00010049 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY X I
CITY OF CUPERTINO BUILDING-El ECIRICAI. E�RMIT NO.
BUILDING DIVISION APPLICATIONIPERNUT PLwIHING-MECHANICAL. SOOO
BUILDING PROJECT IDEN'VIFWATION'
BUILDING ADDRESS: SANITARY NO. APPLICATION SCENE TIM,DAR
MINER'S NAME P ONE: CONI'R RSN IC NO,y
J /I A-,//C N/C CON'1'ROLM
CHITECT i 1 M : LIC N(. ADDRESS M e / J4 ❑
CONTACT: ///��� PHONE /q BUILDING PERMIT INFO
z /O �„�� �O�^� ❑ ConBulli tF*./, y yA tl t(iniDel) JBIDG ELECT' PLUMB MECH
Li ❑ ❑ ❑
LICENSED CONTRACTORS DECLARATION QTY, ELECTRIC PERMIT'' FEE
1 hereby affirm that 1 nm Rcemed node,Prnsianna of Chapa,9(eommendng JOB DESCRIPTION
FOZ with
hSctio 70M)of Division 3 oflhe Business and Professions Cde,ard my license is PERMIT ISSUANCE RESIDENTIAL,
yfyr in ❑STOWE. ❑KITCHEN REMODEL
IOU License
F U Uum Chus(.w+Z2— i . APPLIANCES-RESIDENTIAL 0AI'IIQN ❑PIAMBING RE-PIPE11Gmtrac ,V 10'7
F=y�j ARCHITEC'TS UP LARATION PANELS ❑MUI:H-UNIT ❑STRUCTURAL
Z p v�Z 1 underswnd my plans shall he used us public records MODIFICATION
CZ—O UP TO 200 AMPS ❑INTERIOR C:1 CHIMNEY REPAIR
Licensed Prdealmnai 201-1000AMPS IMPROVEMENT 0SWIMMING POOLS
OWNER-BUILDER DECLARATION
C m 6 l hereby affirm man I am exempt from the Contractor's License Law for the OVER 100IIAMPS El BATH REMODEL/REPAIR El DEMOLITION
Yp$�O y U following reams,(Suction]031.5,Business and Professions Calc:Any city or county SIGNS ELECT RICAL ❑01 HER
W 3❑.F+ which reyuims o pcnnit m construct.uheq improve,dunolish,nr rupuir troy stntmnru
F.`O miortnit.vicsuunro,ulso requires Neupphcum forsuchperminnlilensigneJ swmmmn SPECIAL CIItCUIIIMISC.
NWNW ji (het heir licensed pursuunumthe pnwieionxof the Cnnwcmr's License lmw(Chapter9
commucilLo
yI1�� frommencing with Scmion]IX10)of Division3of the Business anA Polfeisions Code)or 'IEMP.MCTERORPOLE ST.
Es: Y that be is exempt therefrom and no basis for the alleged exemption.Any violation of [1 NEW BLDG/ADDITION ❑DEMOLITION
I+• Sabina 9031.5 by nay applicant far a pemtil subjects me,applicant to a civil penally of POWER DEVICES
F Z Y ❑TENANT ❑FOOD SERVICE
not more than five hundred dollars($500),
60
01,as owner of the probably,or my employecx with wages as their sole compensation, SWIMMING POOL ELEC IC IMPROVEMENT
will do the dark,0 1 the'uncture cam inwnded m mD.1 fur...In(Sec.A—.Business ❑OTHUR
3 laid Professions Code:The Conductor,License Law does not apply to an.,all of OUTLETS-SWITCHES-FIXTURES
popery who builds or improves art i,.,,it who does such work himself or through .
his own employees,provided that such improvements arc not intended or offered for NEW RF.SIDENIIAI.ELECTR S PI'.
sale.If,however the building or improvement is sold within one year of completine,the SQ.Ff.FLUOR AREA LSQ.1'f.
owner-builder will have the burden of proving that he did not build or improve for par,
pose.17'.10,
❑ 1,as owner of the progeny,am exclusively contracting with licensed contractors it,
'TOTAL:
rostrum the pmjeet(Seo.7044,Business and Pull csstons Cada)The Contractor's Li. -
cause Law does not apply toanowner nl"Property who builds or lntproves todcon,and QTY, PLUMBING PERMIT FEE
who contracts for such projects with a r ant.ran a)licensed pursumn to Oro Contractors
License Law. / PERMIT ISSUANCE
ElI am exempt under Sec. .B&P C for Nis reason _
ALTER-DRAIN&VENT-WATER MA) VALUATION
ncr Dom �y
WORKER'S COMPENSATION DECLARATION PACK PLOW PROTECT.DEVICE
I hereby affirm under penalty of perjury one of the tsdlowi OR declarations: 10
❑ I have and will nwintain a Cenificuto of Consent to self-inxurc for Wu,kcr's Conrpen- DRAINS-FLOOR,RODE AREA,COND.
sation,as provided for by Section 3700 of the Labor Code,for the performance of the S'I'ORIE9 I'VPB CONSTRUCTION'
work for which this permit is issued FIX TURES-PER TRAP
❑ I have and will maintain Workers Compensation Insurance.as required by Section
3700off Lu Ctde,forthe perfiycrjlm���Omu�of rhe work for which his permit is issued. GAS-EA.SYSTEM-I INC.4 OUTI.Irl S DEC.GROUP AP�Ny/a
Ca WorkeX fJLa nln /✓ and Policy rty�tla4rwL�`_O/ GAS-EA.SYS'I'EM-OVER4IEA)
Camas L iiVV 1/Policy No.:(/LJK(�(/ ps
CERTIFICATE OF EXEMITION FROM WORKERS' /A/�/
COMPENSA'I'IONINSURANCIi I/ o GRE, SPIINDI1STItl.WASTE 1NflRCIzFMR
BUILDING DIVISION FEES_
(This section ncminm becoinplmcJ it the permit ix rnnmehundreddollars($I00) GREASETRAP arlaw.) PLANCHECK FEE
Icenifyrhm iuthe perfosmancenfthework farwhich,hi,pemtit is issued.l shin SEWER-SANITARY-STORM EA.2W FT.
not employ any person in any manner so ax to become subject to the Workeri Camper- ENERGY IBE
O Z cation Laws of California.Date WATER HEWER W/VENT/ELECT
R EIi
7 Q Applicant GRADING F
G 111//4 NOTICE TO APPLICANT:If,after making this Cenifcate of liscandinn,you should WATER SYSTFMO REA'1'ING SOI LS Hili
become ambjcat to the Workers Compensation provisions of the lather Cnde,you must
Lkl forthwith comply with such provisions or this permit shall he deemed revoked. WATER SERVICE
C Q
CONSTRUCTION LENDINGAG agency NEW RIiS11TiiNT1AL PLMR. SQ,PT" PAID
5 Z Doc Receipt M
V I frwhichrhilhm Nereisacd(Site 30lending agency for rhe performance of
the work[or whleM1 this permit w issued(Sec.909],Civ.CJ
us r Lender's Name TOTAL:
V Lenders Address TOTAL:
4 1 autlfy that 1 have read this applianiun and state Nm the above information is - - - BUILDING FEE
I7,, correct.I agsca to comply with all dry and county ordinances Tend state lows relating It' QTY. MECHANICAL PERMIT FEE
Z
V building conswnion,and hereby authorise representatives of Nis city to cnmrugm the SEISMIC PER
alssve-mentioned pro,,for inspection purposes. PERMIT ISSUANCE
(We)agree to save,indemnify and keep harmless the City of Caperton against ELECTRIC IEE
liabilities,judgments,costs and expenses which may in any way ucerne against said City ALTER OR ADD TO MECH.
in asequence of the granting of this Permit. PLUMBING FIA:
APPLICA NT U NDERSTANDS AND W II-I.COMPLY WI'I I ALI.NONPOINTAIR HANDLI NO UNIT TO 10010 CFM)
MECHANICAL.FEE
SOURCE:REGULATIONS.
AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUC'OON TAX
Signature of ApplicantlCommemr Data EXHAUST HOOD(W/DUCT) HOUSING MI'HGATION FEE
I IAZARDOUS MATERIALS DISCLOSURE
Will theapplicanlor fmure building accupam store mr hanJle hemi mmenal HEATING UNIT CFO I00,000 ETU)
as defined by the Cupertino Municipal Calc,Chapter 9.12,and the Health and Safety
Calc,Section 25532(n)? HEATING UNIT(OVER I WAW BTI)
❑Yes 0 N PAID
VP.NTILAI'ION PAN(SINGLE RI?SID) Data Receipt 9
Will the applicant or future building oecupant use equipmem or devices which
emit hazardous air contaminants as defined by am Bay Area Air Qualify Management BOILER-COMP(311P OR IOIhNNI B'I'll) TOTAL:
District?
E3 Yes ONO, BOILER-COMP(EVER 101000 BTU)
I have real the hazardous materials requirement under Chapter.6.95 of Ne Call- AIR CONDITIONER ISSUANCE DATE
fomia Health&Safety Cade,Sections 255(5,25539 and 25534,1 understand that irmid NEW RESIDENTIAL MECH. SQ,FT.
building does adl cmmutly have a tO lam it is my respomihility m notiry the occupant
of the nammenwntc which must barred prior to issuance of a Camificato of Occupancy.
Owner or authmdzed agent Date TOTAL: ISSUED B5':
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: christya
Sec: Twp: Rng: Sub: 131k: Lot:35709040.00
INVOICE DATE......: 01/11/2000
REFERENCE ID # ...: 00010049
SITE ADDRESS .....: 10070 SCENIC BLVD
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: RYAN MICHAEL A AND BEVERLY A
ADDRESS .......... :
CITY/STATE/ZIP ... : CUPERTINO CA, 95014-2748
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
ID DESCRIPTIONVOICE ID DESCRIPTION
.. ............................ ........ ............................
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB & OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
lilt
•
DLTAN.16.2000 10:50AM NNETCLERK INC NH9.897 FP.73
CITY OF CU :
BUILDING ft0j ,r AftftTloN
10300 TOna Ave. CUp11106nn,Cs.85014
PROJECT ADDRESSI 10070 Saenic Blvd BLDG SUITEIAPT#
PROPERTY OWNER CONTRACTOR
OWN81110 NAME: Rysr4 Mlohool NAME Just Water Hastens Ina
MAIUNOAWRBSSn0070 Scenic Slyd MAILING ADDREBB 176E NativW Ave.
CRYlaTATFJZIP. IalDeltlrta G 9m4dTYISTATIEZIP: Iyyayld CA S4t1�61722
PHONR*( 444UT-7592 PAXO: ( ) PHONE1h( S1g2S9 Q1Z MXA ( )
HdAR ADDRESS: "AILADDR@BS:psrtnlrs®JaelwobMashra.nat
O y� BUSINESS UCENSE W 15119
EXPLAIN WORK TO BE PP3tPOttl+=: WAter Nester RePIBOemalt 60 Gallon Gas
Bt Julie of »zEelTauw 3d5atA>,TCAL� rw3®n3G, ✓
ABBOOF: HAZARDOVSFOIEAR2tTR9NO_ wimmOFS7tImaPAW COVERMOM0
TYPEOPMair as0OFCOvBRDiO: lAOPOl08DBOOPOOV1iR006:
ND7�8E OF i7QS17NO 8001 COvlatCdG9 RID.fOVF.Dt D
M24BER OF 87IST&O ROOF covzR OS RSTAINM 0
P20VIDB LC,B.O.RSPORT N0. VAL I 707.00
IMPORTANT NOTICES NMCE70 APPUCANT
APPLICANT'S CE irmi"7ION 1 �eslttm Ondw pen*Of 000fy one of the T&lawlnp dedm done:
I CERTIFY THAT I HAVE READ THIS APPUCATION AND STATE THAT THE t 1 k Ihsa em we r&nnn a ao0rcete alcomem to-ow4wae ferwatkee'mm
ABOVE INPORMATION 15 CORRECT.I AGREE THAT IF A PERMIT IS I& Ittrrosden,a Provided by S•aem 3700 of IM Leban Coe ,ar bee toMWmerroa
SUED FOR THE DEMOLMONDBSCRIED18TWO APPLICATION,ALL INB Atho%wkrhtdrWepff"tolbauss.
PROVISIONSOFTHEITANDALL LAWS AND ODINACSTBRTOWILL
65 COMPLIED WITH. M eIemend wmnoadmnpeeaeanMeulerlde dsr•gaadb7eq
Ibn3700darlabwCcas.1«the perkame vof the wakfwwhich
HOLD
Pa'Nt b b1s">W'adrkere'm isomsden Inawanbe esrtbr std Do
MARMLE59 CLAUSE The Wm19a(a)by eocoptSnOs of do pennR beat ere: annum•
eD�UI Ib Indemdy and hold hanNata rhe Guy dCuPetOrte fiom and Cpmer Garondon
e&tlotmeu rtltleDeRidLaaapsrdlsdSrlddeeson'afordu"soare°WtlnoF°m PoPgNueroer C2KR000101B
epafnet all wch oWn10.demands eat teell9ance d dCuPertkte
r I n Tbe a7Rdtleaeerkwbs100 vises.
In ani llon. ly with the pmvwom OfSeelen 2500 of the Lector Code d the 1 1 W I detey tletln tbe psrkmnerp Aare•erlrlbrwhioh thb permk b hated,I
Sete Of"IOmle.tiro sPPlieerlt&tell hays Coverap under 0),erQD dalig. I trot emplgaPubmmy nIn ek
now below or shall Itldloeb Items OIIA or(M or M."Nohow Is appllarbk, en'se"Peneaadn Is"d Caldor a II funhir,ae�wpe as I undomo nd
R 1101NOm Ram M It ahedled Rem(IV)must be dwelled w well.Mark to e'et In the arm ft I should become sutdeat to arewarkers'compensation
epplopdate method of eampllerros, pno.kloe sae laadr Cade of Cenfemh end W m comply faRNft Win
P"W"nearaeeRon 3800 A de LAW Code,del lee WOO herein epplbd far
UMV I o CONTRACTaRa PaCLARATION shoe be deemed revoked
Kd10eIne'eramnndsstan,a mead under as aw+WN A amplara RwAgroie to I I K I= eoerekx aro �h�t In tln•wAalhory eine
e1deeeesr3AWMreread preeaekra Omw ardaveero.wwee knee end why
'eodr 16rwhten ab pernvlb lseued�1 who employs oo aag rvna mmPPw
Usew 6.58122E C38 B 03/218000 wAm tM wmksw'semP•reed0n bwe of anro"end aero,prism the nom.
Chent��W mems nontof"work cola of a Q m 4w copy d thle form with de cereal
Pomo aunsu.
PAYMENT
ACCOUNTaa
W11PAUKDATiff., 09D19
CREDIT CARD TYPE NAME ON CARD
SIRE
AMOUNT
a
DEC 8 2 1999 Cott Waterbury
61ane1eedApMewsef OATB PMbd NemedAppaeamt
pJAN_19;2000 10:49RM WETCLERK INC WO.B97 FP.32
TTaoi CLFERTINO $ee Dubuque Avenue
NetClerk, Ina. : e-solutions for the eontreanp Industry south San rrenci.eo.CA 84060
(see)se CLERK
Building Permit Application
From: NetClork Inc. To:•Building & Planning Department
Contact Name: Sam Waterbury Cltyt Cvpettino
Phone: (650)67b-0426 phone (408)777.4228
FaxNvmbtr. 1{877)846-5888 Fax Number, (400)777-3333
Permit Handling Instructions
Pleaee Fax Permit tot 1-(877)""B88 Deliver to Job site at first Inspection
1 will pick permit up at the Building Department In 5 days HiPlease mail to Contractor address below
Others pleas&mull permit to: perealessaun tarkeom
Contractor Information
Compamy: Just Water Heaters Iso. Worker's Comp N: UMU001018
Conbuton Amt.Am Id State Contractor's Lieanm# $91329 Class"6 B
Address: 1764 National Ave. Credit Card Information
C(tyvr Hayward,Ca.94545-1722 Credit Card Number: 6474-6331-7168.6326
phone: 510-293-2011 Name on Card( Jut water Noatats 1ne.
Tom 510-7836360 Z01ratiouDater 09/02
n pormiusJuitwaterheatetsmat Wo MasterCard R
Comments:
Authorisation forms:
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