00110022 CITY OF CUPERTINO
BUILDING.DIVISION PERMIT CONTRACTOR INFORMATION:
BUIUDING ADDRESS: PERMIT NO
22225 VIA CAMINO CT WATER HEATERS ONLY 0011002.2
OWNER'S NAME: APPLICAII ION STIR DATE
CIVELLO JOSEPH L AND MARID.MARSV 500 AIRPORT BLV J1/03/2000
'HONE - SANITARY NO. CON I SOL NO.
(415)349-3747
.9 o ARCHITECTIENGIN ER: - _ BUILDING PERMIT INFO
z w C
BLDG ELfCf PLUMB MECH
za°i 1.I L=1 1�1 LI
2 y 3 LICENSED CONTRACTOR'S DECLARATION s
I hereby arfirm hit I am licensed under prnvisinnv of Clmaw 9(commencing Job Description
to(tiw with Section 7000)of Division 3 of the Bushes,and Profession.Cove.andmy license
am�', is in full force and effect,
C foil Lwemc Class Lic.p '
°" Date — Contractor REPLACE 50 GAL WATER HEATER
3 wF- ARCHITECT'S DECLARATION
so 1 undentand my plans shall M used as public retards '
W
p o
licensed Pmlcssinnul
Oat I am exempt
from
DECLARATION
u� I hereby.(lien Shed 1 1, exempt tram the Comment's License Law Inr the
�<
whichlollmse
a anniaoto of LA R,aiter,imp Professions Ca de:Mycity surcmy
F❑ which it,rut npermit mea...the ulmgimprove;demolish,teare.repair signed
strucmro
e3m Onnnitsiensedp,o,ton,wife
the applicant for wcnperminoliesLaw staleinem
Own thein licensed pnr.mmmt00)of ONi,o of the the Business and
law(Cbapter9 S FL Floor Area
(commencing witht therefrom and tebason3of the Business and Professions Code) f1' YaIUIIIOn
or that he is exempt therefrom and the basis for the alleged exemption.Any violation
of Sect ion 73315 by any applicant for a from,subjects
ts thme applicant to a civil penally
nrnot marethan five hundred emlanlssan. APN Number occupzhldpc
C 1,as owner of pmpcny,o my employee.wiihw...... her,title wonfro.mimS,
will do the work,and the.wewre i,not intended or offered fear.ale(sec,7044. 3264F,017 A -
Business and professionals Code:The Contractor's License Law does napply to an °lkequired Inspections
owner of property 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 sale.If,however,the building or improvement is sold within one year of S02 — FINAL PLUMPING ENERGY
completion,the owner Wilder will hove the burden of proving that he did not)wild or
mprove for pupose at sale.). 1. 505 — GAS TEST
L
° a,owrwofthe polkn woc.clusiaelye°nuracrtgwimlicensed contractors to 507 — FINAL PLUMBING
°onsoa,,the project(See.7044.Business and PmRs.ion.Cede:)The Comment's
License Law doeno
s t apply ,,an owner of property who builds or improves hereon,
and who minacts for ranch projects with a eonm4cmr(s)licensed punuam to he
Contractors License law,
C I am exempt under Sec. R k P C for this reason "
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penally of perjury one of the following declarations:
S I have and will maintain a Certificate of Coosa to set-inc for Worker's
ompensalmic as provided for by Section 370 of the Wbor Code, I'or the
performance of the work for which this pemtit is issued,
111 have and will maintain Workers Compensation Insurance,as required by Section
370 of the Labor Code.for the performance of the work for which this permit Is
issued.My Workers Compensation Insurance carrier and Policy number arc:
Carrie, Policy No,:
CERTIFICATION OF EXEMPT ION FROM WORKERS'
COMPENSATION.INSURANCB
flhis section need not be eomplewd if She permit is for one hundred dollars
(51Off or less.)_
1 certify,that in the pedmmance of ane work for which this Permit is i...ed,I
shall raw employ any premed in any manner.o as a tecome auhject ,the Workers
Compensation Laws of California,Dam
Applicant
NOTICE TO APPLICANT:If,.flat nuking this Cenificale of Exemption,you.heard
Q 0 becomasuhject l9 the Workers Compensation provisions of the Lento Cude,you past
forthwith romply:with such previsions or this permit shall M deemed worked.
CONSTRUCTION LENDING AGENCY
' 1 hereby affirm tMt there is a canmmenion lending agency far the perfcarnmee
of the work for which this permit is issues)(Sec.307,Civ.C.)
0. Q Ixnder's Name
.7 Z Lender's Address
V I certify that I have read this application and same Shat the ehave iwornevion is
O [� comet.I agree to comply with all city and county ordinances and sole laws relating
C.) tobuilding commucdon,and hereby auffambe repro.enaaaivespflhis city aoenicrupon
} the above-mentioned property for inspection purptsses, .
f. Q„ (We)agree to save,indemnify and keep harmless the City of Cupertino against
(O liabilities,judgments,casts and expenses which may in any way accrue against said
U Z City in consequence of the graining of his permit.
SAPPLICANET OURCE
AND WILL COMPLY WITH ALL NON-POINT
CEREGUSIssued by: Date
Signature of Appltcw
outd7wmor Dale Re-roofs
HA7ARIbUS MATERIALS DISCLOSURE
Will the applicant ler future Wilding aecupena.tare or handle heardous rtuyedal Type of Roof
as defined by he Cupertino Municipal Code,Chapter 9.12,cad he Health and safety
Cale.Section 25532(a)7
❑Ye. '°rva All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment ler devices which If a roof is installed without first obtainingan inspection, 1 agree to remove
emit baarlous air communomr as defined by the Bay Area Aar Quality Management p g
Discount all new materials for inspection. Applicant understands and will comply with
° 0N all non-point source regulations.
I have read the h tardnus materials requirements under Chapter fi 95 of the
California Health&Safety Code,Sections 25535.25533 and 25534.1 understood that
if the building does not comedy have a tenant,that is is my responsibility leo notify the
necupana of the requirements which must W mea prior to issuance of a Certificate of
Own.Pat Signature of Applicant Date
Owner tr cut mmaed egact Daae All roof coverings.to be Class`B"or better
OFFICE
'NOV. 1.2000 4:5OPM NETCLERK INC. NO.652 P.1
TO:EPERMITS
720 Dubuque Ave., South San Francisco, Ca, 94080 Permit
Government Services; 888-330-1777 ppltCation
Fax: 877-846-5888 A
"_'CdFq'tl�t.l.'PIC, '11i�...�Ww•.r:.c.d
Emafl
To:Cupertino Permit Handling Instructions
Building Mail
City Hall 10300 Torre Ave The city will mail the approved permit to contractor.
Cupertino
CA 95014
4087773333
Contractor Information
Company:WATER HEATERS ONLY. INC. Worker's Comp Carrier. STATE FUND
Address: 970 E. MAIN ST.#200 Workers Comp: 1516265 Exp. 04/30/2000 02::
City: GRASS VALLEY State Contractor's License: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: 4678037179990 Visa:
Expiration Date: 1 /2001 Mastercard:
Card Holder Name:John P McGee Other. ❑
I N o t e s
Pre-reg: YES Attachments:
Payment:VISA WC❑✓ SCL ✓❑ BASER] AA❑✓
Agent Authorization:YES Permit Type:
ORG❑ NOT❑ FV.❑ PermltIO: 641x4
Project Address:22225 VIA CAMINO COURT
Comments:
•
' NOV. 1.2000 4:SOPM NETCLERK INC. NO.652 P.2
CITY OF CUPERTINO CONTRACTOR
DDD.DINO I9 ION INFORMATION[
HULOAINO ADDrb6561 PID:UvRT NO:
22225 VIA CAMINO COURT WATER HEATERS ONLY, INC.
OWNPla'S Na - APPLICATION SM DATH:
j g JOE CIVELLO 970 E. MAIN ST.#200
PHONE: SANITARY NO. CONTROL NO.
H
�6 408/730-0214 GRASS VALLEY 95945
Al-I{rTIL'DHCICINLmQt DLQDINO PIIIta.Iff Egli
5302743001203 1r.>�H
2 I21sA�caNne mudgr owmace .1
O as I haehy-ion dont 1 em Samuel .clot p e yowl or(raped 9 (rm y snot lab lkie11p1100
' it I.Eellm '!0001 a OMrM 2 of Te O,uhva mm PmRvMm f2dq W my humor
D tin allraaId�d[ea REPLACE 50 GAL WATER HEATER
n GcaaeClmC:-:Sti Gmd374573
peel 11/01/2000
� O nRCBsrECf9pRCLARAnOg
qr �YPl.ns ehdlb.dupvhlb naatlw
"emeu mmeanom
ya OWNER-DVILpBpom Me OmION
R� ❑ 1 meeby M. tY I am mmol from t. Conlmelar+ Gems Lew he Tt Sy.Pt.Plnor Aron Valuation
HrmdwTM mama, (S.h 7o21a, wL l ole Pea, de cave. Any guy m ee. 700.00
wbmh mqukm . pemN tv aealmµ Ylee, impfa, de.11eh, Or repo![ °% meta.
s. were m b Iry 4•Im raviwe Me oPpii.re eudl plait a file a+µneo mentionaN Number ^{-, 1 OOCupOmy'ZypO
Men he e Ikmeed puW,al to to mil aoig-fdp CO..Lice.Lw(ehapm 0(m.mdllt pLrp O'J"W I
wit Sedco 7000)ofDivbim 5 of pix Bmbmor and FOOMMM Cube a due h.le eumpl tvedmn
and me We M to elleliel wa pdm Any ylorlfou triennium 71*15 by my olplieenr my a
p�dl nuysY We o011wv W e YWI penny of our meta ohm Bye handead dollen(5500),
L( L ee orr.r of Mo pasts,a my emeym Nm uepe+m doer nb wmpem+lim w1L do Requlrod Inerpadmis
we wort,led foe.mol.it out intadd a.[fared rot smlo(&o Na,Rmmm W Pnfoerm
coda The corema 'e Irma raw one nor reply to m w aremmgy who Wildo a 1""
Ihavw,and who door well work dmldt tar climate M urn evgleym,provided our Nee
(nN+owe.lm•W urmdd.Rad fa W IC h,,nce.tt Wilding a Mpmvem.w b sued wild.
new be.or cam.kliaA we ower-Wl df will haw in betelnt of a.am9 Ma be did as build
Imp..for pmpuu of nb.).
DL of enact of properly, +m eaYveivdy avmarmg wiM ligand dem.ree191rm
aum d• pul (Sly, 7014, Babul and Nofteslon Cads) Tee Gagmcdt
licar.a Lou, Mea'no, apply to out owns, Of property cob bruMe Or imetaa Ovine,
and who .mama for sour procto wit o eamreaa(l) Fa.d puesvanl to b
Oubteot't Come Law
❑ I.neoptudot5. RbPGm harm...
Owner Out
WORHBR'S CODOVIN"TIONDECUe 10N
• I e.mby X.mdm enmity Of ei me of foe bllavmg derLatimsl
❑ 1 Inve um wYl mvma,m . cmifieme of Concur to aitoeme, tar works'
Cmlp.mtY-fur a pmlded far by Sdodm 1700 of to Labor Gerin to T-
�mMomo.d it tr-dr gamete
vela T1s eget[compel lied
loll Imw vel wiS .Mono R'edal rofIWe* I vq�d by Sm'm
broad.
of to Lebo[ Cady hr d. erfem+nw ra 0e my mbartyr orm dela pv.dl 'v
met eq'Wmkgh Gmanndan Ilwmo.carrier and 9oloy vvmhv w:
GetimSTATE FUND pgtayxm1516265
CDRM=1011 OF DXBMPTrON FROM WOMM'
WorPENSAMN MSLII W
(this ucdm.ved am b+namplpd Ir foo gunnels M me hmdgd dYlm(5100)at leu,)
I wady Ilett to be netlmeney of to work foe whit four parol%Y lined,1
Ywll .t .ploy any pore. in em vmmma w n or beget. aublee m M Wodm's
(:ompe.don Law of W Trow..
prfo11/Ol/2000 APPllmn�
w[TER TD ArpLicmr: II; -der wounp mie cadreYe nr m.eabaa you Funald
been. Wynn m Me Dred. LNmmenr-im ..Mate of 1M Luba Gds, you men
raMwit eemplY'wifo+Ydh pmvlaiom m for pemdl•doll W deemed gyuY
p CONSTRBCTION LENDING AGENCY
Ie.by +ffoae it v woaedm lading energy,fa tet pmfamena
Fw, ef0uwak In which fiwMet tvr
W.Permit b idnd lift+097,Civ.C.)
[B Ladds Neu
u
S L.dds AMgO
1 away Met 1 baro god ext uggleWm and tam tot Me abay.mretaalon
& to— 1 ". b mopy Mid, YI city w array groin. ®d male lam rYaim,
it building -amWGia1 ad fuggy Mounted wimemi nee or we Cy U cllm' Year
Ole tberom.dond peopmY foe inspection purpam.
(We)+L+to tone, Indemnity and keep bud.dv Gy of apmlpo,peal
bb0ula, IdPam, vele und .ep. Writs may In sty eMY gena -trout uid
ay o oXrrr W-of ore pearl..D del•permit
nPdGCnNl'(19^�^/^�'-""��"•'T1 WILL Dph@LY lYTrei ALL NONPOMT SOURGu
REOOLATIONS" 4A-y� 11/0112000 _ R&yi
Sipame nfAppliam/ DnTnIID011SMATaRUlAu18CL06ORR ThmefRoof
Will Te.Poling,Or fm.W Ydimn avant spew 0,b-&Imwdme wneird All pooh iltil be inspected Prior on uq noBpR mprfiel bdmg featllM
de0oel by ds Oupe eme rohO ipd Cade,�a 6.12, NO TO 11WS and SN'vy
Cade,SneIm255I2(.)i YaWe If a goof is IatYled without fixes obtaining out mspmdOq I Ogrtc m remove
all new,mem la.1e flet f ripxllao.Appliounl undatands Med will comply with
WN N appSem of fume back, eetuya . gWpm.r m union whish -d p m.0iol sotto.Lmletiola,
tab homeland W anemhwnv ��n d Dee Aar+ Nr quuhy Mm-Peet!
Ilinke? r,l x�� 11/01/2000
I lave mad he by mowiNs rmulnmmv mdm Chryla 0.95 or to
• O Moody HaNh A Softy Code, Stud. 25505, 255A rd WX I uhdook d doer
It out baur-• •'--•' •-••"'• btrw .am+m dm b e my amooloifity a notify Te BigmRa9 at Appliant Due
fdaaY 0�h mei be mon only n omen. or. Owafroa Of AllrOMtrwelipgs tpbeCl+wwR"erhether
Dampee 11/01/2000
Oar—aoutarmrde ant Dole OFF=
CITY OF CUPERTINO
• 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: nancyc
COPY 4 3
Sec: Twp: Rng: Sub: Blk: Lot:32646017.00
DATE ISSUED.. ... . . : 11/03/2000
RECEIPT q.........: 13920
REFERENCE ID # ...: 00110022
SITE ADDRESS . ....: 22225 VIA CAMINO CT
SUBDIVISION . . . . .. .
CITY ... . . . . . . . . . .: CUPERTINO
IMPACT AREA . . . . . . .
OWNER .... . . . . . . . . : CIVELLO JOSEPH L AND MARIA V
ADDRESS ........ . .:
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-1031
RECEIVED FROM . .. . : MAIL-IN '
CONTRACTOR . . . . . . . : MCGEE, PAT LIC # 18986
COMPANY . . .. . . . . . . : WATER HEATERS ONLY
ADDRESS ........ . .: 500 AIRPORT BLV
CITY/STATE/ZIP ...: BURLINGAME, CA 94010
TELEPHONE ........: (415)349-3747
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL
---------- ---------- ---------- ----------
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
PERMIT : 45.51 0.00 45.51 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER
- ._____OTHER 45.51 VISA
"-svvv
TOTAL RECEIPT 45 .51
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ ............................ ........ ............................
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•