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10100015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21267 STEVENS CREEK BLVD STE 310 CCN TRACTOR:JUST WATER HEATERS PERMIT NO: 10100015 OWNER'S NAME: HOBES RESTAURANT 3400 INVESTMENT BLVD DATE ISSUED: 10/01/2010 JNER'S PHONE: 4082556010 HAY WARD,CA 94545 PHONE NO:(510)293-9901 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL n / (I IN'',TALL(2)TANKLESS WATER HEATERS License Class (� 7� Lic.# S r 1 3�9 Contractor V- q"� to I I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the Valuation:$6756 performance of the work for which this permit is issued. Sq. t Floor Area: I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which t is APP I Number:32627035.310 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, yy� costs,and expenses which may accrue against said City in consequence of the Issued by: Date: Kms— l G granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. __- RE-ROOFS: Signature Date 10 ZI© All roofs shall be inspected prior to any roofing material being installed.If a roof is insl ailed without first obtaining an inspection,I agree to remove all new materials for inspection. L] OWNER-BUILDER DECLARATION Date: Sig nature of Applicant: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) HAZARDOUS MATERIALS DISCLOSURE I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three ms intain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's ms terial. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. wi,I maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by M!Health&Safety Code, ns 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this O,vner or authorized ager' Date: permit is issued. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must I t ereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)Lender's Name APPLICANT CERTIFICATION L!nder's Address I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION mnify and keep harmless the City of Cupertino against liabilities,judgments, s,and expenses which may accrue against said City in consequence of the I mderstand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: I E ATE: REVIEWED BY: APN: BP#: *VALUATION: $6,756 *PERMIT TYPE: Minor BuildinPL LAN Permit AN CHECK TYPE: Water Heater PRIMARY 7<>/ ;. PENTAMATION PCWHEATR USE: Commercial Buildings PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY BP FEES Water Heater/Vent Unit Fee: 1 PCWHEATR 2 $50 _T l Plumb.P.:rmit Fee: 1PPERMIT inVI .00 NOTE: Theseees are based on the relimina in ormation avails sble and are onlyan estimate. Contact the De ptfor addn'1 in o. FEE ITEMS(Fee Resolution 09-051 Elf. 7/1;10) FEE QTY/FEE MISC ITEMS Plea, C;hc(4 t�cc: Seipp'`. /P( 1:cc P1n,P��f "l dri Ci"( 4: Fcc PME Unit Fee: $50.00 PME Permit Fee: $42.00 Ctt�tsl2.Slf°itt`rl7L�/i1 /GLY _tC'tlji')(1(:LF7 l:t.'i��t'SI t'f.c' Work Without Permit? 0 Yes E) No $0.00 Plannitr<'7 FccE). Travel Documentation Fee: ITRA VDOC $42.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $135.0(," 135.0( $0.00 TOTAL FEE: $135.00 Revised: 9/29/2010 CITY OF CUPERTINO 5 ITEMS OF 10 PERMIT RE'-EIPT OPERATOR: SylviaM COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 32627035 .310 DATE ISSUED. . . . . . . : 10/01/2010 RECEIPT #. . . . . . . . . BS000011618 REFERENCE ID # . . . : 10100015 SITE ADDRESS 21267 STEVENS CREEK BLVD STE 3 SUBDIVISION . . . . . . . CITY CUPERq INO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : HOBES RESTAURANT ADDRESS . . . . . . . . . . : 21267 STEVENS CREEK BLVD STE 3 CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM CORNII: GILROY CONTRACTOR GILROY, JOHN LIC # 15128 COMPANY JUST WATER HEATERS INC ADDRESS 3400 =:NVESTMENT BLVD CITY/STATE/ZIP HAYWAARD, CA 94545 TELEPHONE (510) ::93-9901 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ____ ------------- ---------- ---- ------ ----- 1BCBSC VALUATION 6, 756 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICO VALUATION 6, 756 . 00 1.47 0 . 00 1 .47 0 . 00 1PCWHEATR UNITS 2 .00 50 . 00 0 . 00 50 . 00 0 . 00 1PPERMITFE FLAT RATE 1 .00 42 . 00 0 .00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 .00 42_ ------ 00 0_00 ----- TOTAL PERMIT L36 .47 0 . 00 136 .47 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- ------- 518 WATER HEATER 011 S E R • I C E O R /TYPE : 7248 INPUT: 9/02/10 MTV PROMISED: 9/02/10 I, DISPATCHED: COMPLETED: 1 . 00 JOBSITE : 218632 22 HOBES RESTAURANT 10 21267 STEVENS CREEK BLVTE XST-HWY 85/REST �0 0 CUPERTINO, CA 95014 ( 408 ) 255-6010 108 ) 206-3788 CELL BILL TO: 14728 BES RES ROBES RESTAURANT 21267 STEVENS CR K BLVD. CUPERTINO, CA 9 14 � ( 408 ) 25-D5-6010 ( x_08 ) DISPATCHE PHIL SEE : MICH L-OWNER ( 408 ) N PO: TAX CODE : 4 AD: REP BLDG: CL SUM: M ERMS : 3 VISA TRO BZE : TANKLE S WH EST op / �U. JOBSITE NOTES : GO JOB PER LARRY TO INSTALL 2 R94LSES 6756 . 00 852-C1 LncT TROUBLE : COMM. W:? REPAIR MECH-. 566 SO: 386826 &32-0/10 ARE ADDRESS & CITY COR:2ECT??? WHAT IS THE MODEL & SE:2IAL #? � WARRANTY WRITTEN ON INVOICE??? Is the manual on the tank? ; WH $ SEPERATED FROM UG.2ADES??? WAIVER SIGNED IF $750 �DR O E? IS INVOICE SIGNED CORR:'= What is your tag .number? C� Dollar amount? 7C Check # or CG on invDice. ( r CDL if pai y check? IQ 2 invoices on insurance jobs? -,z What is the autho number? ` What is the water pressure?�cu Are faucets and pilots OK? Sticker on the water heater? Customer To Obtai 0 n Permit.7-57tuI4 Dispatcher: c , 9 6 k i o c ILI £ r, , —�— LL q I � � i _ S - I f ! � � � � . i r ' •mac. i i 9 � i f 1 CITY OF CUPERTINO isWATER HEATER CITY E OF PERMIT APPLIC kTION FORM cu D/ 0a0lS--� APN# Date: 4 -Z Co Building Address: J lam(" Phone#: Owner's Name: (p0( n --7 License#: Contractor Phone: �'q l 7 Just Water Heaters- n 5io 3• rz C3� Phone: 14zk Cupertino Business License#: Contact: 1 -51Z,8 Ct3c i GL lro 9� Building Permit Info: Elect ElPlui rib � Mech El Bld ❑ Job Description: r' ae�. Z U ut nes 14 W Residential ❑ Commercial [.�� Iraw Cost of Project: b7-5"6 , CSO Strapped ❑ On Platform ❑ Bonded ❑ New Location ❑ Replacement Qty. if Fee Group Applicable Fee ID Fee Description BPRrHEAID Wat-,r Heater/Vent BUILDING PPERMITFEE -Plumbin Permit Issuance PLUMBING BENERGY Ene� BUILDING BUILDING BUSLIC Business License