iti.cmy resprefillmoc notify the occupant NEW RESIDENTIALMECII. SQ.FI'.
ofthe requircmcns which mus'be It priorto issuance III Cenifcate of Occupancy.
Owner or lairmnsul agent Dam TOTAL: ISSUED BY:
OFFICE
INVOICE INVOICE 'INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: chriatya
Sec: Twp: Rng: Suh: Blk: Lot:36933006.00
INVOICE DATE......: 01/11/2000
REFERENCE ID k ...: 00010045
SITE ADDRESS .....: 10619 S BLANEY AV
SUBDIVISION ...... .
CITY CUPERTINO
IMPACT AREA .......
OWNER PIPE JOEL B
ADDRESS .......... :
CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-1314
CONTRACTOR .. . ....: GILROY, JOHN LIC k 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
ID DESCRIPTTIONVOICE ID DESCRIPTION
.. ....... a........ ........ ..... ...........a.......
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB & OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING