00010040 JOIA
APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY 600106#0
CITY OF CUPERTINO BUILDING-ELECTRICALtt PERMIT NO.
GUILDINGbIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL SOOOL
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: C _ - SANITARY NO. APPLICATION SUBMITTAL DATI
2 J 2-
OWNER'S NA ee PH E: ONTRACTOIS$NAME: CNG'
A N/C CONTROL#
CHITECT/ENGINEER: 11 EICNG. ADDRESS; EDfalY�
CONTACT: PHONE: s BUILDING PERMIT INFO
(I O / ❑ Consahalvt�%(d x tBcant(Initial) BLDG ELECT PLUMB MECII
2- ❑ ❑ 1�/ ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
1 hereby.Flinn that 1 em licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
Q0dz with Smtion9W0)of Division3ofthe Business and Professions Code,and my license is RESIDENTIAL:
FwS in full fmrecond IT PERMIT ISSUANCE
04 VZ U License Clan- � Lic.N A .� � � ❑SPDWL El KITCHEN REMODEL
y6W Dme Contmc��-� �— APPLIANCES-RESIDENTIAL ]ADDITION ❑PLUMBING RE-PIPE
F-7 y ARCHITECTS DECLARATION PANELS ❑MULTI-UNIT ❑STRUCTURAL
Z p m Z I understand my plans shall be used as public records MODIFICATION
O z_4 n- UP TO 200 AMPS El INTERIOR ❑CHIMNEYREPAIR
F 4l•W Licensed Professional - 201-IOIx1AMPS IMPROVEMENT
1 ❑SWIMMING POOLS
OWNER-BUILDER DECLARATION OVER 100)AMPS ❑BATH REMODEUREPAIR El DEMOLITION
I hereby,(Stan that 1 am exempt from the Contramods :Any a Law for the
C t V following meson.(Section comb,al.o net and w,.de io demolish,
Code:Any city m county SIGNS ELECTRICAL El OTHER
FO y which rcquirex n permit re convect,alter,improve,demolish,or repair an,ed structure
6, Chior t be its issuance,e,also requires the theapplic,of forthe such Contrurmit tokensle a Law(Chaptem SPECIAL CIRtS11T/MISC.
dS that be islicenseditpueuom tothe.Mmsns of the eBusiness and
Law IC Code)
I L1 q 0 that he is xempth Section gland the base,for E the aged vis and mn.A s violaede)or TEMP.METER OR POLE DIST COMMERCIAL:
4 that he is exempt therefrom and the basis for the alleged exemption.Any l penalty of ❑NEW BLDG/ADDITION ❑DEMOLITION
W`m'm
Section 7031.5 by any hundred
dollrs(S50rmit subjects the applicant to.civil penalty of POWER DEVICES ❑TENANT FOOD SERVICE
{{.....ZN not methanLf one prpe dol tars(empl. IMPROVEMENT
C a0 ❑losownensl..d pe,toor,or myemployeesintended with Bred usidei(Sec.compensation, SWIMMING POOL ELECTRIC
dd
will dothework,ando no Craitmence is Licenseed Law
dos min apply o an covin,of
❑OTHER
{fig m and arty who b Coda:TTa Contractors License Law does not apply s if owner of OUl'LEl'$-SWITCHES-FIXTURES
property who builds or improves thereon,and who does such work himself or through
his own employees,provided that such improvemcnu am not intended or offered for NEWRESIDENTIAL ELECTR SQ PI'.
Bale.If.however.the building crimptm
oveent is sold within one yernefcmmpletim the ~s, SQ.FT.FLOOR AREA $/$Q.FT.
owner-builder will have the burden of proving that he did mot build or improve far per-
pose of sole.). \.
1,as owner or the property,am exclusively contracting with licensed convectora m �'`w E:
construct the project(Sec.7044,Business and Professions Cedn)The CnnmunorI Li-
cense Law does not apply to an owner of property who builds or improves thereon,and QTY, PLUMBING PERMIT
wh000mmcu far such project with a coatmvt qs)licensed pursuant to the Contractors
License Law. PERMIT ISSUANCE
I am exempt under See. ,B&P C for Ws reason
r Date
ALTER-DRAIN&VENT-WATER(EA)
tu
ne VALUATIOf
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
1 hereby affirm under penalty of perjury one of the following declarations: a
❑Ihave and will maintainaCertifcam nfCnnsent to selGinsure for Worker's Compen- DRAINS-FLOOR,ROOF,AREA,CONE.
,.tion,as provided for by Section 37W of the Labor Cade,Rome performance of the STORIES TYPE CONSTRUCTION
work for which this permit is Israel. FIXTURES-PER TRAP
I have and will maintain Worker's Compensation Insurance,as required by Section
3700.fthe Cabn Cnde,fortheN fmanccofthe wmkfurwbich this permit n e,,ued. GAS-EA.SYSTEM-I INC.4 OUTLETS OCC.GROUP APN
My Werke' and Policy n M1k y5/ /�
Career. Tv^� A�✓e Policy yo.72 Xd1?VX GAS-EA.SYSTENUOVER4(EA) .3"111o36
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE O/S GREASFANDUSTRL WAS TE INTERCEPTOR
(This section need not Ise completed if the permit is for one hundred dollars($1 W) BUILDING DIVISION FEES
tar less) GREASE TRAP PLANCHECK FEE
Nonifythatm1wierfunnancemf Ne vomkfim.hieh Nisparnitni,sued,[,hall SEWER-SANITARY-STORM EA.200 IT..
m th
not employ any person in any manner so is to become subject e Workers'Compen- ENERGY FEE
zZ sation Laws of California.Dote WATER HfiATER WNLNT/ELECTR
Q Applicant i GRADING FEE
NOTICE TO APPLICANT:If,atter making Of,Certificate of Exemption,you should 4"WATER SYSTP.M/fREATINGi
a ' become subject m t
the Worker's Compensation previsions of the Labor Code,you mus - SOILS FEE
L1a forthwithcomplywith sucbprovimmismosi,permitshall bedeemedrevoked. WATER SERVICE:
a Qi
CONSTRUCTION LEND]NGAGENCY ""l:, NEW RESIDENTIAL PLMB. SQ.FT. PAID
Z' Ihmeby affirm Nm nstr
these lsocnuction lending agency fordo nt
he perionu'ce of Date ReceiptN
LUT, �', the work for which this permit is issued(Seo.3097,Civ.C.)
ULender's Name 'rO'TAL:
W. Lender',Address TOTAL: -
I certify that I have read this application and state that the ahmve information i, BUILDING FEE
.H-I rail cornet.I agree to comply with.11 oily and county memances and tram laws relatingm QTY. MECHANICAL PERMIT FEE
U Z building convection,and hereby iuthorim representatives of[his city to enter upon the SEISMIC FEL
above-menhoned property fee inspection purposes. I
We)agree m save,indemnity and keep hanNns the City of Cuperume,against PERMIT ISSUANCE l ELECTRIC FEE
liabilities,judgments,costs and expense,which may in any way accrue against said City ALTER ORADD TO MECH.
in asequence of the granting of this permit. - PLUMBING PLL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO I0,000 CFM) ,
SOURCE REGULATIONS. MECHANICAL FEE
AIR HANDLING UNIT(OVER 10,000 CPM) CONSTRUC'1'ION''I'AX
Signature mf ApplicanUOonwcer Data EXHAUSTHOGD(W/DUCT)
HAZARDOUS MATERIALS DISCLOSURE HOUSING MITIGATION PEE
Will the applicant or future building occupant store or handle havardous material HEATING UNIT(TO 10RXKI BTU)
as defined by the Cupertino Municipal Cade,Chapter 9.12,and the Health and Safety
Cade,Suainn 25532(a)R HEATING UNIT(OVER 100,IXIO BTU)
[-1 yes 0 N VENTILATION FAN(SINGLE RESID) PAID _
Will the applicant or future building occupant use equipment or devices which Date Receipt#
nut hazardous air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP CHIP OR 100,000 it I'Of
Disrict1 TOTAL:
DYc. [7 No BOILER-COMP(OVER Ifq,UfNI RTUj
�r
Ih.vereadthe bamalmn materials requirements under Chapter 6,95 of the Cali- AIR CONDITIONER ISSUANCE DATE,
r (omit Health&Safely Code,Section,25505,25533 and 25534.1 understand that if the NEW RESIDENTIAL MECH. SQ.FT,
building does not currently have a tenant.Nat itis my responsibility or notify the occupant
more requbemems which..it be mel prior a issuance of a Certificate of O,..j amcy.
Owner m,orthodzedupced Dam TOTAL: ISSUED BY:
OFFICE
JRN.10.2000 10:07AM NETCLERK INC NO.893 P.8
CITY OF CUPERTINO
BUILDING PERMIT APPLICATION
10300 Torre Ave. Cupertino,Ca.95014
11111 (408)777-3228
PROJECT ADDRESS:21901 Columbus Avenue BLDG# SUITE/APT p
PROPERTY OWNER CONTRACTOR
lOWNERS NAME: Habeeb,Bob NAME Just Water Heaters Inc
MAILING ADORESSG1951 Columbus Avenue MAILING ADDRESS: 1794 National Ave.
Crl"Y/BTATEMIP: Cupertino. CA 90014 CITYISTATErZIP: Hayward CA 94048.1722
PHONE*:( 40*257.2208 FAX M (_ ) PHONE Ik( 5111) 9M-2012 FAX Y: ( )
E-MAIL ADDRESS: I•MAIL ADDRESS:parmheGjualwaterhsatar8.net
Q BUSINESS LICENSES: 15120
EXPLAIN WORK TO BE PERFORMED: Water Heater Replacement 40 Gallon Gas
BU LIMING: ELECTRICAL: MECHANICAL.• PLUIMBINa
R11ROO11 HAZARDOUS FIRE ARBA: YRS NO_ NUMBER OF EOSTING ROOF COVRRAios:0 .
TYPE OF EMTING ROOF COVERING. PROPOSED ROOF COVERING:
NUMBER OF B70STING ROOF COVBRINOS REIMOVRD: 0
NUMBER OF EXISTPIO ROOF COVERINGS RETAINED: 0
PROVIDE LC,B.M REPORT NO. VALUATION: 861.00
• IMPORTANT NOTICES NOTICE TO APPLICANT
APPLICANT'S CERTIFICATION I hereby SMhm under penelty of perjury one of the following decbretiona:
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ( ) ' I haw and NPI m0aln a arti9este of moment to self4m re for workers'wrn.
ABOVE INFORMATION IS CORRECT,I AGREE THAT IF A PERMIT 13 IS. PenaObn,as Provided by Seadm 3700 of the Labor Code,for the pof Mance
SUED FOR THE DEMOLITION DESCRIED IS THIS APPLICATION.ALL THE dM c'or'k which this perms is awed.
PROVISIONS OF THE PERMIT AND ALL LAWS AND ORDINANCES (0) a I have and win dalnteln workers'mmpenwtton insurance•as required by Sus
THERTO WILL BB COMPLIED WITH, 00117700 of the Labor Code,ter the performanos of the work far which the
Pam*is Issued, My werare'ampa'Ration Insurance order end polhy num-
HOLO HARMLESS CLAUSE.The pemdtea(a)by aooaplanes of tiu pennh, bar harmless Clarendon
agreeW to Indemnify and hold haess the City of Cupertino from and Carder
against any and all claims,demands and ectletl0 for damages resulting from Pons Number 02KR000101 B
opratione under this permit,regardless of negllgenoo of the City of Cuper lno
Spinet NI such claims,demands or actions. ( ) w The acd of the work done re etoo arises.
In conformity with the provlslons of Secdon 98M of the Lobar Code of the 1 ) N I Carey that In the prborrenee of the work for which this permit Is 4swed,I
State of Catifomle,the applicant shall have coverage under(0,or(ip deslg• shall not outplay any person In am manner so as to became subject m work•
noted below or shell Indicate hems(III),or(IV),or M,whichever Is applicable. ere'Rarepensstlon low of California.I furter acknowledge that I undererone
M howawr hem M Is chocked Mem(IV)must be chackad as well.Mark the that In the award that I anould become subject to the wom eW canpen stion
appropriate mathad of compliance. I)MANlons of the Lobr Code of Calhomis end ran to comply fbAI wM with
Prewalona of Sedan 3800 of ata Leber Code,that the pemdt herein applied for
LICENSED COrRRACTORG DECLARATION shall be deemed revoked.
I haeor an dm l ante 9esmee urea ate www"of CNPWO t(octnnmMnpwM 1 ) v. I as"as the owner(er the agent for aro ownsn that In tns prrormana tithe
Section
ee 70M of DMake,3 or Pu e Budrrand Prcbedone Code,sol nq keret Is In NI foto ertl work for whM this permu h towed.I will employ a Contractor who complies
with the wmkoW compensation Jaws of ataorrlls and who,pder to the sum.
U"Me e:591829 Cuae CW B Ga, 03/31/2000 menoement of any work,cad du a wmplaaed copy or this form calm the antral
Penns Bureau.
PAYMENT
ACCOUNTS: EXPIRATION DATE:
CREDIT CARD TYPE NAME ON CARD:
&TURB: AMOUNTS:
Siorwhs,otAppeant r Apert DATE Printed Neta 61 Applicant
SAN.10.2000 10:07AM NETCLERK INC N0.893 P.7
BOO Dubuque Avenue
Ne;Clerkp Inc. : e-sOlutionS for the contracting Industry a ei a n Pran ace.CA 04000
EM
ask Building Permit Application
om: NetClerk Inc. To: Building & Planning Department
Contact Name: Scott Waterbury Cityl Cupertino
Phone: (650)624-0426 Phone: (408)777-3228
Fax Numbers 1-(877)846-5888 Fax Number: (408)777-3333
Permit Handling Instructions
Please Fax Permit to: 1{87'37846-5888Deliver to Job site at first btspecdon
I will pick permit up at the Building Department in 5 days X Please mail to Contractor address below
Others please email permit to: permits®netclork.eom
Contractor Information
Company: Just Water Heaters Inc. Worker's Comp M 02BTt0001018
Contractor: Atm:Arnold State Contractor's License N 591329 C1assC-36 8
Addreaa: 1764 National Ave. Credit Card Information
City: Hayward,Ca.94545-1722 Credit Card Number: 5474-6331.7168.6326
Phone: 510-293-2012 Name on Card: Just Wata Heaters Inc.
Faxl 510.783.6360 Expiration Date: 09/02
permits@Justwataheatus.net Visa El MasterCard X
Comments:
Authorization forms:
Credit Card Autheti=ationPenn •AgantArnhortratlon=8yompledngand returning the Informationbelow.
you authorlra NetClark Inc to as assn agent on your behalffor the owpose
d wbmltdrg i7ermlcepp0eatlurrc
oe 6a�aa J r WArea ai as I.0
To When hAlaytancgne
Fee
Let f senerautho*eNvOrkineandhrempbyeasmd
sum auMOO*dauodaasfoaaasanagmnanourbehalf-sWkV(marry
anda06uly/nppemtlnendacenrea iiredbj1pyourcompny,
eamrcre av '8neu ire: "
Printed
• &W�s'ase.t�vsxeCh,ae>.�Lmaoomaf�Db)daae>meeaeL rdW cad. s5;S,1'hrM'
�mds�ae0ak sdparmemaeed aaayyope.Aaaaeer Cwrtan% ft±907041
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• tarn
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: chrietya
Sec: Twp: Rng: Sub: Elk: Lot:35614036.00
INVOICE DATE...... : 01/11/2000
REFERENCE ID N ... : 00010040
SITE ADDRESS ..... : 21951 COLUMBUS AV
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: RABEEB ROBERT A AND JEWEL E
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4714
CONTRACTOR .......: GILROY, JOHN LIC % 15128
COMPANY ..........: JUST WATER HEATERS INC
ADDRESS ..........: 1764 NATIONAL AVE
CITY/STATE/ZIP ...: HAYWARD, CA 94545
TELEPHONE ........: (510)293-9901
FEE DESCRIPTION CHR 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
vieID DESCRIPTION---a--.-. VOICE ID --.---. DESCRIPTION
ie.. ...... ...... ........ ...............
106 SEWER 6 WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB 6 OR SHOWER
502 FINAL PLUDB3ING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•