28974 APPLICAtiT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO 2 _I'-(�
BUILDING-ELECTRICAL. PERMIT NO. ,8 9 7 A
BUILDING DIVISION APPLICATION/PERMIT PLUMPING-MECHANICAL. L
BUILDING PROJECT IDENTIFICATION
BUILDINGADDRFSS: SANITARY NO. APPLICATIONS SUBMITTAL DATE
-�2,03 4
OWNE 'S NAME: PHONE: CONTOR'S M :RA LIC -
KI N/C CONTROL
rRCHITECT/ENGINEER: - LIC NO: ADDRESS: - ❑
CONTACT: PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial). ' BLDG ELECT PLUMB MECH
1:1 •; rk` ❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE
I Hereby a fvro that 1 and licensed under promm
visions of Chapter 9(cnstran g JOB DESCRIPTION
oZ in full Twee mJ effect.with Section 9001om Division 3 ofthe Business unit profcsaians Code,and my license is
00 PERMIT ISSUANCE RESIDENTIAL:
�U�U License Class _ Lic.g - ❑SFDWL ❑KITCHEN REMODEL
viza Dam Contractor - APPLIANCES-RESIDENTIAL CADDITION ❑PLUMBING RE-PIPE
[[.... ARCHITECTS DECLARATION QMULTI-UNIT CSTRUCFURAL
y p v Z I understand my plans shall he used ss public records PANELS MODIFICATION
OZ4O - L UPT0200 AMPS (A/ ❑INTERIOR El CHIMNEY REPAIR
hiR" Licensed Professional 201-101KAMPS IMPROVEMENT
�hd OWNE&BUILDERm the ComIun OVER 1000 AMPS - C BATH REMODEUREPAIR [I DEMOLITION
C 1 hemby affirm ran 1..exempt from the Communes License Law for the _
3 F V following reawn.(Section 101 IS,Puniness and improve,
de in demolish,
Cole:Any city as county SIGNS ELECfRICAI. CDTHER
4 which rtqutresupemso to requires tealter,itIorsudemolish,ore a sig any structure
15y
prior ioits censepubsureto the thovisioso for Contranniunfiense Lw(ned shaptert SPECIALCIRCUITIMISC.
} thaheatran wit pursuannf00).f Provisions Soft Conma.a,v License Law(Chapter
00 that he
xempth Section IO and
h thad,nm;of meeged exemption,An,
Gyle)or TEMP.METER OR POLE INST. COMMERCIAL:
a o y mm n is exempt therefrom and the cia for me alleged exemption.Any violation of 'C NEW BLDG/ADDIOON' O DEMOLITION
t4 Section 1031.5 by any applicant forepermil subjects the upplicennoecivil penalty of POWER DEVICES
mm []TENANT El FOOD SERVICE
y not more than five t hundred dollars($5011.
ZO C Lo the work,the property,mmyemntended with wages ustheir role com,Business SWIMMING POOL ELECTRIC IMPROVEMENT
willad do the work,and the swcturc is rnot m',Lia me Law offered do for sale(Sec.]044,Business ❑OTHER
3 and Professions Code:The Contactors License Lew saes ratw apply s to...at of OUTLCfS-SWITCIIES-FIXTURES
property who builds or tided t a Thereon,and who does such wote himself or throughdfor
his own xaweve the building
mal such mentisimprovements w ere not intended or offered for NEW ftF.S[DEN'(IAL ELECB SQ PIT.
sale.t-howevw the have
tar improvement is in he do non wildyear of
or improve
the SQ.IT.FLOOR AREA LSQ.FT.
owner-huildcr will have the buNen of proving that he did not buil)or improve for per-
po. of saleI
as owner of the pmfi am exclusively contracting with licensed emomemra m
-noif on project(Sce.7044,Business and Professions Calc:)The Convectors Li- pp��g pp
cense law does not apply to sonname(of property who builds nrimproves thereon,and QTY. PLUMBINGPERMIT FEF. P A 10
who contracts for such projects with a contmcler(s)licensed pursuant to the Convectors
License La PERMIT ISSUANCE DEC❑ lame t pt under Se. ,Bffi PCfar this rtason D
ALTER-DRAIN&VENT-WATER T Ar ION
Data
;mer
WORIf CYMPENSATIONDECLARATION BACK FLOW PROTECT.DEVICE sllY Ur l Ut-dlIINU
achy affirm under Penalty of perjury one of the fallowing declarations:
I have and will maintain a Canificam o(Consem to sel6inwrc for Workers Camper- DRAINS-FLOOR.ROOF,AREA. D. STORIES TYPECONSTRUC ION
sation,as provided for by.Section 3000 of the Lahr Code,for the performance of the
work for which this pemtit is barred. MIXTURES-PER TRAP
1 have and will maintain Workers Compensation Immunce,us required by Section
3400ofthe Labor Cade,for the performanacofthe work for which this perndl is issued. GAS-EA.SYSTEM-1 INC.4 OUT1 5 OCC.GROUP APN
My Worker's CmnNnsation Insurance amber and Policy numhcr are:
Cartier policy No.: GAS-EA.SYSTEM-OVER 4(EA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASIVINDUSTRL WASTE INTERCEPTOR
_ BUILDING DIVISION FEFS
(This section need not hecomple¢dif the Permit is(aroma hundred dollars(EI W) GREASE'IRAp
or]am.)(This
FEE
I verify Malin in parformance anymurdero as
subjectch this o permit the theses' urrenl SEWER-SANITARY-S'THEM EA.200 FT.
not employ any person in any manner so os to become subject m me Workers Campem ENERGY FEB
O Z sation Laws of Celifomia.Dora WATER HEATER WNENTIBLECTR
7 O Applicant GRADING FEE
F7 y NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you shi WATER SYSTEMaREATING
a ; become subject to the Workers Compensation previsions of the Labor Cod,you must SOILS FEE
forthwith comply with such provisions or this permit shall b,deemed revoked. WATER SERVICE
Q
� CONSTRUCTION LENDING A NEW RESIDENTIAL PLMB. SQ.FT. PAID z Ihercby offtm that mere is acnnswction lending.pmaagencyy(onhe per(onnantt of - Dae Rec' tp
{UTr the work for which this permit is issued(Sec,30ari Co,C.)
Lenders Name 4c AL:
V Lender,Address TOTAL:
as 1 certify that I have read this application and stale that the above information is BUILDING FEE
(Zcorrtct.I agree to comply with all city and county ordinances and state laws relafing to QTY. MECHANICAL PERMIT FEE
U building construction,and heathy uuthorire representatives ofthis city m enter upon the SEISMICFEE
above-mentioned property an inspection purpose. PERMIT ISSUANCE
(We)agree to save,indemnify and keep foamless the City of Capetian against ELECT
liabilmes,judgtr¢nts,costs and expenus which may many wayaccrueagaiost said City ALTERORADDTOMECH.
in cons¢ue a of the mining of this pe it.
PLUMBI
API NT UNOERSTj.ND5 AND /ILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO IO,afO CFNHOUSING
HANICAL FEE
SOU C RIMULATI rS.
le
AIR HANDLING UNIT(OVER 10,100 STRUCTION AX
of ApplicanUCon ctor am EXHAUST HOOD(W/DUCT)
HAZARDOUS MATERIALS DISCLOSURE MITI ATION FEE
Will theapplicnumfuture building occupant starcor handle Normal.,anal HEATING UNIT(TO 10 .000 BTU)
�.dcfinad by me Cupertino Municipal Code.Chapter 9.14 and the Health and Safety
Cade,Section 25532(a)P HEATING UNIT(OVER 100."BTU)
❑Yes C No VENTILATION FAN(SINGLE RFSID)Will the applicant or future building occupant use equipment or devices whichand harardous air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP(3HP OR 100,000 BTU)
TOTAL:
District? - BOILER-
CYes CNo COMP(OVER 100,000 BTU)
'
I have mml the ha a rdous materials rtquitemeno under Chapter 6.95 of me Cali- ' AIR CONDITIONER ISSUANCE ATE
(omit Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the NEW RESIDENTIAL MECH. SQ.FT.
building does not currently have a tenant,that it is my responsibility to notify the occupant
of me requirements which must be met prior to issuance of a Certificate of Occupancy. ,.
Owner our normal agent Was TOTAL: ISSUED BY:
OFFICE
NOV-10-1995 13:21 PG&E DE ANZA 408 725 3342 P.01
23
•
P.,Swimming Pool Clearances For.Utility Service Drop
s
The Installation of utility service drops above public and private swimming pools shall be avoided
where practicable.
The Celifamie Public Utilities Commission(CPUC),not local agencies or codes, regulates.by Its
adoption of General Order 96,the installation and clearances of utility owned,operated and
maintained supply lines and service drops. General Order 98 contains specific requirements for
Installing and maintaining clearances of utillty supply lines and service drops above awlmming pools.
The drawings In Figure 48 are Intended to illustrate the minimum permitted clearances of General
Order 96 where utility service drops are installed above swimming pools.
Minimum Clearance
Minimum Clearance
20R 18' 20' R 18R f 12' R
Lam/ 18' 12'
4' Highest Water Level 'd•' *' Highest Highest
Water Water
Level Leval
All Poole a Private Poo
Minimum Clearance for Open Wire Drops Reduced Minimum Clearance
for Trlplea Cable Drops
Minimum Cleamnoe 0-300V Only
Edge-
18' x-17 Minimum
12' learance 18'Mlnlmum Clears c
Diving Board 8 8'R Diving Board
or Platformor Platform
a' Highest Water Level 3'R
All Pool All Pools
I 8
section Plan
Figure 48
Minimum Clearance for All Drops Above or Adjecent to Diving Boards or Plattarms
�D
e(pC QFC Os Jy � Electric Section 5
INSp 95 Overhead Service 1995
. CI
OP 6P7 Fp
FqT/ND 'IFN;, TOTAL P.01 \