00110024 (2)• CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING AIYDRF-SS', PERMIT NO.
18453 FARMINGHAM WATER HEATERS ONLY 0011
OWNER'S NAXIG APPLICATION SUB UAtli
- TOM MACDONALD 500 AIRPORT BLV 11/03/2000
HONG - SANITARY NO. CONTROL NO'
(415)349-3747
G�p ZQ ARCflffliCf/IiNGINEIiIL a BUILDING PF-RMfr INFO
F F PLUG ELECT PI.UMH A1LCH
0Zi 1=1
y LICBNSED CONTRACTOR'S MCI-ARATION
I bcmhy mOm,that an,a, nr=d IIdle,Prol.siomor Ch.,Acr 9(,annnavc,, Job Description
Cyt wan secam71xo)mMh.•i.mn3nr dr x.eil,ea..m Pmfesvhmscde.aid m,beau
in full forte aid cR,a,.
< ca 1Jc., REPLACE, 50 GAL WATER HEATER
o Dae CDTC[_A
C"Og3 u ARC1ball bCfS OIiC1.SRAl]ON
1unJcmard my Plan Jwll hk used.,PUM1lic nciN.s
�p
ccy
d L I.lecna•J Pnrressinnal
(him I am BO or,t b DECLARATION
1 Mvny.flim,r m I am ec=mpl rim,Inc Contractor's corks:
UAn,c Ina for the -
- t=n whichBilottnp n-.wa.oroc inn ocrac031�5.x.11,o nd Pmri1coml Cnt:Ivy dlr..Gamy 11
I � ankh rtyuim a Pmmil m.,rtslNtl,elle,inmmrc.OcmoliJ,,m corsair any etmnurt
f5�� Poor lots lswm,cc,.Uw rtquires Neapplhvnl lirvuch prmd,,o likasigrW sa,mrnl
that the is l:amv, r chartl.r9 Sq. Ft. Floor Area . - Valuation
Iumualming aim Snykm MgU of Division 3 or the BLLdrleas am!Profeasiom Code)
r Ihst he is caem g Inttef can end Inc basis for the ell,od-carbon.Any cinliciorr -7
CA M
of Scctiou 7011.5 by troy alRlicantfir a Bcmlil..njctir,dr applicant m.civil perahy P Y -
oftxcnarNar
efivenmldrddJl
eI.(S511o). APN Number Occupancy Type
• ❑I,an owner artist,Pr9cny,or my cmMMccs with wag-u lhcim sole cormcroatitm. :;75P207 ..
will do dr work,and the slmclum is nor itnnxLvl or oaarrl for sale(Sec.7 W.
Bmehrs.and Profession,cat,:Tnc Com mar's brava Ina dos t.,t.,Iy o a Required Inspections
ow, m of Pn p,ri,Whir builds or il,Ipmves Ihrroo,and wN,o4r.such w.A himwlf
ortroughhm nmploy=r.�lha"ac,imfrnow,n t.an, +
r. imcaJedm 502 — FZNAL PLUMBING ENERGY,
oBd d for ale.If,however.me bonding m irnprovenmrit is IoW within me yam of
mmlrktion.theoarer-buaderwiBbseticbmdenofPirvithat hedid ewh,Jdor 506 — GAS TEST - -
nrowe rm wisp<.arealei. .
Ol. me lioror,y.:m,a.ewo,ml, orlmrim,will,h,rn.aa=nnln.lm,to 507 —. FINAL PLUMBING
ctmuruc,the pis tti ISec.]WJ.Buxircas ami ramocoimrs Cut:)The Contrvnm's
Uccme Ina does nor apply m an owner cat pri tPory who bids or imfmrvcs IIKM1vm,
mW is Ins, w
s,contracts for ch Projects with a emvx+M.)lice Pursuant to me
♦ com..r's Cxcemc law.
❑1 an evenyn urxkr See. - .R k PC for this«awn
Gwh,r Dat,
WORKER'S COMPHNSATION DIKE\RATION -
' I ncrtby e(Ertn urdn Penally of Pcrlury nrw uf,hc fM h,wine Jsl.mtinmr: v '
1 hast, ars! will maintain a Coif le of Consort to nclf-inmm for Wtrlor'v '
us PmviJeJ ,cm fur by Sd370() of Nc Whrc Coate. Ile th<%,orn'r,armo
acrnana of Inc work for which Nis Pconi,a iswcd. _
°1 ha.e and will maintain Warmer's Cunrscr,mkm Inwcace,as ocito awl by Section
371X1 o1 me Whor Culu.fi r,ht,Krfomam'e of Ne work For which Nis Penni,is
ssuM.Aly NSokeh Cunlrnamvm lnsuramc carrier and Policy number are:
Cartier: Policy Nm:
Cl!RT11'ICSI ION OP ?K-MMION FROM WORKI:kS'
COMPFNSATION INSURANCE -
rDli. ,tckrs Deed cwt be can i if the Moor is for mIe hunched dMlan
1511Xo m Ina.l
1 Genn,Ihal in Inc orkmo,occ ul Iho wale lar which Iho liermil is mood,I -
d,ad am employ a,peva,in any manner w as,u p,come subject m dre WtrmevF - - - -
Companm,im Laws,f c:difori a.Dro
A,li,am
NorfazFOAPPIJCANT,Jr.rear-.king this Cerifcaln or Hxonmtion,you,0ould - - '
become ecoe subject to the Wool Copea .
ntalion Pmviaxraof Bre lshr Cm.k.you mat '
O .hempl
forthwith coy with such provisions or this Pcm,it shall bere
Jmxrr ravWcJ. '
Z O
(• y CONSTRUCTION LPND1NG AOFNCY '
a > I hcrch,affim„ha„Irrt is it comm pian firstling egeay far the Perfmarce
oflhe wool,for which his rymmi,i.i.wca(See ANI.Civ.C.)
L LalWcr'.Narim r
D 7. 1<Idem'x nedrt..e -
U 1 ttnify min 1 ha.c read Ihis.,Iln,im.oil e,ae Name shove information i.
k, t.. urrzct.I ug,ce m calmly with all ci,y.al,wmy,mlinanra.and Late laws rclahm, '
O U In Wikting mnlmaFra,nd hneby amlbon,c rt mnm,lves of this city,..critic.,in s .
y W ,he abovcsrcmlmlyd pm,rty for iro,oc ion lw rx. .
F, M. M'til.pee to mc.ivdenmify and keep hari Inc Cityof Culcnirlo again. ,
Uy liabilili,w,judgments,.:men anti cxpcmr+which may in any way acrtw against ud
Z City in con.ttlucntie of dbc rimming of this Permit. ..
APPLICANT UNDERSTANDS AND WE LL COMPLY WITH ALL NON.PCrNl' 'm
SOURCE REGULATIONS. - Issued by: Date
Sigamrt of Applic.nllContranir Dae Re-roofs '
IIALAkD0US MATF.RIAIS DISCLOSURE t
Will Ill antAicra„t,rfar.bailJingne..lont.«w.mhazardous;macriw Type of Roof
m unfired by to Culcnino Nbcdkipal G.k,Ch:Ipmr 1).12.wd Iib health and Safety
Coils.Smian 25538.)^.
El Y., °n" All roofs shall be inspected prior to any roofing material being installed.
wuthe.Pere,ntnrlrbtm rildingIklatam oi, lmrsoaarich Ifa roof is installed without first obtaining an inspection, I agree to remove
mil huxar,kms sir cuwmiantx a<JefuRd M Jrc Bey Area Au parity Moa6emen,
`ix„ice all new materials for inspection: Applicant understands and will comply with
°3- ON. .all non-point source regulations. -,
Mn read Ne IwaNws na,rmwls rcquirtn,enu order CTaPler 6.95 of Ih' _
Cnlihrnin Ilea it h SofnI C,dq Secrlm,15Nn,25533 and 255th.l valers,Iod lbel
It,h Wilding Ja:s out cunrntly have u anmL that it is my rt Ehimu olity to carry,Be
oc.,am of,l,e".mmcnu whiih oma be mer psi,,m is.uarce of a Cccir"am of -
lkcuhvsry. -
Signature of Applicant -Date '
Char in am cirind afml Dae All roof coverings to be Class "B" or better
OFFICE
NOV. 1.2000 4:36PM NETCLERK INC NO.983 P.1
TO'EPERMITS
720 Dubuque Ave., South San Francisco, Ca. 94080 rernut
n r.1 r,' i��
• ;Nk;�� � +i; 4t h,F4.FJ �4�j� i f,'r' Government Services: 888-330-1777 Application
,I• I '�. u� Y.�-r�,,fi�*` Fax: 877-846-5888
00 k no
Emaq
To:Cupertino Permit Handling Instructions
Building Mail
City Hall 10300 Torre Ave The city Will mail the approved permit to contractor.
Cupertino
CA 95014
4067773333
Contractor Information
Company:WATER HEATERS ONLY, INC. Worker's Comp Carrier. STATE FUND
Address: 970 E. MAIN ST.#20D Worker's Comp; 1516265 Exp. 04/20/2001
City, GRASS VALLEY State Contractor's Llcense:374573 Exp. 05/31/2001
State/ZIP: CA 95945 Exp,
• Phone: 5302743001203 Exp.
Fax: Business License #: Exp.
Email; H2OHTRONLY@AOL.COM
Credit Card Information
Credit Card Number. 4676037179990 Visa:
Expiration Date: 1 /2001 Mastercard: F1
Card Holder Name:John P McGee Other.
N o t e s
Pre-reg: YES Attachments:
Payment:VISA WCQ✓ SCL❑✓ SASE[]✓ AA 2✓
Agent Authorization:YES Permit Type:
ORG❑ NOTA FV.❑ Permit ID: 64176
Project Address: 18453 FARMINGHAM
Comments:
NOV. 1.2000 4:36PM IETCLERK INC NO.963 P.2
. - QTY OF CUPERTINO CONTRACTOR -
BVII GDIVISION YNFORMATEON[
DCI3LDDNG ADDP sS P13RMIr NO:
• 18453 FARMINGHAM WATER HEATERS ONLY, INC.
OK ]Ml's NAM& APPLICATION SVD DAT
0 TOM MACDONALD 970 E. MAIN ST. #200
amoo 6ANMT YNO. CON7aOLNO.
�b 408/2525095 GRASS VALLEY 95945
B wcrDTacrYtTrosretsr: BVI[DING PISMCCf'CNPO.
5302743001203
IlCF1.4DCQYDL1l0¢'sDFl]ABn9001 Iab Dgmlptivl
6�� f bnehy ,fmu m, 1 ,a Mmeµ wea pooMYar of Cbapm 9 (wmmuiK
a J .fa SnYpe 700D) or Driiv 1 of iL. Bvas - I1afm'me fam, m1 q 4em.
g b b mu bew,�{p¢w1. REPLACE 50 GAL WATER HEATER
4s7
G y a nab: 11101!2000 „m
.uICDflacr7nccLAn,enoN
�g� ��y�W.,m,A.0 a vend m p8tlarnn�
a
y OfM'Fh6UIlAIW DECLAMnON
❑ I bwbY .0 0v, ] l vho,t Som oho kw CA, LAV y tr me $4.FL PIDOr Ar® Veluetlm
g a m0aeinp AO (Walt woos, Owl.en ad yw([abm hd, Aro aH a [vrY 700.00
®� rnbn opy[bw [ anti[ 09 oerlrrry a.'1w, mwa'n dmetieb, v rm0[ m, ,a,e1w
M Y 0ow1y1 .Iq¢q® 0a gPll®[far w8 pmob b 01e[dgaeM ama� APN N=bff Ocwpavay TYPO
pwrmleree pq,4br alae Cam.[uY,Lks,[Isv(gpeD(e gamy[ , I P
(ho 7lbo a(Dlr pd l cmp DCmar bd Peefmlm Cvb)v mr y V !! I
ed roe moi.fw dor ekow w ci�i Ab, violin.KSmfv 7011.7 by my eppkm(s b.
�anE,[!km u[MDlibip q a eiMl pbelb or pu min has Ilia YutrW lellu,(1500}
LJ Cra.wrSm[pryrb,m,q aplq[[[nim Mpwrdmd[ew�mvtlm Num
m rmk and me mane b w Imsdd w ef4 M fb W e avoo' Y Babes rd pop. 1t�lbHd InpOpl00!
Cage TA,CmAnvaY Cigar Isr ger yr eNb
Oft elm el a w+W yea bi[1Y w bmaar
uvaem ut..ha duel,e[b�blvd!fw Ib,p1+3h env�pmided[bel rd
h�mm'm m✓®ad�tr nor 7C Aav4 m hvgEy w bgaeene k m r1Ab
am Aur aC rmpltlieq N[oreaJwdOa+1T bays b hada of wav'm3 @n he dJ.m b.Jd
OPm`r b pmpv.drl�l
L bo wqi of prppng, .m uahul.ey' awxdvD vbb Meerµ <eamape
mminn be Asir- (Sr. wy, eo® ,d Pre• . Cad[:) the G.mmf.
Ilnma lar dor .w 9p1Y q v ..+,v W DrWmY ter ulke a 10'Navee orrea.,
gad Abu mamcb for ,.A PAS rim a [avmem[(.) nc.o,.d ymom b m.
C�utrL I.mr taw
Im nbar mdb Seo BaPC Cw m:,vrev.
Ow[r Due
{VoR,S cOham IONDCGLu1LTBN
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ODa[maq m' p�rolEouio'.iGd W by Smdvm 3M orr do [�bp[v wm,�f�rd�e
conga of me wh[w,[bi[h 9u,paI, o e
C brn and rN cle, o P Coma fa r hl it M
of he I.b', Cede, far e l petro oo N m[ fir mr vN[Il my pbmil v
YD�C0.KY`+UOar'[Cemperulm rrbo[a mdw sed Pell[y aemL[r re
c,,,,STATE FUND 141kyA.1516265
CnRDPILnI W0 �I7pNlwasDA�iR3'
C9A49 Ma,pN A'tlDMNCd
(Dl6 ruim vd ml be cm¢b[d D m.yor M, fw for
Okh dam(.h 1,
1 waN my a lAe pfemwn of me rat for rylap mb pm.h o kwed, 1
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mm1110112000 ,lpaumm
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twm. mpw b ma tibial Como o pe,mm, aC rho I cod. o o ®rt
h.mrvb me91Y rlih...•).oH[Ime w Nb pwmh eAell b:dumwi evmbed.
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order rah 6rr6�mbyr[®lb ivved X1097,Gv.Ca
0
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$ � 1 . . q emepy .,m m e:y r away wd®m.. ..e .r I� la®I
M oboe roaebur4eo, y bapbY oo KCIY�YNn r W, nb a amt .den
Ne ebevesnperd woo b Mda FvPow.
(W[)Q.b uw,rodamlfy m,bM 7nm1[r uc City a[Oaeatiap aC[art
libdiuv, judyemq boy and Qj arllah v.y b M vnY ,ma .pito da
01Y ie ewrgeaee slot pamiel eC1EY pump
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o b�7 r00Er>s ana1L1 baps Iw rmc
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Will dr yptieme of mme bvlbdu, ohm egWpvet�m dvall nvno0papp mpWClimi
mh !®saw m �a e0oef L��dl. M/AJ%/10e•
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1 haw reed rhe arm W, mgamvmb mda Ch[pm 697 of de
WIfbmb Hath a Wow Orr, 90;4ar vM 3577) rod v M. I or me im
iC mo bulli — -••..--.1. 4- A !man" i a tib rwWu lWb w 1* roc SAIPI a of App6mW Dam
oo. h . be m[I pre r Vivre W[ C.lAa yr Nl nefaovtlm�tmyeClus"B•or6akr
11/0111122000 OFFlcs
CITY OF CUPERTINO
1 of 1 BUILDING PERMIT RECEIPT OPERATOR: na cyc
COPY # 2
Sec: Tp: Rng: Sub: Blk: LOC:37522077.00
DATE ISSUED.. . ....: 11/03/2000
RECEIPT 4. . . . . . . .. : 13922
REFERENCE ID # . . . : 00110024
SITE ADDRESS ..... : 16453 FARMINGHAM
SUBDIVISION .......
CITY . . . . . ........: CUPERTINO
IMPACT AREA . . . ....
OWNER ...... . . . ...: TOM MACDONALD
ADDRESS .. . . . . . . ..:
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM ....: MAIL-IN
CONTRACTOR .. .....: MCGEE, PAT LIC N 18986
COMPANY . . . . . . . ...: WATER HEATERS ONLY
ADDRESS .. .. . . . . . .: 500 AIRPORT BLV
CITY/STATE/ZIP . . . : BURLINGAME, CA 94010
TELEPHONE . . . . . . . . : (415)349-3747
PEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPWHEATER PER HEATER 1.00 9.99 0.00 9.99 0.00
PPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
SPERMIT : -----45 51 ------0.00 -----45 51 ----------
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ -----
OTHER 45.51 VISA
............
TOTAL RECEIPT 45.51
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ ............................ .....................................
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING