00010035 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY 0001003
f CITY OF CUI'F.RTINO RHILDING-F.LECfRICAI. PERMIT NoOsooi�
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MF,CHNTIFIC 50001
BUILDING PROJECT IDENTIFICATION
EUILDINGADDRESS: / ::.SANITARY NO. APPLICATION SUBMITTAL DAL
OWNER'S NA E: PlI E: CON OR'S NAME. N('
I p NIC CONTROL#
000
CHITECT/ NGINEER: e ADDRESS: / C' ❑
CONTACT: PHONE:
9�•�/ ��I BUILDING PERMITMBINFO
El AXIY ) I Ap`At titial) BLDG ELECT PLUMB
MECI
Sid A-91-35 I,Hl
❑ ❑ IfJ ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
I heethy ammo mm 1 am licensed uon
nder provisis of chapter 9 @ommoming JOB DESCRIPTION
DaZ with Section 700(d of Division 3 ofthe Business and Professions Cale,andI licenwo RESIDENTIAL'
W O p PERMIT ISSUANCE.
EWA in full l,rce end effecpp .+A/� �� WFDWI, os- ❑KITCHEN REMODEL
aUU License Cintas (�3GA Lia# -� 7 APPLIANCES-RESIDEWIM- []ADDITION ` CD PLUMBING RE-PIPE
{�.ZZ Ouil1 Date Conmucmr
NQ6 MUI.TI-UNIT ❑STRUCTURAL
ARCHITECTS DECLARATION MODIFICATION
PANELS
Z p N Z 1 understand my plans shall he used n+public records
pZ4Q UP T03W AMPS ❑INTERIOR C1 CHIMNEY REPAIR
rt9 Literati Professional 201-INX)AMPS IMPROVEMENT ❑SWIMMING POOLS
•] OWNER-BUILDER DECLARATIONOVER 111(10 AMPS ❑BATH RF.MODELJRHPAIR El DEMOLITION
1 hereby alRm that 1 am exempt from the Contscmrx License Law far the
�y(O6 U following name.(Section 7031.5,Business and Professions Code:Any it,,or county SIGNS 1?LECTRICAL .❑OTHER n
LLl a W y which requires a permit m construct,alter,improve,demolish,or repair any suumure G
pn prior in its issuance,also requires the applicant for such permit o file a signed mimmem SPECIAL CIRCUIT/M ISC.
that he is licensed pursuannn the provisions of the Contracmrs License Law(Chapter 9
a a'E (commencing with Section 7000)of Division 3 of the Business and Pnnfessinns Code)(it 'TEMP.METER OR POIAi INS .
IN� that he is exempt therefrom and the basis for Ne alleged exemption.Any violation of ElNEW BLDG/ADDITION [-IDEMOLITION
W Section 9031.5 by any applicant for it perntitsuhjects the applicant to a civil penalty of POWER DEVICES NANT OPOOD SERVICE
t mare than five hundred dollars(55(10).
N ZS Y Ih1PROVEMLNT
F� I]1,as owner of the property,or my employees with wages its their sale compensation, SWIMM ING POOL ELECTRIC
' €" will do the work,and the structure is not intended or offered for sate(See.]IW4,Business ER
63 and Professions Cock:The Common/,license Law does not apply on an comer of OUTLEI:S-SWITCIIIS-FIXTURES
pmp,ny 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 NEW RESIDENTIAL F.LECTR SQ rL
sale.If.however,the building mimpnwement is sold withmone year ofcompletion,the SQ.Ff.FLOOR AREA $/SQ.Ff.
wncnbuilder will have me burden of proving that he did not build or improve for pur-
pom of ed c.d.
I]1,us owner of the prnpeny,am exclusively contracting with licensed counselors to TOTAL:
construct the project(Sec.70,44.Business and Professions Code:)The Commerce s Li-
strew Law does notapply toson ownerofproperty who builds or improves thereon.and QTY, PLUMBING PERMIT FEE
who cnnuncis for such projects with a s ornmenr(e)I lenient pursuannn the Cmame nr's
License taw. PERMIT ISSUANCE
❑ I am exempt under See. ,B A,P C for this.,.
ALTER-DRAIN k VENT-WATER(IIA) VALUATION
Owner Dane
WORKER'S COMPENSATION DECLARATION RACK FLOW PROTECT DEVICE QO
I hereby affirm under Penalty of perjury one of the following destinations: Z 3 `�
I have and will mormina Ceruficumof Cmtsem to self-insure for Workers Co.,.- DRAINS-FLOOR,ROOF,AREA,COND. STORIES TYPE CONSTRUCTIOb
action,as provided for by Section 37W of the Luton Code,Gn the performance of the
work Inn which this permit is issued. FIXTURES-PER TRAP
❑ I have and will bedroo n Worker's Compensation Insusnce,as mqulred by Section
3900 o1'thel.ahor Cnde,fnr Chop nanecofnho work for which nhispermh is issued GAS-HA.SYSTEM.I INC.4 OU'11111 S OCC.GROUp PAIN
My Wor tion has crc 'erendpolicy /� yq 7/yq
Camcr. atm Policy Nn. WOR&.- — V GAS-EA.SY•STEM.OVER4(HA) 4Zl D-
E I IFICA'IH F HXEMPTON FROM T RS' GREASEIINUUSTRL WASTE INTERCEPTOR
COMPENSATION INSURANCE BUILDING DIVISION FEES
(Thismmi emednm he completed ifthe permit is Intone hundred dell.1$IIID) GREASETRAP
nr less) PfANCHECK FEE
I certify that in the performanceof Ne work for which mi,pcmit is issued,Idall SEWER-SANITARY-STORM F.A.2N)FT.
not ema
ploy ny pervon in any owner so as us become suhjcen no the Workers ComPen- ENERGY FEE
O nation Laws of Califnnia.Date WATER HEATER WINENT/ELECfR
O Applicant 1 GRADING FEE
ti NOTICE 9'O APPLICANT:If after making this Certificate of Exemption,you should WATER SYSTEM/fRE.KfING
a > become subject to the Workers Compensation provisions of the labor Code,you most SOILS FEE
LkI fir/ tit comply with such provisions in this permit shall he deemed revoked. WATER SERVICE
0.
O z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PhMB. SQ.TT. PAID Dat, Receipt#
LJ O I hereby hrhuhauherc ie construction tenting agency for the pvrfitrmnc
ee of
theLe work for which this permit is issued(Sec.3097,Civ.C.)
Lenders Name IOTA("'
O Lender's Addrc.v TOTAL:
Iy I certify than I have mad this application and state than the above information is BUILDING TEE
rn comes an
lagrce In city and ntimyadinces and state laws relating In QTY. MECHANICAL PERMIT FEE
L) z building examination.unit hereby subsonic representatives of his city to enter upon the SEISMIC FEE
oboe-meminnW propeny for inspection pmr,xv.s. PERMIT ISSUANCE
(We)ngive m save,indemh
nily and keep armlces the City of Cupeemo against ELECTRIC 1'EE
liabilities.judgments,costs and expenses which may in any way accrue against said City AI•TERORADDTOMECH.
PLUMBING PEE
in consequence of the granting of this permit.
APPLICANT UND ERS'TA NDS AND WI LI,COM PLY WITH A L I.NON-POINT AIR HANDLING UNIT(TO 10JX(1 CFM)
MECHANICAL FEE
SOURCE RF.GUTAfIONS.
AIN HANDLING UNIT(OVER 111,1X111CFM) CONSTRUCTION TAX
Signammaf AppliwnVCnntmnor Date EXHAUST HOOD(WIDUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building excepantsme or handle harandnm mamdal HEATING UNIT(TO 103,000 BTU)
as definW by the Copcnino Municipal Code,Chapter 9.12,and the Health and Safety
Cade,Section 25532m)7 HEATING UNIT(OVER 100.000 BTU)
❑Yes ❑No VENTILATION PAN(SINGLE RESID) PAID pant Neceiptp
Will the applicant or future building occupant use equipment or devices Which BOILER-COMP CUP OR Ifq,fp0 BTU)
nit boundous air contaminants as definW by the Bay Area Air Quality Management 'fOTAI.:
District'!
E3 Yet Fl No BOILER-COMP(OVER 100,000BTU)
I have read the micr nue materials rogiiremems under Chapter 695ohe Cali- AIR CONDITIONER ISSUANCE DATE
farms Health&Safety Code,Sections 25505.2533 and 25534.I understand that if the NEW RESIDENTIAL MUCH, SQ,FT.
building does not currently have a tenant,that it is my nesponsibl Iity to notify the occupant
of the requirements which most be run poor to issuance of a Cmifcam of Occupancy.
Owner or authorimd agent Date TOTAL' I ISSUED BY:
OFFICE
JAN.10.2000 10:04AM NETCLERK INC N0.893 P.1
4 080 Dubuque Avenue
iNetClerk, Inc. : e-solutions for the contracting Industry South San Francleco,CA 94080
(888)88 CLERK
BuHdi n Permit Application
rom: NetClerk Inc. To: Building & Planning Department
Contact Name: Scott Waterbury City: Cupertino
Phone: (650)624.0426 Phone: (408)777.3228
Fax Number: 1-(877)846.5888 Fax Number: (408) 777-3333
Permit Handling Instructions
Please Fax Permit to: 1-(877)846.5888Deliver to job site at first inspection
I will pick permit try at the Building Department in S days X Please mail to Contractor address below
Other:please email permit to: permits0netelerkcom
Contractor Information
Company: Just Water Beaters Inc. Worker's Comp#: 02SS00010IS
Contractor Atm:Arnold State Contractor's License# 491329 ClassC-36 B
Address: 1764 National Ave. Credit Card Information
City: Hayward,Ce.94545.1722 Credit Card Number: 5474.6331.7168.6326
Phone: 510.293-2012 Name on Card: Just Water Heaters Inc.
Fax: 510-783-6360 Expiration Date: 09/02
permitsQjunwaterhoators.net Visa MasterCard XX
Comments:
7TAI -TIM
Authorization forms:
CraditCard Aathorkati0nPenn •AGIOMAuthaladon=6ymmpleangand mourning the Information Maim.
Yow�thodu NerOerk,Ine to as scan agenton yourbehalfrlerthe purpose
r 6*Tr&tefil!Ms, Ilia n9pentdtapplkadom
To Whom ItMay Conmn
yec Let ddc Mrteratahortaa//ett7erfc lac and ftrempIbyeasand
ams: authodredasmcrates to sawan ageoton ourbelwU—s/gnlfrg kwany
tVtad _ at � «w. andsllbuRdtagperrlowdsconswwy !r dbvourouapany.
L�hQAS4 4 � tits. )
IDelaomoDsm,�[PjL � .
orartddNarat �' Ce' C2vyK .�
• efd�[kow[r+t�d r%.amwrrao0r +maeeaaat 17d I+ri S7 ✓t"t"I
°ltiaakf°elpaeih rant ep�rlW mt�16eppor W Daaefl
' ConWny.-iiol V I
312114.10.2121121121 10:04AM NETCLERK INC NO.093 P.2
CITY OF CUPERTINO
BUILDING PERMIT APPLICATION
10300 Torre Ave. Cupertino, Co.95014
�a (408)777.3228
PROJECT ADDRESS: 1100 WndIlmar Court BLDG# SUITE/APT#
PROPERTY OWNER CONTRACTOR
OWNERS NAME: Fan,Sherman NAME Just Water Heaters Ino
MAILINGADDRESSy4150 Dorene Court MAILINGADDRESS: 17844a6onal Avo.
CITYISTATErLIP: Saratoga, CA 96070 CITYISTATEfZIP: Hayward CA 04846-1722
PHONE#:( 408)741.0281 FAX 0. ( ) PHONE#:( 510)293.2012 FAX ilk. ( )
EMAIL ADDRESS: E-MAIL ADDRESS:permits®)ustwaterheaters.n rt
6 BUSINESS LICENSE M 18126
EXPLAIN WORK TO BE PERFORMED: Water Heater Replacement 40 Callon Gas
BUMDnva. ELECTRICAL tw KHANICAL PLUMBING
REROOF: HAZARDOUS FIRE AREA: YES_ N0_ NUMBER OF EXISTING ROOF COVERINGS:0
TYPE OF EXISTING ROOF COVERING- _ PROPOSED ROOF COVERING:
NUMBER OF E7Q91TNO ROOF COVERING$moves: 0
NUMBER OF EXISTING ROOF COVEMOS RETAINED: 0
PROVIDE I.C3,0,REPORT NO. VALUATION: 732.00
• IMPORTANT NOTICES NOTICE TO APPLICANT
APPLICANPS CERTIFICATION I hereby a18mt under penalty of pedury one of the following declarations:
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ( > I, I hove and will melrrteln a aMdOeete of consent to sae-insure for w'orkere'oom-
ABOVE INFORMATION IS CORRECT.I AGREE THAT IF A PERMIT IS IS. ansmon,ss provided by section 9700 of the Labor Code,for the perfomrenee
SUED FOR THE DEMOLITION DESCRIED IS THIS APPLICATION,ALL THE of the workwivclh this permit Is issued'
PROVISIONS OF THE PERMIT AND ALL LAWS AND ORDINANCES (�) p, I how and will maintain workers'compeneatlon Insurance,as required by Sao-
THERTO WILL BE COMPLIED WITH. tion 3700 of the Labor Code,for the performance of the work for which this
permit is Wooed. My xorkara'componodon Insurance carrier and volley num-
HOLD HARMLESS CLAUSE.The pormltoe(s)by acceptance of the permlL Oam � Clarendon
ogroo(c)to Indemnity and hold hermlow the"211y,of Cupertino from and
against any end all claims,demands and actions for damages resulting from POW Number 02KRDOOI OI B
operations under this pemdt,regardless of negligence of the Clry of Cuporilno
against an such claims,demands or actions. ( ) m the cost of the wok done is$100 or tem.
In conformity with the provisions of Section 3800 of the Labor Code of the I ) N I cattily that In the Performance of the work for which this perms Is Issued,I
State of California,the applicant shell hove coverage under(1),or(II)da619- shall not employ any person in any marmot iso as to become subject to work.
noted below Or shall Indicate items(III),or(N),or M,whichever Is applicable. ere'compensation laws of California.I furtMr acknowledge that I understand
It however Item M 16 chocked tem(N)must be dhooked as well.Marie the that In the event that I should became subjed to the workers'compensation
appropriate molhod of compliance. provisions of the Labor Code of California and roil to comply forlhwllh wldh
prtMelore of Section 3800 of the Labor Code,dei the semina retain 00plied far
shall be deemed revoked.
LIC6N6®CONTRACTORS DIR:LARATION
I Ie"alarm that I am a Awns ed unow Ne plwMlaa of Chapter 91kamnendnoven I ) V. I COW as the owner(or the agent(or the owns*that In the Performance of the
�n 7000)a,Mellon 7 orae Budnaw oret Palf"we Cade•end nrysoenso k H lull fomo and work for which this Perm le issued,I will employ contra120r who compiles
win the wan
ke 'componsadon lows o1 Colltornia and who,prior to the ooh-
uPenm r•891329 Gas+ C38 B Ex 0.9/31/2000 menament of any work,will me a completed cosy of thle lbrm with the Cantel
Pam*Bureau.
PAYMENT /' /
ACCOUNT e: .� 7 7� E70 b EXPIRATION DATE: 09 DO
CREDIT CARD TYPE NAMEONCARD: jjr
80URL AMOUNTS:
JAN - 7 2000 Scott Waterbury
9lpettlro Of ApOsant AgentDATE printed Name of Appsant
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: chrietya
Sec: Twp: Rng: Sub: Blk: Lot:36619059.00
INVOICE DATE......: 01/11/2000
REFERENCE ID H ...: 00010035
SITE ADDRESS .....: 11630 WILDFLOWER CT
SUBDIVISION ...... .
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: FAN SHERMAN S AND LILY L
ADDRESS ...... .. ..:
CITY/STATE/ZIP .. .: SARATOGA CA, CA 95070-9727
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
V ID - DESCRIPTION.-.-.--.. VOICE ID --- a DESCRIPTION
...... ........ ............
6 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB & OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING