00010033 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES—USE BALL POINT PEN ONLY
CYf V OF C^UPERTINO BUILDING-ELECTRICAI. PERMIT'N
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL
BUILDING PROJECT IDENTIFICATION 50001
BUILDING ADDRESS:
' SANITARY NO. APPLICATION SUBMITTAL DATE
OWNER' NAM 1 /O V, 1 HONE: CONTRACTOR'S NAME: LIC NO:
ILLI -JT NIC CONTROL#
RCHITECT/ENGIbi LIC NO: ADDREJS: 14IJ^T_ u� El
CONTACT: PHONE: till!, BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
/ 0 2 3 Zoi2 W � 6/ D
LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE
1 hereby arm that 1 am licensed under provisionsf Chapter 9(commencing JOB DESCRIPTION
WC)Z affirm
Section AGO)of Division 3 ofthe Business and Profes (if Chapter
Code.andm Iicenseis RESIDENTIAL
F " in full force and i W Ot �.y,�7,r�(� .may�J PERMIT ISSUANCE
X_U License Class LI0.# �F� e J I �3 ❑SFDWL ElKITCHEN REMODEL
H<0.
[Frr D. eVJ— L1Contractor APPLIANCES—RESIDENTIAL ❑ADDITION El PLUMBING RE-PIPE
IFTCTS
DECLARATION PANELS 11 MULTI-UNIT El STRUCTURAL
p'/�r.Z. I understand my plans shall be used as public records MODIFICATION
5z1❑ UP T02(X)AMPS
� ❑INTERIOR ❑CHIMNEYREPAIR
,� 41 Wcesed Professional 201-1000AMPS IMPROVEMENT
ppCC�d raj OWNER-exempt fr m DECLARATION ❑DEMOLINGPOOLS
1 hereby affirm that I am exempt from the Contractor's License Law for the OVER I(NN)AMPS El BATH REMODEVEEPAIR 0 DEMOLITION
following reason.(Section 7031.5,Business and Professions Code:Any city or county SIGNS ELECTRICAL ❑OTHER
which requires a permit w construct,alter,improve,demolish,or repair any structure
y<, prior to its issuance,slso requires the applicant for such Permit to file aligned Iropment SPECIAL CIRCUR/MISC.
x y, that he is licensed pursuant to the provisions ofthe Contractors License Law(Chapter 9
(commencing with Section 7000)of Division 3 ofthe Business and Professions Code)or - -
TEMP.METER OR POLE INST. COMMERCIAL
that he is exempt thuafrom and the basis for the alleged exemption.Any violation of El NEW BLDG/ADDITION El DEMOLITION
Way Semion]03156y any applicant fora permit subjects me applicant to ucivil penalty of POWER DEVICES
I„ y not more than live hundred dollars($500). [D TENANT [_1 FOOD SERVICE
sic C]I,as owner ofthe property,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC IMPROVEMENT
G will do the werk,and the structure is not intendedormbound beside(Scc.7044,Business OTHER
3 m and Professions Code:The Contractor's License Law does net apply to an owner of OUTLETS-SWITCHES-FIXTURES 0 01
property who builds(ir 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 ELECTR SQ ET'.
sale.If,however the building or improvement is sold within one yeaofcempletice,the SQ. OORAREA $/SQ.FT.
ner-builder will have the burden of proving that he did not build or improve for put-
pose of cele.).
❑L as owner of the property,am exclusively contracting with licensed contractors to TOTAL:
onstruer the project(See.7044,Business and Professions Code:)The Contractors Li- '
sense Law does not apply to an owner of property who builds or improves(hereon,and QTY, PLUMBING PERMIT FEE
who contracts for such projects with a conuactor(s)licensed pursuant o the Contractor's
License law.
❑ I am exempt under Sec. ,B&P C for this reason PERMIT ISSUANCE
r Date— ALTER—DRAIN&VENT—WATER(EA) VALUATION
cone WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE /
I hereby affirm under penalty of perjury one of the following declarations: / e
❑I have and will maintain a Certificate of Consent to self-insure fe Wmker's Compen- DRAINS-FLOOR.ROOEAREA,GOND.
ent
satin.,as provided for by Section 3]00 of the Labor Code,far the pea ermarms of the STORIES TYPE.CONSTRUCTION
work for which Nis permit m issued. FIXTURES-PER TRAP
❑1 have and will maintain Worker's Compensation Insurance,as required by Section -
37M o
Wo eke Lab^Geode,f Chep a once tp
Pang Prligfor eh this permi1OOis d GAS-EA.SYSTEM-OVER LETS OCC GROUP � N
CERTIFICATE OF EXFMPTION FRO YI>t R�O.O^ /Z
COMPENSATION INSURA C+L✓ GREASMNDUSTRL WASTE INTERCEPTOR
(This section neednorbe completed BUILDING DIVISION PEES
p permit ie fo[onehmdred Jollars($IIMI) GREASETRAP.r less.) PLANCHECK FEE
Ioy any tpersnds,in lerfaanymmancao as tohe ork urbecome subject
to perthe it Wrkersued,I'Comptall SEWER-SANITARY-STORM EA.2W FE
not employ any person it any manner en as to become subject to the Worked Compen- ENERGY FEE
0 Amici Laws of Cttlifomia.Date
O� A ( WATER HEATER W/VENT/ELECTR- GRADING FEE
Applicant
455 NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should WATER SYSTENITHEATING
abecome subject to the Worker's Compensation provisions of the labor Code you must SOILS FEE
W forthwith comply with such pro nturs or this permit shall be deemed revoked. WATER SERVICE
Q
� z CONSTRUCTION LENDING AGENCY NEWRESIDENTIALPLMB. SQ.PT. PAID _
hembyal'firm that there leacenlen
rtmeti.n diagageney for e performance of Dale Receipt#
W the work for which this permit is issued(See.3097,Civ.CJ
VLender's Name
4iI Lcaders Address TOTAL TOTAL:
1 cenify that I have read this application and state that the above information is BUILDING FEE
ny rA entree[,1 agree to comply with all city and county ordinances and state laws relating to QTY, MECHANICAI,PERMIT FEE
V building construction,and hereby authorize representatives of this city to enter upon the SEISMIC FEE
.have-mentioned property for inspection purposes. PERMIT ISSUANCE
(We)agree w save,indemnify and keep harmless the City of Cupertino against ELECTRIC PEE
liabilities,judgments,costs and expenses which may in any way accmc against said City ALTER OR ADD TO MECH.
in consequence ofthe gmnling of this permit. PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT TO 111,00(1 CFM)
SOURCE REGULATIONS. MECHANICAL FEE
AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
Signature of Apphema/Contraemr Date EXHAUST HOOD(W/DUCT)
HAZARDOUS MATERIALS DISCLOSURE HOUSING MITIGATION FEE
Will the 1111com.1 future building occupantmore is,handle hazadous material HEATING UNIT(TO 10mmi0 H'UU)
as defined by the Cuperino Municipal Code,Chapter 9.12,and the Health and Safety
Coda Section 25532(x)] HEATING UNIT(OVER 100,000 BTU)
Fl Yes No
VENTILATION FAN(SINGLE RESID) PAID
Will the applicant or future building occupant use equipment or devices which Date Receipt R
mil hazardous air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP(3HP OR 100,"BTU)
District? TOTAL:
E-1 Yes E]No BOILER-COME(OVER I W,NX)BTU)
I have read the hazardous materials requirements under Chapter 6.95 of the Coli- AIR CONDITIONER ISSUANCE DATE
foroia Health&Safety Cade,Sections 25505,25533 and 25534.1 understand that if the NEW RESIDENTIAL MECH. SQ.FT. D
building does not currently have a mnatn.Our it is my responsibility ro ratify the occultism
of the requirements which must he met prior m issuance of a Certificate of Occupancy. D/--y�
Owner or authorized agent - Date TOTAL: ISSUED BY: / {/
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: chrietya
Sec: Twp: Rng: Sub: Blk: Lot:35922041.00
INVOICE DATE......: 01/10/2000
REFERENCE ID # ... : 00010033
SITE ADDRESS ..: 7573 BOLLINGER RD
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: CHEN CHIOU-FENG AND HSU TERESA
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4334
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 0.0D 9.99
PPERMITFEE P 35.52 0.00 35.52
--------- ------------ -----------
45.51 0.00 45.51
I ID DESCRIPTION VOICE ID DESCRIPTION
... ----------------------------
..-----........ ..............
106 SEWER 6 WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB 4 OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
MTRN.10.2000 1i10122RM WETCLERK INC NVL.f394 PPy4 ^
CITY OF CUPERTINO
BUILDING PERMIT APPLICATION
10300 TWM Ave. CUP0 4n0,Ca 85014
(408)71'7,3228
PROJECT ADDRE88t Tan kNAM Road SLOG 4 BUIT91APT III.
PROPERTY OWNER CONTRACTOR
OWNIRS NAME then,Chleuhni NAME Just WSW Nuhra Inc
MAILINGAMMOS7573 IblMpar Rad IkWUNGADDRESS 17UNNonalAra.
CrrY/BTATB7�P: G ttwu CR1'AiTA7Il71PI Haywad G 94545-1mPHON6f:( a0W7I3iei7 FAAR ( ) PHONBiI( Mq=3.2012 pAf(8 ( )
E�MIIR AODRESB: BadAILADORESB:
Pamlm@jwteslsAoalan,ne!
2 OUSIN8SB LICENSES: 15170
EXPLAIN WORK TO HE PERFO]BOD: Water H98ter Replacement 50 cellon Gas
null DDals, II CTAMA ,
cxANtcAi�_ PLu marc. ✓
BAzASD"Im ARIA: Y84, NO_ NtDml{&oY Et0i7pRO8001 OOVERRo08 0
TWz QUI=T W4 AW COVmNO: — 1ROTOSSD ROOl00VER1N0:
NUlD EROF DmomROOFCOVIIIN06RWOVSA 0
Nt7I$)I,tDTEXMTMROOFCovD WO,UT^WM 0
MOVmR LCSA,R370RT No. VALUATION: II84.0`0
IMPORTANT NOTICES NOTICE TO APPLICANT
APPLICANT'"CERIIPIOATION I daraby a141n under p enaW of pal ono ante folio sIrtp daentfana:
I CIRTIPTTHAT I HAVE RFAD THIS APPLICATION AND STATE THAT THE l: 3
ti I new W rel nobaagt a ordrlua amnwr:I m aatpkrwn Arwakpe•bun
ABOVI INFORMATION 18 CORRECT.I ACRBB THAT IPA PERMIT Is IS• Ierfie■rI-Y P"*d by 3114k113700 of ft Low Odds,terms Wknenes
BUID FOR THE DBMOLmom oSSC LIED 18 THIS APPLICATION,ALL THE of ao'wrR vAlell thb pa7M b bgted.
PROVISIONS OF THE PERMIT AND ALL LAW"AND ORDINANCE!
THMMWILLSOCOMPLIEOWITH, 07 a thave and%Vmaintain ronras•mmp■nwOallnrumde,asrequlr■ebyCc.
Gan lfwrthe tabor Code,tet the penbrmann ergo wrk for h1w,inb
HOLD HARMLESS CLAUSE.The agn4a a WwA1@"'udW—rasa'denwiatlenWmaeeeeenWand peltoynw.
p K)bf' fCupmnoedthe W l; brace:
apra(s)m k■7pmdy end held hartNaee rho Gb dCupertlno floor end CenW Clarof On
epahlN erq aro ae olelnle,damenda ane aotbns lertlemepa teaYdinOlfdm
opems"under this pvmk raperdlaea of ropllp nm of the db at Cuperoro PaMr Nembr 021070001018
$111121ma0 such dakna tiamertda a etllona. f I R 11111109 Of du wk dem to 8100 a ta■a.
M donfdnNly aefth del ptOvlalOnear Sedmn 3800 of Ins Labor Code drtha t I N I Ow:ifydwinge paRanWorra afdrs twutbnrleelt ale permitb 4ewd,r
Ste4a(Calimmb.Ihaapplleantehe0leweaaeapeYrdrO) or 00dYlg bull:"employ■nywon MdnyWun�tereourot:edern■au eam,vrk.
noted below or shall kWkgte norm(111),Or(M.Or M,whldrwr Is applicable ere•aorrpenYam ilea al Cgldamla.I fuMw a Ow I YndwdwW
W hW^%Vr Gam M Irel"111111 Item(IV)mut ba choaW so was,Mwk dM Plot
In the aware ort I Ovula bmme sumac!10 o•Iminpummilm
eplit"ifam mated ddempWilds. Pakwon■er dr taper Code dallromA and ted to mm*to*#"wild,
OwWwO deeeden 71100 of Ora Labor Code,met the prink MMM spplled kr
LMMED t:oN7"cTimaa a .1 Tm "I be scanned wawa,
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PArMeNr L
ACACCOUNTS: a/ IfwIRATIDN 09OQ
CRIDITOAM"PB NAME ON CARD•
AMOUNT k
OEC 171999 Scott Waterbury
eloncae.rapenarar w>1:
• Pdr:ae Wine AApelmaR
D,JRN.10.2000 V10;22RM WETCLERK INC NM. 94 pP43
www°
y�l Sao Dubuque Avenue
ic. : e-solutions for the contracting Industry, sow,sae FreMlaea, CA 94080
(Bea)Be CLERK
71rauBuildin Permit Application
x
rom: NetG7erk Inc. To: Building & Planning De
ntact Name: Scott Watabuq g partlnent
onst C$yt CuP°�O
(�0)6Z4-0426 Pboaeo (408)777.3228
Numben 1{g77)8se.5888 FIXNunber.
(400)777-3333
Permit Handling Instructions
Please Fes permit rot I'(shM6,4"# toJobBitentiro iaspocttonI will pick permit up at the BaMUS Department in s days HXDeUYGr
Phma mo j b site t9eror nspatlAdilress tt
0003 Please email Permit tot perm,teonswerLeom
below
Contractor Information
COMPNW: Iuet Weber Fleets Inc.
worker's Comp it
Contractor: Atm.Arnold _--
Addressi I764Netfoaal--'—"f
City: FLtyward°Co.i
Phone: 5I0-2931022
Fa::
520-783-4360 ?`�a 6 'eJ—
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