00010139 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY Q Q /Q l
L'IVINE,RNAe,
Y OF CUPERTINO BUILDING-ELECTRICAL. PERMIT NO.
ILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL S
BUILDING PROJECT IDEWIFICATION
ADDRFSS: 11 SANITARY NO. APPLICATION SUBMITTAL DAL
1 cv_,19i—// 'Wag" 'S AMp,: n L NO:l�17[ NIC CONTROL.
WFZIRI LUULNUMEER: LIC NO: ADDRESS ❑
6rtX /a A✓e Son Cor/
CONTACT PHONE I BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PL
UM
B MECH
❑ ❑ LO ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
Metz I hereby affirm that 1 am licensed under provisions of Chaper 9 omltteneing JOB DESCRIPTION
WO with Section 900xp.f Di,W.n oftwftcoma,and of Aere,codc, n licensees RESIDENTIAL:
U License Lic #
F O in full force and effect. PERMIT ISSUANCE
CWF G [ISFDWL [I KITCHEN REMODEL
Q V .
y¢L Dae Commnur APPLIANCES-RIiSNENTIAL El ADDITION � ❑PLUMBING RE-PIPE
ARCHITECTS DECLARATION ❑MULTIUNIT ❑STRUCTURAL
Z O l4 Z 1 understand my plans shill be used as public mesas PANELS MODIFICATION
OZ—W UP TO 200 AMPS
[I INTERIOR El CHIMNEY REPAIR
F W LicemeJ Pmfecsionul 201-1000AMPS IMPROVEMENT
OWNER BUILDER DECLARATION ❑SWIMMDEMOLITION POOLS
y C 6 1 hereby affirm that I am exempt from the Contractors License Law for the OVER ELECTRICAL BATH REMODEIIREPAIR DEMOLITION
p(a d V following reason.(Section]0315,Business unit Professions Code:Any city or county SIGNS BLLCTRICAL ❑OTHER
W W y whim requires a permit m<.mtrvd,al¢r.imprmn'e,demolisn..r mpan any Hrvdure
oe prior to its issuance also Tramurs the applicant ln isuch rermiuo rile a signed statement SPECIAL CIRCUIT/MISC.
f y, that he is licensed pummlt to the provisions of the Contractor's License Law(Chapter 9
wC) (ooninerrem,with Section 7")of Division J of the Business and Professions Coder or TEMP.MM- ROR POLE INST COMMERCIAL'
3.q o C that he is exempt therefrom and the basis for the alleged exemption.Any violation u[ ❑NEW BLDG/ADDITION ❑DEMOLITION
W rn Section 7031.5 by any applicant for v permit subjects the applicant to a civil penalty of POWER DEVICES ❑TENANT ❑FOODSERVICE
nm Inure[halt five hundred dollars($50(1).
F-ZQ Q Las ownerofthe progeny,or my employees with wages.,dairsole,smpcocation. SWIMMING POOL ELECTRIC IMPROVEMENT
�o will Jo the work.und themmctoreis nntimcnded or offered lin sale JSecA04y Business ❑OTHER
W 3 m and Professions Calc:The Contractor's License law does not apply to an owner of OUTLETS-S WITCHES-FIXTURES
property who builds or improves me..,and who docs such work nlmwB or through
his own employees,provided tha such improvements am not intended or offered for NEW RESIDIII TIAL ELECTR SQ FT.
sale.If.however,the building or improvement is sold within one year ofeompler( the SQ.FT.FLOOR AREA $ISQ.FT.
terhuiWer will have the burden of proving that he did not build or improve for par- J
pose of sole.).
❑ 1,a,owner of the pmpeny am exclusively contrasting with licensed commetors m �ED'AL'
nno...I the project(Sce.91141,Baseness and Profession,Codea'rhe C.mmctoh Li- '
cense Use does not apply to an owner ofpropeny who builds or improves thereon,and QTY. PLUMBING PERMIT E
who afor such projects with a contractors)licensed pursuant Contractors,to theContracContracContractors,Llcense w Law.law. PERMIT ISSUANCE
❑lam exempt underSu. ,B&PCfor this reason
ser
ALTER-DRAIN&VENT-WATER EA)Dam VALUATION
WORKER'S COMPENSAI ON DECLARATION BACK FLOW PROTECT.DEVICE jyM
Iheranya marunderpenulty ofpa,.,,,neoffha following declanturns: 5l//L0 (_�J
I have and will maintain aCeniecatcof Conocam salf-insure for Worker's Compen- DRAINS_FLOOR.ROOF,AREA,COND.
umian,as provided for by Section 3910 of the Labor Coda,for the performance of the STORIES TYPE CONSTRUCTIOI
for which this permit is issued. FIXTURES-PER'TRAP
worl he c and will maintain W'orker's Compensation Insurance,as required by Section
37M ofthe Labor Cole,for the perfornwnm ofthe work for which this permit is issued. GAS-EA.SYSTEM-I INC.40UTLES OCC.GROUP APN
M1fy WorAds(:ompen. n,yte Insurylce casrieralJY No.: GAS-LA.SYSTEM OVER 3s /30y
Carrie, . fY Jf--z)-/T//
CERTIFICATE OF EXEMPTION'FROM WO IERS' t
COMPENSATION INSURANCE GREASEANDUSTRL WASTE INTERCEPTOR
('Otis vection nerd oat beconiplmal if inepennil is Taurus hundred dollars(SIO.) BUILDING DIVISION FEES
.r less) GREASE TRAP PLANCHECK FEE
Loy any thusinthe per any
eo as
workria subject hida to permi the Wrkesued,Lshvll SEWER-SANITARY-STORM EA 200 FT.
not employ any penton in any manner so as to become subject to the Worker'Compen' ENERGY FEE
O Z Aaiun Law,of Ctdiftmfifr.Data / WATER HEATER W'/VENT/ELE7IR
z O Applicant GRADING HE
y
NOTICE'1 O o ,,the Work If,after making Inis,ki.cute of Exemption you should WATER SYSTLM/I'RfiATING
a ? femwitho.m to the Wmkcl's menet or his provisions of the tabor Calc,you lot SOILS FEE
lJ.l
forthwith comply with such prnrisions or his permit shall be Jcemul revoked. WATER SERVICE
0.
Uz CONSTRUCTIONLENDING lending
GAGENCYagency N'Ew RESIUENTIALPLM H. SQ.FT. PAID
(-) Ito,by whiffrm that nlereissued Sce.3( lending agency for performance of Dam Receipt.
Lg. Uthework for which this Pemtit is isem,l(Nese.31M1],Civ_CJ
LendeName
O IsnJc,' A lfify t TOTAL:) TOTAL:
I
H L1x certify tont 1 have read this npplicmian and m:uc that the above in(urmvtinn is BUILDING FEE
ZI ton eel.I agree to comply with all city nad...any ordinances vnd,one laws relaingm QTY, MECHANICAL PERMIT FEE
V Z huddling Ionslmction,and hereby arm rx,newmad rs of this city to emer,upon the SEISM IC HE
abovomemioned prpeny for inspection purposes. PERMIT ISSUANCE
(We)dgm,to sec e,indemnify and keep harmless the City of Cupertino against ELECTRIC FEE
liabilities,judgments,costs and expenses which may in any way accrete against said City nspLTLR OR ADU TO MECH.
in eque a of the granting of this permit. PLUMBING PER
APPLICA tNDERSTANDSANTI WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO IO,IMO CFM)
SOURCE .f 1LATIONS. MECHANICAL FEE
AIR HANDLING UNIT(OVER IQOIO CFM)
GG CONSTRUCTION TAX
Sign.mrc of li omfwlor Dam EXHAUST HOOD(W/IJUC'19
1AZARDOUS MATERIALS UISCLOSURL 75i
Wilby the Clicant nr(muni building e.Chant rstore 9.12,handle Health and material f1EATING UNIT(TO If10,UW BTU)
as de.Sec by the Cupertino Municipal Cade,Chapter 9.12,and the Health and Safny
Code.Section 25532(0) HLA'1'INC UNIT(OVER 100.000 BTU)
❑Yes �Nn
VENTILATION FAN(SINGLE RCSID)
Will me applicant or fuwre building by the B ace equipment or devices which
lit huraNnus air ammmin.nt as defined by the Bay Arca Air Quality Management BOILER-CO.NP(3HP OR IW,L00 BTU)
District?
❑Yes + BOILER-COMP(OVER 100,0011 BTU)
I have mad the harardous material.mluircricnts under Ch:gncr 695 of the Cali- AIR CONDITIONER
fomia Health S-rely Cale.SmGom 25505,25533 and 25534.1 undervalued that if the
huildingdce it mennyhnventenunt Waliti,nt bilis mnntlf these. t NEW RESIDENTIAL.MIiCH. SQ.FT.
y cc ul y y pan
of mere ni � xwnmh nta,t rte ma l>nmem i.,aanee nr cenire.te.rpc^puny. ,x /�
Curatorial r Data TOTAL: ISSUED BY: J9 e— AA'dZ�C('
OFFICE
880 Dubuque Avenue
NetClerk, Inc. : e-solutions for the contracting industry South San Francisco, CA 94080
(888)88 CLERK
Building Permit Application
401.
From: 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)846-5888 Deliver to job site at first inspection
I will pick permit up at the Building Department in 5 days Hx Please mail original to Contractor address below
Other:
Contractor Information
Company: Hot Water Inc. Worker's Comp#: 1548386 State Fund
Contractor: State Contractor's License# 763612 C36
Address: 2531 Graceland Credit Card Information
City: San Carlos, Ca. 94070 Credit Card Number: 4246-3115-0117-2578
Phone: 650-298-8494 Name on Card: Chris P. Guslani
Fax: 650-298-8493 Expiration Date: 06/00
mail: Visa MasterCard
Comments:
Fax
Authorization forms: Credit Card Authorization
2. "Agent Authorization"-By completing and returning the information below,
you authorize Net Clerk,Inc.to act as an agent on your behalf Company Name: sf
Company Address:
To Whom It May Concern:
Let this letter May
NetClerk,Inc.and all currently employed and Phone: b 'I
authorized associates of NetClerk Inc.to act as an agent on our behalf— Fax: J
si nin or an and all buildin Email: r—.Ca�-
8 gf Y gpermits and required by our
company. Type of Card: -Lisa _MasterCard
TCnrdholdere Name: Alf
o/
//7 5 8
_ l>Credit Card#: Al , Expiration Date: li as
Sincerely, �/G,A , ,4 ,,.
Name: 0/"1 l t,S lr�=
• Title: ;icS By signing below,I give NetClerk,Inc.and all currently employed and authorized
// //� associates of NetClerk to sign credit card authorizations for the purpose of permit
Comapany: )'/a�- /4CTU , `QM t— applications.
rlm;s Gttstdet H44
Contractor's Name Signature Date
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• • BUILDING PERMIT INVOICE OPERATOR: chriatya
Sec: Twp: Rng: Sub: Blk: Lot:35613048.00
INVOICE DATE......: 01/28/2000
REFERENCE ID # ...: 00010139
SITE ADDRESS .....: 21865 HYANNISPORT DR
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ....... . . . ..: CALLENDER E D 3 AND MARILYN S
ADDRESS .......... :
CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-4015
CONTRACTOR .......: GUSLANI, CHRIS LIC N 21311
COMPANY . . . . . .....: HOT WATER INC
ADDRESS .... . . ....: 2531 GRACELAND AVE
CITY/STATE/ZIP ...: SAN CARLOS, CA 94070
TELEPHONE ........ : (650)298-8494
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
Vie ID =
.......DESCRIPTION VOICE ID DESCRIPTION
106 SEWER 6 WATER .. 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB 4 OR SHOWER
$02 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•