00010054 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES—USE SALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL. PERMIT NO.Al
BUILDING DIVISION APPLICATION/PERMITPLUMBING-MECHANICAL. S0001
WEENZIm-
f. BUILDING PROJECT IDENTIFICATION
BU1LDI ADDRESS: SANITARY NO. APPLICAN N SURMIITAL DATE
O
OWNERS NAME: - gAze PII O ACH)N:SN Cap n ". LIC NO.
NIC CONTROL at
l 4z
CHITIiCf/FNGIN[ER: LIC NO: ADDRESS: ElGym
CONTACr: PHONE: <'V� �,p/&P PUILDING PERMIT INFO
/�r}I �n ���/ / ❑ canva[S. ,,Paid by Applicant(inVitial) BLDG ELECT PLUMB MECIi
v t> a y/ ❑ ❑ V ❑
LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMIT FEE
I hereby affirm shat I am hcrnxth anm-rr rormoni of Cbnger 9(coT av nt JOB DESCRIPTION
"Z volt SectionDXX))of Dlvldan 3oftha llusioaranM Ptok pooh Calc,and my license is RESIDENTIAL
intullforce and effccL
til O p t FERM1t'ISSUANCE 0 SFI WL 0 KITCHEN REMODEL
F n
aF.V�j Ixcnx Clarvc_O�d—Iic.N APPLIANCES-RESIDEYIIAL ❑ADDITION ❑PLUMBING RE-PIPE
N Q a Date Coal.
SDE [IMULTI-UNIT ❑STRUCTURAL.
ARCIIITECI'S DECLARATIONPANELS
zoyz IuM,suM my plw shWlM�xil as puNlc l¢mds UP TO 200 AMPS MODIFICATION
pZ-0 ❑INTERIOR 11CHIMNEYREPAIR
Llcea�vocc"onal 201-10(X)AMPS - IMPROVEMENT E]SWIMMING POOLS
OWNER-BUILDER DECLARATION OVER 1000 AMPS O BATH RENIODEI-REPAW ❑DEMOLIT(ON
I haeby JRnn Ilw 1 vm e,ti,W,fpm We Cunlrncl«s Littnx Law f«The All z
K C 1 V follnainF rmsan.(Seaico 70313,Busircsx with Pmfevmans Code:Any city«ec^Imy SIGNS ELECTRICAL ❑O7NER
1113 LL wM1ich its
i a Iwnnit ,the ahva Or
u i pbrunah,o rtpuir any...at
Fop¢ prize to iu i.uuvna.alsa reyuirn Jx npplicanl far such pmnitmfdeasigrcJstaxmenl SPEC]77
E > dw he is lkenxd gboo,,l ,the pbvisi,f ld Caaramots Lbenx Uw(Chatinc 9 COMMERCIAL,
W C, (mmmening with Sculion Y(X10)of Divivion 3 ofthc Buvica.0 and Prafeisions Ode)Ix TEMP.METER OR POLE INST.
al,e IY That he u cxcmq Ihemrrum and the hasia fur the alleged excmgion.Any violation of 0 NEW BLUCVADDITION 0 DEMOLITION
-h ti¢tion'l031.5 by an,ts,licant f«apermitsubica the apps•,..to a civil penalty of POWER DEVICES GTE.NANr GFOODSERVICE
�Zy nal more than rive hand dolla,(55110). IMPROVEMENT
f=0 I,muwncr of the gq'cny,ur my employs..wish wages ar lhir ndc mmpcnsatiun, SWIMMING I'c%SL ELECTRIC
F
willdothewart,anal Je W-� aM R6tomf«sok(Sa.9lua.Business
[I OTHER
of¢aom Code:The,CoamMv Luc.Law diao
nth apgY to an war of OORErS-SWITCHES-FIXTURES 40
L 3- gopcny who huids or impmra lhec ba,ad who skes such work himxlf m thmugM1
his own rouPoyee,,pnwidd that such iaTmvmm ns am not InlenkJ or ufTerM for NEW RESIDENTIAL ELI CTR SQ Ff.
Er. AREA LSO'FT'
,de.If,hwevepr
r,Oe building a inovenrnt is wld within one ycu tt,.mpl,iaa die `i
nvrcr.FuiMkr wJl have the burden M paving that She did not build or imgvvc for par-
M"c nLulcl, TUENU
1,W minter of the MPWY,an exclusively conte vng with I'tanxd crmwetm m
.,haK1 the projm(Sec.90W.Business aM Plofcvi.C.:)The ConaactNs Li-
uLaw that,not apply Inanwoerof roetty whobuilds or imgo—dn,enn.and QTY, PLUMBING PERMIT - FEE
who rommeka for.meb,,jets wish a ro...ecn(r)laterad pu,.at In the Comranor's
I.a.Law. PERMIT ISSUANCE
E)lun cxcmq oder Sec. ,B&PCOrlhia.
ALIIiR-DRAIN k VFNf-W'ATIiR IFA) VALUATION
-gaiwncr Dan, _
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE GOO
1 heret,alBtmudcrprna11YofgrjaY unitofthe ftlk 'declao arms: y
(] Iharc onA will ervtinlain aCunibalc nfOmxnn to mlf c'urvf«Workcta Con', DRAINS-FLOOR,ROOF.AREA,CORD. STORIES TYPECONS'I'RUCl1ON
.ation_m qo vidod fur by Section 3700 of the Luborz Code,for the pedoncou l¢of the
work forwhich this permit n issud. FIXTURES-PER TRAP
1 have aM will nxintain Wurkera Omen ion lnuurena,in Teyuiml by Section
3700ofnht Lu Oak. or On, wren the work far wh uM1 this pcnnil ix irauW, GAS-EA SYSTEM-IINC.4011U.iTrS OCC GROUP APN
Nty'rier. �o an l aM Polity ou t GAS-PA.SYSTEM-OVER R(EA) 15-9 .224W
Cmricc Policy Nu.:
CIiRTIFlCO EI SAIIONINNIRAN1 WORLERS' GRFASMNDUSfRL WASTE INTERCEPTOR
COMPENSATION INSURANCE BUILDING DIVISION FEES
I..)fThissectionr i cot be cumpkld if Ox,Permik is f«ac WMml daikci(SSW) GREASF.TRAP "LAN
CHECK _-
�w Cf¢CK PEE
I
cot,On inda, ifninaoc—fda,work liar which Nis permit ix Ined,lalm11 SEWER-SANITARY-STORM EA,?00 F..
nal mnpdoy any p,xm in any mance,ra.b becume subject to the WorkerCampco- ENERGY ltiF:
eZ ration Iicvs of California.Date WATER HEATER WATFNUELECfR
O A,I"al I GRADING FEE
'= NOTICE IO APPLICANC IL atter nwking but Cunldulc of Eoempiun,you sMmIJ WATER SYSTEMO1 EAUNG
F become whjecl to Oe W«ker'a Compen.uuion pravusk,oi of the Ib Cade.Ce,you 5011 S FEE
fonhwdth comply with such pmvisiom«this pennd alullM Jeened lev.ked. WATER SERVIC2
Q
ZD z CONSTRUCTION LENDING AGENCY NEW REMDEN'DAL PLMB. Q.IT. PAID D x Receipt
Y
I hereby affirm than dere is a cvrutrucdoa Sending ageaty far the perfmmTee of
the work for which thin pmnit is issued(Sec 3097.Civ.C,)
O OTAL:
ca lcr',Ntmc 'T
} CU I<wkra Addres TOTAL:
1 I ccnify that 1 have red this.,l and wile and the above information is BUILDING FlJ:
.F., ZZ) .ince.l agroe to amnply with all city mol county rcdicancoi atd s,Ic law.mauling it) QTY. MECHANICAL PERMIT FEE
U'Z huildinpmmvrvdina,zed lxyeby autcroe lv ObentO,e,t.f Ols city to enxrugm the SEISMIC FEE
above-mcndufed'b'dy for inspection purpm¢ PERMIT ISSUANCE
(Wp
Dice)ase to save,mdalnnify and keep humlem the City of Cupcnirno againM ELECTRIC FEL?
liohilitica.judgmmla,comaand crpenseswhich may In any way accrue egulnx stud City ALTER OR ADD TO MSCI I.
PLUMPING FEE
A APPLICANT
of the,arRSTAN of thisD WILL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-MINE AIR HANDLING UNIT(TO 10.000 CIN) MF,CILWICALFEE
SOURCE REGULATIONS.
AIR HANDLING UNfCfOVER IILDXI CTM) CONSTRUCTION TAX
Signutuxof Apgicant/Ccbbacta Dme EXHAUST HOOD(WIDUC) HOUSING MITIGATION IEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicnnl or Finnie building oacupenlnom or bundle n•,nhn.r nulcri:d I]RATING(INfr TO 100,00)BTU)
as defred by the Cup,Jtn Municipal Code.CTngcr 9.12,ad the Health and Safety HEATING UNIT LOVER 100,00],BTU)
CMe,Solon 3.5532(a)? 1
❑Yo ❑No PAID
VENTIIATIONINNISINCLE RESIU) Doe Receig0
Will IN,."licwt«None Stamm,accuput ux ryuigrcnt or denim which BOILE -
RCOMPI3HP OR IOO.WU BITn
nit hnaardvs air,maminvnls as def ted by Je❑aY Arc+Air Quality Manegamrnt 'TOTAL: S
IFWrina Y¢ [:1 No BOILER-COMP(OVER 100.0(00 BTU)
s o0
hove maJ Ih hamnlwr numrialr reduirenena wake Chngcr M1 95 of Jw Cull AIR CONDfIIIINIiR ISSUANCE DATE
hurda Health&Safely Code,Section 25505,'15533 and 25531,1 oder and Jut ifthe NEW RESIDENTIAL MECH. SQ.in
huiWiog docs lu cvnen ly have a a..that it u no,responsibility to naxify Ne oeupurn
of the lryuiremenu ahwt mol M mel San,to lusumce of.Ccrtif eta of Oao brie,
Uwtcr«authuriad a{eot Date tOTAL: ISSUED BY:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: chrietya
Sec: Twp: R g: Sub: Blk: Lot:35722021.00
INVOICE DATE...... : 01/12/2000
REFERENCE ID # ... : 00010054
SITE ADDRESS . . . ..: 10636 GASCOLGM DR.
SUBDIVISION .. . . ...
CITY ........... . .: CUPERTINO
IMPACT AREA ... . . . .
OWNER ... . ........ : LEROY HANSON
ADDRESS ... . . .....:
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
CONTRACTOR . ......: GUSLANI, CHRIS LIC k 21311
COMPANY . . . . ......: HOT WATER INC
ADDRESS .. . . . .....: 2531 GRACELAND AVE
CITY/STATE/ZIP ...: SAN CARLOS, CA 94070
TELEPHONE ........ : (650)298-8494
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 DESCRIPTION---__-_-- VOICE ID ---_--- DESCRIPTION
6 SEWER & WATER 202 UNDERFLOOR PLUMING
301 ROUGH PLUMING 302 TUB & OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMING
•
URN.10.2000 10:4641 rETCLERK INC p0. g.06
CITY OF CUPERTINO
BUILDING PERMIT APPLICATION
70500 Torn Ave. CIIp■rtirtO, C■.85014
(408)777~1228
PROJECT ADORN&10636 OASCOWNe
BLDG —�SUITWAPTO
PROPERTY OWNER CONTRACTOR
pLC1TY/SWTAT:ff:0P:
: LEROY NIINSON
NAME hot wnr bee..4246>RW
SSryp636 OABCOXi4�DR AWUNO ADOR688: 30.11 W�lerk Avg
CUPERTINo CA96013 Cf T'/tTTATEMP. aWn adCAy n 66 FAX* ( > PNONE 6:( �42ie-8164: FAX* ( 66Qd98.64p
E411UL ADDRESS:I9uW rd®ad,odm
OMNESS UCENSE A 21311
8701-AIIa WORK TO BE PSRFORNW. REPLACE WATER HEATER
ammDo
R.1A�®Ilxr. ./
R3ROOi~ BAZA'RDO�Fl1l8�Sti .
)i10� MUXIIER OF wama A00F C0D
TYPE OF LCQdTDaO ROOF COVIRDCO
NUMZE OFZXIE a apXWCDVEERmwXDd0V3M o FROPOSM X0 0:
NUMBER OyW=TNG ROOF CCVERSa06=AM=0
FA0VmR LC,RA.REPORT ND,
1rALUA80TT 4650.00
• IMPORTANT NOTICES NOMETOAPPLCAXT
APPUCANT'afCERTIPICATIOR I dYdqffnwedorPW44QrP.6urYONOfttmftgm*ledeclapSom
ICERTMYTHATIHAVEREAD TAM APPLICATION AND STATE THATTHE '( ) L I�waaNllgrrtlnaorpllemdmna.nttdwMns..�.�yM �m
ABOVE INFORMATION IS CORRECT.I AGREE THAT IF A PERMIT l8 IS. P.r11a0en.upreMd.a br8.mert 3700 dth Lager Cod.,tarep
SUED FOR THEDEMO(!►IONDESCRIMISTHIS APPUCATION.ALL
THE tlYtapre.at4Mbad.
PROVISiOn OF THE PERMIT AND ALL{AWS AND ORDNµ6gg
THERTO WILL EE CO#APLIED WITH. t� a I I■1.nna.m n11FtW .e lnN mmp. �aett h.u.r oo q 6e�
U����w 401V00d ft Labor co"br ON P�annvw�S to work 16rwNeb Ntr
"MOD)
hdv S8 CLAUSE,The pless a(a)ty l euplu o.dlna darrdL =N% Il...d MY�0, ae.ppRatldn h.✓J'db 3111.1 Ord PdID!
a0toalV I hedwnrf 01 am hold and,and
e11 Cid fo C M.rdnd 9om.nd Omer IBM*flAd
a6.lnd aAr.nd all oMbr11.AereOred.and ee»ern far daneana0 nenma hors
a94411tRllaudrol.I nmrrrrlLnBerdlwWhBOIC& .c( t.gddC�p.rQnd Potka,Ijww 164""
n%OWMd00r■dome. f1 ■ 111am6th•.rk61111I.IIODarIna
In on
9rebd nddf th pdPPh'md WW h.r.�M Ytlder Code dtlh ( ) M 1a■dbe11th deePMerrdrro..7dl.work 6rM4ah Pete PeTRY
n.oeabohr.orHwatrNd.(.Iyn.rnn.a or r M6rQnmoo- 4111111aampley.nrD11.enInmymerry,aBeIDbeams e�y.amvv
u 1h Waw Asm(1�u dl.do.d Ik.m Ml mvat�he *1dde.e r M 6ppGahq, .n'oanp.n.uDn tam or cafibmb.I f e0w odmm f d.e d11t I unarA.m
apprdPAaY m.Ned doarnp9artoo, dl.pl.d u-r.IL Mark R1. themIn nre erm 0111 I rndukl h.onni..ubl.rz 11 ee.werwrr ooni.rr.Part
Proridem or Pe Labor Cede d411bmNand fa4 to coni*%Mae*on
LOD of dr 4tm Cdd.,o"(ft p.r.rb h.,.tn oppWd for
r I�.ss..��r.y�nmn OWI7■Ae7pW GIGI.ARATION r.e..ed,
e" O�dt•Iden Oet�Orer�t .wed was, ��.and�.4w aMy�.My ( I � I�'a1110`13pw Onglue .4th oe�nor)that h 0is drrknn.na.Rtb '
Lk.rl..a,783E12 616 eidrMrohr.' mon fienIm ld •aenb.ciarwhoamplas
0 013 12 0 01 aw11em.td d ^�^brq d rnu and w*DAer b 611 am.
N.etn,Bureau. w.rk u■1e..aerril.t.a.oprd M brm wide tM O.r11.1
PAYMENT
AGCOW+T6: //7 QE
CREDIT CARD rfPE IRATION,DATR:
MAME ON CARD;
SIG^!
ALaou14T.3:
DEC 8 11999 Scott Waterbury
pbrr11w.dAppYar. Aq■s . U7E
.Prtnbd N.rr11dAppW■.
URN. 10.2000 10:46RM NETCLERK INC ff;:0;B97 P.27
NetClerk, Ino, : e-solutions for the contracting industry 10001 bs.�n°Franaiee, cw y,oee
(see)ee CLK1tx
Building Permit Application,
rom: NetClerk Inc. To: Building & Planning Department
CootmName: Soottwatetbury chr- Ciao
Phone: (630)6244MM
Phosses (408)777-3228
Fes Number 1877)846.5888 Fut Number. (408)777-3338
Permit Handling Instructions
Pkase Fax Permit to 10771846f8ti8 DNiver to job site at brat 1natn
I nW pick permit op at the Bo11dtt Departsneet In S dayr HxpkM malt orlPal to Contractor eddrew below
Otho:
Contractor Information
Cotapaays Hot water leo. Worker's Comp Ok 1340,186 state Pond
COn&a O Stab Contrector'e IJeanee dl 763612 C36
Addr.ee 2531 Grace]sod 7M ,.
dit Card Information
City: Sea�.CIL 94070 s 4246311SA117,2578
Phone 630,298.8494 Nam Chtie P.Oavleai
Fes: 650�Z98-8d93
06/DO
V ldaatcrcard
Commettta:
Fat
Autitorizatioa forms: Cnd(t Caro AuMarInUon
1 •Me:Aod�4.dein•$yo�k�yailla6mlep�6ehtPoauUo�51o�
1'°e��+Ne�:ctesbrereaya:tltavhebrla C�t�e
b IleehM4w Caama: r+aVa:►Ad�i
iaa41e�oay�,YyQet At ndaB a" �VbD'tl�d ihwr •�
��4r��tG OY urs are�glaoreb�= the
�� �P/utrfs�/L®a.ywbdlps �� Cep
�1rST�eefOek
`M�du �ldgpm S.a �a
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l�ip�e r��,,�,�d,14fJa1ta+�M+adE<o�,/ trdspv�a(p,edt