00010047 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CQ !d O'�/9
CITY ON CUPERTINO BUILIIING-EI,EC7I'RICAI. PER 11T NO.
BUILDINGDIVISIONAPPLICATIONIPERMIT PLUMBING.MECHANICAL. 50001
HIIII.DING PROJECT IIIEN'DF'ICATION
BUII.IIINGADDRESS: SANI'I'ARYNO. N'1'I.ICAI'I(INSUI3NII'TD\I.UATI
X33 e k1)
OWNER'S NAM PHON CONTRACT AME: NIC CONTROL#
CHI' ECDEENGINEEW U O'. ADDRESS:CONTACT: PHONE: ]��// BU ILDING PERMIT INFO
Consultanll'C�Y/al Itt iBLDG HLEC'f PLU�M}- MECH
LICENSED CONTRACI ORIS DECLARATION Cry ELECTRIC PERMIT FEE JOB DESCRIPTION
I hereby aRrm that I am licensed under provisions of Chapter 9(commencing
DMZ with Sem]o.7000)of Di1oinn 3ofine Buxl-essand ProfilOmti Code.stud my license is RESIDENTIAL:
W O PERMIT ISSUANCE
a�� in lull limw•unJ eB'-cn�.�.. �... ^/� C51'DWL ❑KITCHEN RIiMODEL
QUU 4censc CtactI.ie.b— --N�-/-r—y—.�— APPLIANCES-RESIDENT Al, [I ADDITION ❑11I.UMBING RE]']III,
FZuI Dae Comrac —=/
FDh ARCHITECTS DECLARATION PANELS ❑MULTI-UNIT CSfRUCTURAI.
MODIFICATION
Z p m Z 1 understand an,plans shall be used as public records
OZ-� UP TO 200 AMPS E)INTERIOR [3 CHIMNEY REPAIR
F�F-Iy Licensed 11 1...mand 201-100I)AMPS IMPROVEMENT EI SWIMMING POOLS
OWNER-BUII.D]?R DECLARATION OVER list)AMPS El BA1'II REMODEURGPAIR CDEMOU PION
5 N Q I he¢by affimt that I am excmp(front the Contract License law for the
K 3 a U following mason,(Section]0315.Business and Professions Code:Any city or county SIGNS IR.1.CI'RICAL ❑OTHER
W LL ti which requires a permit m e...cum,alter,improve,demolish.or repair aov xtmcum,
p-ti0Q� prix t I alsocy the'ppli (I such pt. n fl :'g d.l tenant SPECIAL.Cl RCUIT/M ISC.
yy that) :dP-11--al( th p LIF C t' t I' . I' (Clapter9
I liOM�ME�RCIA.:
Q.Q. that he muxemptbhSection
refrom and ofDivision(sok nrth the Businessxempt on.An ovi Udc)or HEMP.M1?'TIiH OR POI.Ii INS'1'.
Q.a e IY that he is exempt therefrom and the hasiz for the alleged exemption.Any violation of [I NEW BLDG/ADDITION ❑UEMOLI'I']ON
XLHSection]031.5byanyap,lic.nt fora pemti(xubjects the-,Plica-(or a civil penalty of POWER DIiV ICES [I TENANT ❑FOOD SERVICE
Or marc than five hundred dollars(SSW). IN OVEMENT
F^Q plmnwner of Ne pmpeny,or my cntpinyccs with wages us their sale ttrmpensmion, SWIMMING POOL ELECTRIC THER
?�O lil
will dothroak.and,twOonconcOnot intendedomRmed l'or xale(S.c9(W4,It.,ine,,
3 mend Profession,Coull On,Contractor's License Law dtw,not.,Y(-an owner of OUTLI?'fS-SWITCHES-19X'TURES
property who hands or imp r.se,(hereon,and who dues Inch work himself or through NEW Rf51DENTIAL RECfR 50 FT
his own employees,provided that such impronm
vcenare not intended or offered for SQ,FT.FL(bR AREA $/SQ.IT.
.ale.If,however the building or improvement is sold within one year of comp]ction.the
wr¢rAailde,will have the harden of proving that he did out build or imitate for pur-
pmcoftalc) 'TOTAL'.
❑I,as none,of the progeny,am examively c.nuacna,with Lceawd coal...bm1.
construct the projmr(Sec.](W4.Business and Professions Ctdcq The Comrucmr's Li-
moo,Uw does not apply to an owner of progeny who builds or improves thereon.and QTY. PLUMBING PERMIT FEE
whocontracts for such projects with u s ontr-cton0lteensed pursuvntto the Conwetors
Liccmc law. PERMIT ISSUANCE
1 are exempt under Sec, ,B&P C fill this reason
ALTER-GRAIN&VENT'-WATER EA) VALUATION
Owner Date
WORKER'S COMPENSATION DECLARATION BACK FT.OW PROTECT.DEVICE
I bele#)affimt antler pewlty of ariaryone of the following deci mal...
,)Ihavc nnJ will muinluinu Ccnificalc ill Conaenunsdf inmrcfor Workcr'a Cnmpcn- DRAINS-FLOOR.RfIOF,AREA,CONDSTORIIN 'TYPE CONS'BUCTIOP
xmion.ns pnwi%d Thr by Section 3000 of the Labor Code.far the perforinonce of the
work
for which Nis pcnnil is issued. FI%TURCS-PER TRAP
C I have and will maintain Worker's Compensation Insurance,as required by Section
3]W of the labor Ae,for the ped. noeofthe work for saichdr,permit is issued. GAS-FA.SYSTEM I INC.a OUTLETS OCC.GROUP A]'N
I Workcr r )c c:nir Invrl� nr'cr nJPolicynytljlYaJjp OD/ GAS-ITA.SYSTEMOVER 4(F.A) 3�6 y/od
Carlini 'oll.y No.:{�G� /
CEKI'IYICAIEOF PXEMPT]ON FROM WORKERS' O/g GREASI%INDUSTRL WAS'N::INTERCEPTOR
COMPENSATION INSURANCE6 BUILDING DIV ISIUN PEF_ti
(Thin session it not he completed Brae prrmit is Enron.handled dollars(SIM) GREASETRAP
or I"'.) I'IARCHECK FEE
terrify that in the performance oftc hwork forwhich this permit is sister,I shall SEWER-SANITARY-STORM EA.2y)Er.
not employ any person in any-tanner so m of hernaw cab eel m the Wnrker:Coulter. ENERGY FEE
,Z saiion Lawn of California.Dae WATER HEATER WNENT/ELECTR GRADING FEE
ZO Applicant '
NCA ICE TO APPLICANT:If.after making this Cerufic:ne of Exemption,you should WATER SYS'[ TRIAL ING SOILS FEE
become subject to the Workers Compensation proviounc of the Until Codes you must
0. Q forthwith comply with xa h provisions ormi,e Permit shall be deemed revoked. WATER S17RVICE
DZ CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL('LMB. SQ.FT PNU
I hereby affirm that there i......oucuon le-ding agmey for the pedm
nan.of Date Recd,p
LLA-t the work for which this permit is issued(Sm.3097.Civ.C.) TOTAL:
0 U Lender,Name TATA L
Lenders Address :
G I amithI have reed this.,nimtion and sum that the above infoneaion is ItI111.DINC PITH
tyat
lip mrmct.I agree m comply with all city and county ordinances and sate laws renting to QTY. MECHANICAL PERMIT FEE SEISMIC FEE
7) Z building consouction,and hereby authorize representatives of this city to enter upon the
.Owe.n emioned property for inspection purposes. PERMIT ISSUANCE ELECTRIC PEE
(we)agree to save,indemnify and keep hornless the City of Cupertino agaimt
labiliticajudgmcnu,pxasandetpen,ce which may nany wry.rcmea,.in.a mid Cily ALTER OIt ADD TO MITCH. PI.UMBING FIT.
in nwquence of the granting of this{wrntit.
APPLICANT UNDERSTANDS AND WILL COMI'LY WITH At.[.NON-POINT AIR HANDLING UNIT('1010,00(1 CFM) MECHANICAL IT Z
SOURCE REGULATIONS.
AIR HANDLING UNIT OVER 10.IX0 CFM) CONSTRUCTION TAA
Signal.,,of AppEmnifContnttor Date EXHAUST HOOD(W/DUCT) I IOUSING MI'I'[CATION FET?
HAZARDOUS MAITRIALS DISCLOSURE
Will tbeapda,up,or future building umupant tram.,handle hazardous material HEATING UNIT(TO RNL000 BTU)
as defined by the Copeman Municipal Cede.Chapter 9.12.awl the Itcahh and Safety HEATING UNIT(OVER 100.00s)BTU(
Cole.Section 25532(0)'!
❑Yes El No VFN'I'ILAl]ON FAN(MNGI,E RES]D) PAID
Ilam Receipt b
Will Ne ap,la.an or fawn buildrun,mcapant ace equipment nr device which BOR.ER-COME QHP OR I WAW 11YU)
m hoarders air comanitmn,as defied by the Bay Area Ail Quality Management ('
TOTAL: 7��
L�qmi,�.Otl
i4 CNo BOILER-COMP(EVER IWJNMI BILI h
ord the hmmdousnmtrnill,requirement,under Chapter 6!)5ai he Cali AIRCONUI'IONER ISSUANCIE DATE
Safety Cede.Sections 25505,25533 and 255311 undemo ndthat ifthe NEW RISIDENTIALMECH. SQ.ot conend,has..mwnt.that it is my res,tmsihiliry to nmify hcu=at
tents which must be ten poor m inuartcc ofa Cvis"call of(kcupamy.amized agent Ilam TOTAL: ISSl11iD BY:
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: chris Lya
Sec: Twp: Rng: Sub: Blk: Lot:31641063.00
INVOICE DATE......: 01/11/2000
REFERENCE ID # ...: 00010047
SITE ADDRESS .....: 20335 NORTHGLEN SO
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: JUNG HENRY H AND MIRANDA M
ADDRESS ....... .. .:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-0519
CONTRACTOR ..... . . : GILROY, JOHN LIC # 1512B
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 Y 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 -'---. DESCRIPTIO.-
. .. ........ ........._.. ........ ........
SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB & OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
LSRN.10.2000 10:32"M INETCLERK INC IN0:697
CITY OF CUPERTINO
BUILDING PERMIT APPLICATION
10300 Torre Ave. Cupertino,Ce.95014
�. (408)777-3729
PROJECT ADDRESS:2036 NORTHOLEN SOUARB BLDG# 9UITEIAPT#
PROPERTY OWNER CONTRACTOR
OWNERS NAM& JUNG,HENRY NAME jug Wwar Human Inc.
MQUINO ADDRESB:p14SS HOLLYONC DRNE MAIUNOADDRESE: 1754 NeOorhalA»,
CITY/BTATSRIP; 048ftfa a 25014 CITY/STATOOP: Hayward Co W6"
PHOSIg A N0g.j65,1M Mx 0: ( 1 PHONE 0:010481201! FAXAI: ( )
E,MULADDRESS: BAWL ADDRESS:
BUSINESS LICENSE e: 16126
E 12LAW WORM.TO SS PERFORMED water heater replacement 40 gallon gas
BUSDWL4 31=711ICALr WB=AAW1CALt-- FLUS>HAdO:
RIDtOOF SAYARDOUSMRARU YFS, NO_ NU149&1.OFWaF Od0AOOFCOVERWGS:
TYPEOPS)MINOROOFCOVSRIa10, D PAMLOROOF COVMWQ.
NUMBU OF=57MI0 ROOF COVERII OS PD40VW 0 '
tJLOOM OF BY FMG ROOF COVEEEi05 AET^MW: D
PAOVIDfi LC$A,ISPORT NO. VALUATrfXt1:
• IMPORTANT NOTICES KOMITOAPPUCANT
APPIUC AMrS CERTIFICATION I hereby athm undrpena7lt,of PPWry ora of the fallowing doth rodonc
I CERTIFY THAT I HAVE R2AD THIS APPLICATION AND STATE THAT THE f 1 LI rears ars vel mNNaln a aanRleab dmrwM to eaWnsva brworlela'neer
ABOVE INFORMATION 19 CORRECT.I AORM THAT IF A PERMIT 1818• Wa tim a FrWded by xbon � der tabor Code.%r Ne pW nnana
SUED FOR THE DEMOLITION DESCRIED 13 THISAPPUCATION,ALL THE
PROVISIONS OF THE PERMIT AND ALL LAWS AND ORDINANCES M L Ihswand willmabvaiewomonrcompensation Insurance.araqufndbygs
THERTO WILL 8E COMPLIED WITH. don 47M of the labor Coda for dr p offer anon of the vmk ferwRish this
hie Woad. Myucriar'oanparta6nod a
on Wufarria Utd Palley Run.
MOLD HARMLESS CLAUSE.The parmRse(s)by afaaplN0/of01a Pafndl 4rraam Clarendon
since(s)lo indemnify and bald harmless the City of Oupardne from and
spinet any and 90 wims.demands ark alien for damages rem"sem po*Numbs 02KRDOOIO18
Wers5ons under Ihh panne,regardless d negligence of the City of Cupar6ne
spinatall such claim demands;oractions. et Ter muare.wtdanarasi000rw
In mrdorm'd with the orwWons of Section 3800 of rte Labor Cods of the f 10 1 afft do In the aarfamerus Mer Werk for whine this Pam*Is Issued,I
Esse of Calff"Ne,the apptaard shed hews coverage under(Q.w(10 dsslo- ahel not avair arty Pawn in any manner to as to became"ad Is wmb
noted below or shall Indicm hems 010,or(M,or M,whit suer b opplkvb)C ora'aomparisaftm Iowa of eadomrs.I tomer adunwfedge mu I urroawnd
If h wavr tsm M to cbedked Rom(M maser be chocked as wall.Mark the eat In ter 0"Whet1 shotnd lemma su4aet to the wa kaw CUMP naa60n
sitpropilats method of compliance, inrWon of the Labor Coda of Glyemla and rad to campy IhnWin with
aIffoutl bamdaanrd 0"364. M dr WmCaaa.mat eta Pena 11"r ad tm
418001"36M PPa
LICDLUD CON 11ACTORa OECLARATIOM
I nhraaeeerrMRtf"10me"aaeufindupwrasd ricenaf Iftfflimeaalt fI I Wkfepar anter(m lisunwed.ar u ms"ar Irse who
irSrrt7eooiAdrYatasrgs auarwaurr Fra6alsnaoma.ore„ygm.hhlnNl rOtv__suo wdk(arwNph eta panM4lauad.own empegacenbaner whe ewnppu
ase oh drvorkbW eompematlon Is"M estfomu endow.Inform ha own.
use"AM 9PE eeas C B an 0"," ngmsmantolary cert.v7t lflaaoompIotad eopyAmblenm wide ma Central
Pemiltawrow,
PAYMENT
ACCOUNTk $474-6331.718&6326 EkPIRATIONOAT& DEW
OREDrr CARO TYPfi MABT9R NAME ON CARIX JUST WATER HEATERS INC.
LURE: AMOUNTS.
DEC 15 1999 SE22TWATMBURY
SlgnasdApptoarsor DATE Posed kemi dpppiwea
IJRN_10_2000 10_32RM )NETCLERK INC pN0_897 P.2
7 :CUPERTINO uthnFnndNac6iterK, tnc. : a-solutions for the contracting industry Sosoo�CA eaaea
(sea)ee CLGRK
Building Permit Application
rom: NetClerk Inc. To: Building & Planning Department
CoauekNames Scot<Waterbuty, Ctty: Cupordno
Phoxe; (6SO)Q"426 Phone: (408)777-3228
Pax Number. 1-(877)846-5888 Fax Number: (408)777-3333
Permit Handling Instructions
Please Fax Permit to: 1-(877)8464688 Deliver to Job site at first inspection
I will pick permit op at the BuM4 Department In 5 days HxPbm mad to Contractor address below
Olbert pita&*email permit to: permtts(adelerk com
Contractor Information
Compa"t Just Water Heaters bre. Worker's Comp#s 021=001018
Contractors Atm:Arnold State Contractor's License N 591329 MuC-36 B
Addrwst 1764NadonalAve. Credit Card Information
Cityt Hayward,Ca.94345-1722 Credit Card Numbers 54744MI-7168.6326
Phone: $10-293-2012 Nam on Card; Jun[Water Reason Ise.
Fax: 510-783-6360 $xpitati®Date: 09=1
d: permia®jnsewmterhoswn.net Visa MasterCard X
Comments:
Authorization forms:
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