00110021 CIn IL0[nNCiIVISIONNOPERMIT CONTRACTOR INFORMATION: ! .
`
BUIWING pllk)W:S.s� WONDERLICK DRIVE WATER HEATERS 'ONLY PERMITNL110 J.1,0 z--,i
Oill NAML': APPLICAT4I: SUB T
GEORGE_ GOEDEI_ _ 500 AIRPORT BLV
`HONE: SANITARY NO. CONTROL NO.
(415) 44-3747
M deO AtcHi PECVIINGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
y z f=1
Z LICENSED CONTRACTOR'S DECLARATION
0 Z=C I hereby altimr mat 1 oto licensed order pmvi,,imm of Chapter 9(cmmowneing Job Description
_t y withSmtion](NXOnI'Di ,mil3offlicBminessandPufessiolmCodc,anJmylicense
a 's m fun force and elan.
aoMa LicentIClas Lie.g REPLACE 40 GAL GAS WATER HEATER
O n U Date Cantrucmr
m 3 , ARC'THTECr'S DECLARATION
C a I understand any plans shall be used as Public reexrd.t
z �Z
i p Lrmnmd I'mfessional
x OWNBm exempt1ifron the Contractor's
w_�, 1 hereby affirm that 1 1. exempt from the Comm,Otte:
e:An m Low for the
zS
following uiresapermittcoILA It.alter. and Pmfes.iunt Cole:Anycity structure
f s❑
which requires a permit m consrrvci,cher,innprove.Acmolish,m repair any swaurc
asees
x3°9 prior it)in issuance,also requires thcapplicmR for such permit o file a signed statement
man he itLia, Chapner9 Sq. FL Floor Area Valuation
(commencing with Seenion 7gM1)d Division 7 of the)fastness dmf Professions Cute)
or mat he is esempr therefrom amt the basis for the alleged esempnio I.Any violotim
of Senior 7031.5 by any applicant for a pcnnit suhjeas the upplicarlm.civil penalty
ofnotmnrcmanr.ehandreddmmr,(t5w). APN Number Occup n'cy pe
111.m'owner of the papery,or my nnployeex with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7DW, 67722007.
Business and Professions Cole:The Contractor's License law dtws not upply m an egnlred IllspeClTOn$
owner of property Who holes or improves ancon,land who doss. u h work himself
othrough his awn employees,provided I)ea,such inrpmvements Me not intended M
mlim d for sale.If.haxevea me hadding or improvement istold within one year of 502' — FINAL PLUMB T.NG ENERGY
completion,the owner-builM:r will have the burden of proving th5i he did not build or 50S -' GAS TEST
fur purpose of salt).
13 1.as owner of the Insipidly,am cxclueivcly contracting with licensed CMIFMCL,rs to 507 — FINAL PLUMBING
consumer the project(Sec.7(14,1,Business and Professions Cule:t The Comrae or's
License Law does not apply to an owner of property rho builds or improves thereon,
and who contracts fur such projw%with u connotations)licensed pumuant to the
Count License law.
❑1 am exempt under Sec. ,11&P C satin,reason
Owner [)am
WORKER'S COMPENSATION DECLARA9'ION
I hcrehy affirm under penalty of perjury one of the following declarations:
I I hove and will nmlmain i Cenilicwe of Consent to self-insure fur Worker's -
ompenmrion, las pnrvidnl for by Section 37f10 0l' tin Labor Code. Inc the
pertmmMwc of the work for which this permit is issued, -
❑1 have and will location Worker's Compensator Insurance.ns required by Section
3700 of the Lohnr Cn I,for the perfnnnmme W the work for which this permit Is ,
issued.My Worker's Cmnperomion insurance currier and policy ournlm on:
Came, Policy It - -
CERTII9CATI0N OF HX17MM ION FROM WORKERS'
CUMPENSAI[ON INSURANCE
(This.cairn,iecd nm be nnn.Pleted It the Permit is lis,one hundred dollars
(S 1 d0)rr lens) -
1 csnify that in the serfurouln in of in, ,,,it ran which this pcnnit is issued,I '
shall not employ tiny perznn all any manner wi as to beaomo supiu9 to the Workucs' -
CompensmumList,I,f C.11donu..On,
NOT.n,-,ss CE TO It ,,the
AN Wor ,1 r,ullenoutlng this Ccoti.icma of B,d,or o d you should
bechwith c tem to me Workers Gini,,ertion pint's melt bed lsdMr Cale,yon roan
Q z fnnhwhlt rnmply with such Pmvisiuns orilnis penult cion))he rleameU revoked. -
CONS rRI,a LBNUING AGIaNGV
a cre
hhy affirm dmre is oi thenmsm®tionleading97.C agency for the perfornnnnce -
Ga:
of Leader',
work for which mis permit is insneJ fSec.7119],Civ.C.) -
Lerl,,'s N:dre
z Lenders AJAress. � z
V 0 I certify that 1 huvc read oris npplicmion.,,it utile mar the eNum information is
�+ to Correct.I agree m comply with xll city and county ordimmecs mW stain law.,minting -
0 V m buildmtm
gcomction,and hereby unionizere
opresentativesol'this city to anter upon
} W the all wartiuoned property for in.tpecalon purposes.
Er A. (We)time in ave,inllonadynmd keep harmless the City of Cupeninn igahnM _
Gr CO) Iiuhilities,judgments,costs and espentes which may m any wady oecme.,oust said
t..1 City in nmsegneacc of the immingnfmns pcnnit.
SOURCE TUNDEISTANDSANDWILLCOMPLY WITH ALI,NON-POINT Issued by: Date
signature of Applicann/Contmct Il:nc Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant nr failure Wilding occupant unemor hawle hlu=hwx material Type of Roof
as defined by the Caperton Municipal Crates Chapter 9.12,and the Health and Safety '
Crile,Section 25532(x)1
11 ye, ON. All roofs shall be inspected prior to any roofing material being installed.
Will nheapplicamorforum building ascapantuse equipment ordevices wHIM Ifid,roof is installed without first obtaining an inspection, 1 agree to remove
u h t,nMdm.t air enmmormanrsas defined by the Buy Area Air Quality ManagementI.met. all new materials for inspection. Applicant understands and will comply with
0YP, 0Noall non-point source regulations.SIM
.
I have read the hazardous materials requirements under Chapter 6,95 of the ,
Cali6mia Health&Snfny Cole,Seaiom 25505.25513 unit 23534.1 under.ranJ that '
if rhe building mwt not currently have a mi a t.that it is my m"nsihildy m notify the
accupam of the requirements which mmn be met prior m i sta of u CeniEcmc of
Omatem" Signature of Applicant Date
ownermiudlinzed ,eat Tom All roof coverings to be Class "B"or better
OFFICE
•MOV. 1.2000 4:3epm NETCLERK INC N0.9e4 P.1
r TO:EPERMITS
720 Dubuque Ave., South San Francisco, Ca. 94080 Permit
• ,'( ;�,pt';'',; Im :4.l �; ";�I;t ;i;' Government Services; 888-330-1777 Application
Fax: 877-846-5888
oo 00a
Email
To;Cupertlno Permit Handling Instructions
Building Mail
City Hail 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.0200 Worker's Comp: 1516265 Exp. 04/20/2001
City: GRASS VALLEY State Contractor's License:374573 Exp. 05/31/2001
State/ZIP: CA 95945 Exp.
• Phone: 5302743001203 Exp.
Fax: Business License M 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:
Notea
Pre-reg: YES Attachments:
Payment:VISA WC❑✓ SCL❑✓ SASE❑✓ AA ❑✓
Agent Authorization:YES Permit Type:
ORG❑ NOTE] FV.❑ Permit ID: 64178
Project Address:10880 WONDERLICK DRIVE
Comments:
•
-NOV. 1.2000 4:38PM NETCLERK INC NO.984 P.2
' CITY Or CUT IMTIN'O coNTRACTOR
SVU[,DING DMSION INrOIIMIATION1
DiJD-DINiG ADDRIJSS: ppR\.fIT NO:
• 10880 WONDERLICK DRIVE WATER HEATERS ONLY, INC.
O W Ovs NAML: APPLICATION SIID DATSI
g GEORGE GOEDEL 970 E. MAIN 5T.#200
r PHOND: SANITARY NO. CONTROL NO.
e 6 408/253-5574 GRASS VALLEY 95945
ACPM'I=4!NCiUSi : I=EIrNO P8RrvarT'INDO.
5302743001203 Tdlnc ITLecr. PLVMa Ndacfl
S y ucLNb'EDCOMRAGRaR'uUPL TION
3 1 hanby e®,re Out I w Ilene under amid", of Cloapar 0 (mmmeao'mp Job Doamipdon
e � wish Session 70W) of Dlublon 3 at me Dui.. W Papvdms Coda W y )uveas
e Y h m mu romagyp r REPLACE 40 GAL GAS WATER HEATER
SonLimmae Chun EW Lin.d 374573
gDart; 11/01/2000 enaaa,mr
nftcfnreclsDECl.°RATION
O
L.
y plana mall an sed M public nmrA
: aJ� 1. ' r1U,dY1WNl
OWNER-RaDLDER DRCLAMTION
i ❑ I bMaby afmm Pm I Mm M.,ndr Atom aq conuMwrs 'Arara. 4e Our Ib. Sq,FL Floor Aron val"liOD
1 611wna MOM 19ocelon 7031.!, 11.1. and P,otbv.iom Cada Am tib a Manny 700.00
pl xddah dgn:U . Ward w wmlNmh Mkt, mrprexq mm°6-.h, or M ie Air imawN
DOW u he Isere=also nguim W a"amt Oce Audi perch M Ok.dp;d. APIN Numb�ej 1�/1L. /f /� Occupancy type
lathe Is untnow normo,ears pmMapm efm.Cmtraclw'.Ii,xma Ur(LMptn 9(MmroaMl.g LS A I-I '/.�a(P
ukh SesOm 7000)of Di�Nien J Of um eudb,eP end hokmm Cods)er Ibis M b MPopl ThCNeam dI Y f V
^' rear dx bare ar Iha dbpd mampam Aro xibladan of Bmpe 7¢11.1 by my spp0om fon e
offit Mbjw ave glpuren M now pPely of not mora than five Wand;dahom(sim).
n1/eats,Moa.m°fmunXO MI.w aryndM elvess,rcd W w�(seo'laMab 0 01 do Requited ItuPwuam
eal
Calc The Canaoegrl Lkenua law ft.ms.ppy aa An Donne arpmany who bnnm as l;opmu.,
Proem,And An done nein",it Ithwelf N PM11,he.a"pI"yn.,provided Pal oath
unportaewha nM Mede amfh;M an new l(hpw.ro,,Dar bukleg or InWmurnmt b add N,ph
Don hear of rmrylatim the p-am lft whi We on,bmdw of rovig disk M did net Wild
1mpmuc for putpwe of Ws}
u I, ar oenP of me". am eedminky mnamun, Ash Ik.w waUaeWN M
counter du levied (Sea 7014, DaneveM and PMOUlmn Godes) TM CanMmw'1
[ionise Uw doe rot mpN 'a m Duret, of papeity An bui or IW" durmq
am wro m"u.m Ort Pmh praiero with a Wntrat,oe(a) uaeMed pmsunt 1. the
Cmu,ewrY uwMt LOtu
Q Imna®pk mdM See, DdPC fm ael,Wab
(invent Oto
WORRLR'S COMENSATION DECLAMATION
• I booby affitin enOd penalty of pfryry me of is nsuov,h t stdOwasw
❑ 1 ba'. and -NI Maintain a CeAm Ce
ldceof nsus re MY-n.ua fM worker
CareMougum, N ,.,Eared our ban Semi 37M or at Lbor Code, 0m Pa
dban"ao of P,-ark for Aid,kilt paron t i,inuMd
1 hove and will mann. wma.), CbmpmWpn hmmrrm "srenpMd by swim
of the Lobes Coda, me raaM Pe p norOr to "an rapwhies me parents is
bound.My Winker.Cbmaan1dien]auMMI caRIM and POhoy ma bor Man
CnMIP STATE FUND par yw.;1516265
CERTURCADON OP D%B1dPDONAMOM WOAI mill'
COMPWI ATION INSUPANCR
(Ihh Baum AW car be en"pMad N de pemit i.Ion wa bpa0ted doilan(UN)or Inm)
I mne, Pda is IM mommenM or A.work fpr whirs thin putt,it IDoed, I
a]al ne w'Pby any Pena" on W mamar w e M breamn object An m Woryar'.
Compemnnm Lava of CNllbinl,.
D,1a11/01/2000 Aw
N=CE TO APPL1CANn it, After tutu, Pb Certain, of rxzwrlon, fan dmuld
hatlRl mbjet in P° Wbdm', COnamennM PM6Mma of on, labor Coda, you own
Ib".01,mnply a.hb m.b provision.nr Oda perm¢shall be d.taradesselO d.
PC CONSTRUCTION LENDING AGENCY
t haahy staren&I uses, N.muamim bdng .pmw Da Pc atfonwWa
ofrMuvh Ox a61�Pp Amir b ieued LSM.30W.pµGJ
u
e Lnh .Nm
I«nlfy it.1 coxa nW ll ,pplidum van Nat urea the.bow nam rda
b
an son. 1 +8uo q mnhN x1m all airy rear Wendy onsmmM AN RPo pus rtpd;rg
q pxift, eunuch, and bvdT mPedM 'Manmhe, of Ai. ay q ave open
the.bo•amausivmd dmpaAy(or hapadm pupae.
(We) Mine q ens iadmnify.nor keep hamla s use City oI CuPad!0 09d P
thibililiu, jpd "mv, score roar upMSM shish np)' in try, any .noise .peat eh
Gq I"mMmuwu of Me gendn0 of Ebb penin
nPPLICAM VA-'--"—'-9 WLLL COLOrLY nRT1f AIS NON-POINT 60VROg
RDcv ATIDxsr_ 11/01/2000 RPNof1
SlpPtumarAopliewl,Can. Dean Type ofRmf
' IfnZAMDOVSMATg(uAISDISCLD9UDE
Will rhs spittoons,or furan building Moupn,Won or hudh mainland Maelld
e ddurd by aM Glpndrn Mori I Cade GOO M R1L end the NMIP end Sehy Ali rpo6,hall be i without
pilot ro any mAn u materialtion,being lna Mort.
wk Saadm23!32(a)r YMff Noll all new iahrahlled wftboutfint obtaining minepaeida Ind Will amply
all new mnmNdle fm lmpectioa ADMlimnt undoeeMvde and well comply vrikh
MMI[ du yrpliem eP Om¢v bmlGvm OWpm are -M;-MW or dwiee rtueh dl a 601111!Duce"julAtionp.
ands hmmlou, tie WIWI a ear by Day AmM Nr Onlhy Manogmmk ,/°�, „ 11/01/2000
DicaicD YUP No�" �x^^'7
y IMW Mad m. valviep tMuiemrvw redo Chepsar 0.93 of Oo
• Ca]ifnueM Nonat 13mhy Cron Smema 15505, 25513 1/d Y111, I mam'nd Mur
U du Ym'IF-- M,ua a Rront Jp 11 As my aap®biliy 1° nelify Pt 91s11611rc Of Applimal Dant
Mmpm( a ^b must be ,ret the to undue of. Generous of All natfawarrapb to be Claba'S"arbco r
Data, 1110112000
Owa—er urbddzwn en No OPFICE
CITY OF CUPERTINO
• 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: nancyc
COPY # 3
Sec: Twp: Rng: Sub: Blk: Loe:37522007.00
DATE ISSUED. . . . . . . : 11/03/2000
RECEIPT #. . . . . . . . . : 13919
REFERENCE IO # . . . : 00110021
SITE ADDRESS .....: 10880 WONDERLICK DRIVE
SUBDIVISION .. . . . . .
CITY . ..... . . . . . . . : CUPERTINO
IMPACT AREA ..... .:
4
OWNER .. . . . . . .....: GEORGE GOEDEL
ADDRESS . . . . . . . ...:
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
RECEIVED FROM ....: MAIL-IN
i 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 BAL
---------- ------------- ---- ----- ---------- ---------- ----------
BPWHEATER PER HEATER 1.00 9.99 0.00 9.99 0.00
IPPERMITPEE 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 45.51 VISA
TOTAL RECEIPT 45.51
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ ......:-------------
. ..... ........ ...............:............
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
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