00120038 CITY OF CUPERTINO
nun.DING DIVISION PERMIT CONTRACTOR INFORMATION:
NIIILDING ADDRIiS.; Y '
PIiRMIf NO.
2IB69 OAKVIF_W LA JUST- WATER HEATERS 1NC 00120036 .
WNEWS NAM):' APPLICATION SUB DA'I E
MCREAN,EN EARLE E ,AND FERN E 1764 , NATIONAL AVE. 12/06/2000
PHONE: " SANITARY NO. CON1 ROL NO
(510)'c93-9901
BUILDING PERMIT INFO-
zz AItCI II'Itil;f/IiNGIN111iR: 'BLDG IiLliCf y PLUMB MECH
W
,65 65
FF t' 1 ICI MLU CONI RAC.'IOR S DI11 ARATION' Job Description
Qo C Iheby11 11m,I 'JmJ p a4dCh.pmrYbmunencmg p- ,
m$ r 7000) m n Baa dP rshmnac«k mmrlcen REPLACE .40 GALLON GAS WATER•HEATER
in full tares and effect
z 'e "License CID,., Lic,p '
X U -Date Cnmmclor
m 3 LL v ARCIII'rEcT s DECLARAHON
F.u O g 1 ondcmmind my plans shall be used as public records
Y
'ado d O O I,i¢nnnl i'ndessinwl . ' ' •� i .
OWNIIR-BUILDER IIECLARAI'ION
e.t'7= I hereby arena that I am exemm four the Comnclor.License Law for the
C z tells.ing re:uon.(Section 7031.5,Rosiness and Profes,ion,Gide Any.........ietoy
-
•'x o which oa,macs o permit m um.run I.alter.Improve,demolish,or repair'any stncmreLe 1–
�` pnun 's. 1 q _thellpl t IIx is tl -g J.rp cn
but he-.I vaal maravantT ch,Mwisioi ofte Contructoev 1 La (Clef erg Sq. Ft. Floor Area -:.Valuation
cummene ng with Section 70(to of Division 3 of the Business and Profc%stom Cwa) - - 8 1 108
or that lie is exempt ma efrom and the hall,tur the or egcd exemption.My,vinwtialf _
Lal Scarier 70313 by any apPlic:mt lar a fwriat subjec&the applicant to a civi l penalty - s
of notmmech.live hundreddmmn($500). APN Number. T•' Occup'ancy,Type'•
C1 1. fin P P tY Y piny with y as th l,mallm
3261.9101. 4'10
will d d k J d of ulatulcd or offered to,sale(S,,'7144
BmmC,,and Pm4:smT. Code:I he Lnt t License Law does it, Pply to on Required Inspections
owner ml progeny Who builds or improve thereon,and who d.es such wort hinmlf` •. lir —
or Ihrongh his own employees.provided that such improvenmnts are not intended oi, •.: y 503_ ,FINAL' PLUMBING ENERGY
offered ter vale.E,how"ar,ma nailding.,r ilnpmvnn.,n i„oal within.,Lae rem of 506 -- GAS -TEST
icompletion,the owner Wilder will have the burden of proving that he did not Build Lar '
atpmveforpurpo,cof,.I,k 507 — FINAL PLUMBING =
. ❑I,a wne ,[lee,n,pert,.an ddmivdy courant,with liwn¢sl ummnet.irs m -
Liaslrun the project(Sec.OM4,Bus and Profen s Code)Ihe Cootracax's
cense Law does not apply In frowner of prnpcnr who Wilds or improves mention.
and who ennum s for such projects with a contractors) licensed pumoant to the - +
Contractor's Lidrn>c latw. -
❑I um exen)pt under Sec. .B&1'C lir mi.,rcuxnn - - g 4
0,our Date I - • . .
WORKER'S COMPENSATION DECLARA PION •it -
.ill, I hereby atlhor kinderPenalty lty feel Y one of fficlollow ing d P _-:
❑ I have find ill unain;ain a Ccrfiricatc of Consent to,If for Worker's
Coinp a T i t. r, p ry Jcd for by Seut . 971x) of me 1 boy C.xle f r d, „
pernmaantt nLthe wnrA for which This permit is issued. ^•
❑1 have Land will maintain Woder',Compensation Insurance,m required by Sectio ,
37(X)of me Lnhnr Cale,1'nr mU pa tunuan a at d e work for whmh this permit is
,ted.My\vorkere Camponsatmn hT,unnec catrid and Poliey nunmer are: -
Carries Policy Ni,: s '
CEKT IFICA'I ION OF EXEMPTION FROM WORKERS' -
COMINiNSAI'ION INSURANCE t.
IThi.s section need not be Completed if the permit is for one hundred dollan
'($l OKB Lar less.) '
I eCAify that in the performance Lal the work for h,,h thiC Permit is ,,.ad,I
shall not employ any panni in any manna in as in been.s.bjw m me Wmken'
Compcnwtion Laws of California.Dale
Applicant - .a -
'NO1'lei:TO APPLICANT Ie.11,,making thin Cenif Cee,of Excmplinm You should •• . -
become mdjeco the Worker's Compen,dmn provisions of The Labor Code.you must
Q O nforthwith Comply with such provisions of this permit shall W deemed revoked. "
Er'CONS'l RUC NON LENDI NG AGENCY
Ed 7 1 hereby afemt that them is a completion lending agency for The perlammncc
of The work for which this permit is Isued(Sec.3097,Ci,C.) ,
Lenon'.,Name 4 s
Z I,aml,s Address
I verify But I have read this application and.state That the above information is
f.L t'_'r Correct.I agree to comply with all city and rummy milnances and stoic laws relating -
Q V mnasdmg coa,lmmtion,aIu.ba ......
yula"iercativa,of nth arty In era,a eon
the aNice.lo ndened jimpery for m,corn n par,",
F'Z (Wc)ogrt s,costs
a,ii which
in the Way a em,against
said e
Vi Labii r I J ii t:,I :t: J penins h'ch my in any xuy accmc uga est mid .f ,
U 7a. AP q '.mph 6 Ti d f tela t t .
SOURCANTUNDIiIONS.: SAND WILL COMPLY WITH ALL NON POINT Issuedb Date
SOURCE REGULATIONSf y'
sisnmmom Appliram/comateta Date Re-roofs
' IIA7,1R1lOUSMAI'I:RiAISDISCLOSIJRI'. - _ •• '
Will the applicant or hame Wilding occu stat Mme or handle lon ardaus material - .Type,of Roof .
it,Joined by the Cdpcnino Municipal Code.Cb{per 9.12,and the Health and Safety'
Cole,Station 2553200' - z. - '
❑Ye. El No - -All roofs shall be inspected prior to any roofing material being installed.
WTn the ap,l;eam ar future Wild,o�C.,somue tripream or device,which` . If a roof is installed withfiut first obtaining an inspection, 1 agree to remove
mit huranlnus air mtnnminanu;is detned by the Bay Arca Air Vw1ity Management Applicant understands ubtaCtr .t - t '•'III new materials for inspection.` rstands and will comply with..
0YC, C.]No ' 'all.non-point source regulations. .1'.' ._
I have C.I the hv:Woua interim,requirenmm,under Chapter 6,95 of the _
C.Aitomin Ilcnhh A Safety Code:Sam ons 25505,25$33 and 25534.1 undc,unal Thal
.it lM1c building Jucs nm curcnJy havo a tcnnnt.thin 11 is my usl o,dahly lL nodly the
occupant of The tegmroinems which Dmf Be met pair m 1....are of a Ceailicale of
Occupancy Signatu'r'e of.Applicant ' Date .
Oxmetaammlam agert Dare '' All roof coverings to be Class "R"fir better.
OFFICE ^'_
• City of Cupertino Building Permit Application
E-Mail 04101143$
Jobsite Address: 21869 Oakview Ln. Date: 12/6/00
Owner's Name:---McReaken Fern
Phone No.(408)255-1234 .
APN#: 326-19-101-------------- Project Valuation: 51108.00----------
Building Permit Info: Bldg__---- Elect----------- Plumb------X___ Mech__________
Job Description
Replace 40 gallon gas water heater.
Contractor Information
Company: Just Water Heaters Inc. Phone: (510)293-2012
• Contact Name: Fax: (510)293-2022
Address: 1764 National Ave. E-mail: permits@justwaterheaters.net
City,State and Zip: Hayward,CA. 94545
State Contractor's License# 591329 Exp. Date: 3/31/02
Worker's Comp#: 03KR0001018 Carrier: Clarendon Exp. Date: 4/l/01
f
Credit Card Information
Credit Card #: 5474-6331 -7168-6326
Name on Card: just Water Heaters Inc.
Expiration Date: 9/02
Visa MasterCard
Comments
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• CITY OF CUPERTINO
Item 1 of 1 BUILDING PERMIT, RECEIPT OPERATOR: nancyc
COPY h 3
Sec: Twp: Rng: Sub: Blk: Lot:32619101.00
DATE ISSUED.......: 12/06/2000
RECEIPT 4. . . . . . . . . : 14197
REFERENCE ID 0 . . . : 00120038
SITE ADDRESS . . . . . : 21869 OAKVIEW LA
SUBDIVISION .... . . .
CITY . . ...........: CUPERTINO
IMPACT AREA .... . . .
OWNER . . . . ........: MCREAKEN EARLE E AND FERN E
ADDRESS .......
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-1145
RECEIVED FROM . . . . : MAIL-IN
CONTRACTOR . . . . . . . : GILROY, JOHN LIC 0 15128
COMPANY . . . . . . . .. . : JUST WATER HEATERS INC
ADDRESS . . . . . . . ...: 1764 NATIONAL AVE
CITY/STATE/ZIP . ..: HAYWARD, CA 94545
TELEPHONE ........: (510)293-9901
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL
-------"-- ------------- ---------- ---------- ---------- ---------- ----------
BPWHEATER PER HEATER 1.00 9.99 0.00 9.99 0.00
TFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
Pe
TOTAL PERMIT 45.51 0.00 45.51 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ -----
OTHER 45.51 MASTERCARD
TOTAL RECEIPT .. 45.51
VOICE ID DESCRIPTION VOICE ID, DESCRIPTION
........ ............................ -------- ...e=.....................s
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
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