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S 3176APPUCANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY 1. - CITY OF CUPERTINO BUILDS -ELECTRICAL rUU°ILDINO DIVISION APPLICATION/PERMIT PLUMBING- MECHANICAL. r BUILDINGPROJECT IDENTIFICATION - Pea ITNO. 3176 K \ - �/ �! 1 1 7 6 BUILDING ADDRESS: SANITARY NO. APPLICA'I'[ON SUBMI'PI'AL DATE La %/.3o -4J O ERS NAME _ 'HONE: P"j�G CONIRACI' 'S NAME' LIC NO: S/ NIC ❑ CONTROL# RCHITECT/ENGINEER: LIC NO'. ADDRESS: 2 oNl'ACT: PHONE: -. BUILDING PERMIT INFO 2 0 fI5 / -- U � /� o CO TI lJ ❑ Consultant Fees Paid by Applicant (Initial) BLDG ELECT PLUMB MECH ❑ LJ ❑ ❑ DE LICENSED CONTRACTORS DECLARATION 1 hereby affirm that I licensed under provisions '' of Chiumer 9 (amnme " a wall Section 7(X)O)ofD -.' 3 f,h3Basi dP lesions Codeanllmy lice i s is fall force anA elf License [1a. Lic.# UVJ VJ DmaJh C.OM ARCHITECTS DECLARATION � Iundecaand myplvnsehall be madas public exceeds ,QTS' "ELECTRIC PERMIT FEE .I =r aZ DO Iy �. U <y W I" {� p� del o, 6 d U y JOB DESCRIPTION RESIDENTIAL: ❑ SCOWL ❑ KITCHEN REMODEL ❑ADDITION ❑ PLUMBING RE-P[PE ❑MUINI UNIT El STRUCTURAL MODIFICATION ❑ INTERIOR ❑ CHIMNEY REPAIR IMPROVEMENT E] SWIMMING POOLS ❑ BATH REMODEUREPAIR El DEMOLITION ❑ GTHER y 1117 NUI ISSUANCE �� APPLIANCES - RESIDENTIAL PANELS UPT0200AMPS Licensed Peofessianal m DECLARATION but I am I hereby v(Srm est 1 xm exempt from the Contractor's Co License Law for the a (Section IlYi15, d, rhatss and vet d Professions Coda: Nry city armeture county following express pang mit, ,, a permit to commas i alley, improve, demolish, nr repair any mmetnro pdonodscense the Novisio iatsof forthe sLaw( 201-IOWAMPS OVER IWO AMPS SIGNS ELECTRICAL SPP.CIAI. CIRCDITIMISC. OONatheiscingwiit en C pursunre to Contractor Licensle pursuant ulheproviskica of the Contrmmr's License Law (Chapter 9 hapten (tom toeing with Sactian]W(I)of Dlmnon3oRhe Business unJ Net nvsinrvrCWeJor th Nat he in exempt erefrom and the basis for the alleged exemption. Any selenium nlium of 'fP.MV. METER OR PULP, INET. COMMERCIAL: Ll NEW BLIXTADDITION DEMOLITION POWER DEVICCS ^ ob ^,Z} 2d Section 9031.5 by any applicant foe a peema xabjecla Nx npplicnnl loo civil penally of ar n more than eve hundred dollars ($500). wi I,n ownuof the pmpeay, ra myemployees withwagesastheirsolaeompensinen. will doth, work, and the intended 9044, Business ❑TENANT' ❑FOODSERVICE IMPROVEMENT [I OTHER .SWIMMING POOLELECTRIC mand he Concis Code: The Contemn- License Law Nsuc nm apply to an owner of Livens Lisa, does our Pty OU'fLF?'TS- SWITCHES -MIXTURES who b who builds or videdvpe sushi and who does such work himselfci through his own his own are not intended or offered foe provided Nal such impn3eold NEW RESIDE IAL BLBCTR SQ IYI'. © SQ.IrI'.fLOOR AREA $ISQ. PT. owev,braph,cas, bower w or in issoldhe within the ownersale ,buildne wi(hebuilthe humng of proving u -halide will have the buNen of proving thvt he did net build or improve far Dnr- or improve p sa ifsale), ❑ L i s owner of the peeped am esdie vol, emalnone, wiW licensed conductors to - TNTys construct the Forever (Sec Il44, Business and Professions Cmil The Curators Li- seLaw does not apply to an owner of property who builds or improves person, an QTY, PL OPERMIT - FEE ' who contracts for such p Jests with accelerator,) Ileausedimsenotto the Cnlmmors ' PERMIT ISS F. License Law. Iantexemplunder Sex. ,B&PCRr I1d,Susan ALTER -DR N -WAT ( ) Owner Date VALUA'T'ION WORKER'S COMPENSATION DECLARATION BACK PLOW PROT I hereby alum, under Penalty of perjury one of the following declarations: I have and will maintain a Cenifiwre of Consent to self -insure for Workers Compere- into as provided for by Section 3700 of the Labor Code, for the perp rourna of the DRAINS -FLOOR, ROOF, ARA, STORIES 'TYPE CONSTRUCTION LIST -PER TRAP rk for which this penult is issued. IEJ 1 have and will maintain Worker's COmpanmicn la rron e, n, reqired by Sern Wofthe Lubar Code. for lheperfonnance at he work forhich this permit is issued, yWorker' oto Dread, Insur cc carrier and Policynylypraareeriee GAS -EA. SYSTENTI INC.4 OU"PLOTS "OCC GItOIJP APN GAS Policy Nn.: i%.``LL CERT11 CATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This eetien neetl ere, beenmplemd ifthe pantie is fnnmc hundmldelhtrs l$I(q) or less.) GREASE/DI TRI. ERCE k ,. . ° .. s u *NUI40INSi DR'IFION'FRB$' s ,. GREASE _ PLANC IECK FEC z Q ory Q z 0 Nthe U W 04 I certify that in the performance of Om work for which this permit is issued, IshallSCWP.R-. notemploy mylwrs.a in anymannasn as to becomesubjeermthe Waders' Compere- settle laws of Cali foram Data Applicant AR�R�1(/'��I kM•>A. W NO - ENERGY PRP. WATER IT .R WNENT/ELECTR - GRADING NEG NOTICE TO APPLICAN'P: If, atter asking This Certificate of Exemption, you should become subject to the Workers Compensation provisions of the Labor Cade, you muse forthwith comply with stmh provisions or this pennh shell he deemed revoked. CONSTRUCTION LENDING AGENCY I Ihereby affirmthat them is a construction wending agency for the performance of work for which Nis permit is issued (So, 3097, Co. C.) Lender's Name WATER SY. P /TREATING SOILS FBI. WATER SER PAID Da _ Rover,,# NEW RESIDENTIAL. PLMB. SQ. PC '- - TOTAL: Landr-Addreus 1 certify that I have read this application and state that the above information is TOTAL. BUILDING FBI. m ,z come d. I agree to comply with all oily recreation ordinance, and come law, returns to building cnnswdinn, end hereby mnhoriarepresenmeivcu ofthis city letabougmlhe QTY. MECHANICAL PERMIT, FEE SEISMICFEE above-memioned property for inspetinn purposes. (We) agree m save, Indemnity and keep homeless the City of Cupertino rani.., PERMIT ISSUANCE ELECTRIC FEB D linhilitica,jndgments, mNs and expenses whichmom any way accrucogn3s„vid Cu, in ,sequena ce of the rming of This permit. ALTER OR ADD'fOMEC II. PLUMBING FEE AIR HANDLING UNIT(TO IgO011CFM) MECHANICALPCC APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCG R CUL PIONS. N AIR HANDLING UNIT (OVER IBAWCPM) CONST RUCTION TAX Sign Iroof App cu VCont.mor Dam MAT HRIALS DISCLOSURE EXHAUST HOOD(W/DUC'q HOUSING MITIGATION PER I IEATING UNIT (TO 10X.000 BTU) Will the valor future building oceupara mre or beadle himucho decamial roach by the uper ino Municipal Cade, Chapter 9.12, and the Health and Safety Code, Section 25532(a)1. C] YE, �No use equipment,ArQor devices whirl Will the applicant or mama, building by the ithmrirdons air 'couuminonmmdefinul by the Bay Arco Air QuWiry Manrigement st a^ �k..nn ❑You �t No HEATING UNIT (OVER 100,000 BTU) PAID f VENTILATION PAN (SINGLE RCSID) Dom Receipt # T BOILER - COMP (JHP OR 100,(g08'Put BOILP,R- COMP (OVEk 1110,00II BTU) AIR CONDITIONER I have read the becommuuss materials reLs under Chapter 6.95 of the Cali- 925533" P IS$UANCP. DATE NEW RESID9NTIA1. MIiCH. SQ. FT. acrid Hy,olhgdoes &Safety Coda Sabana 25505, 25533 end nsibil 1 undeiffy th that it building Mics no currently Lava a t,nnnh Ihnt it is my rccpnneihility ¢r notify the eecupam d p� of in.tawhic tusI line, 1 ccuprray,tn or or ave H da m Dale TOTAL ISSUCD BY: / OFFICE WHITE PACIFIC SECURITIE5, INC. SIGN ELEVATION: 10555 5. DE ANZA BLVD. CITY OF CUPEKTINO 5" T�IVIDUAL CHANNEL LETTERS OP OR INTERNALLY ILLUMINATiON. 3/4" RIM -CAP, RETURN PAINTE OLOR. COLORS: LOGO WILL 5E WHIT=_ 5ACKGROUND WITH BLUE GRAPHIC #607—� CHINESE LETTER5 WILL 5E SLUE COLOR #607 WITH WHITE OUT LINE 048-Z ,_c3 Lo 4,7� 6 t+6— .Z 5CALE: 1/4"=1'-d' DATE: 11-19-95 NORTH BUILDING ELEVATION: APPROVAL: DATE: _ PROJECT: All designs & art works belong to Allen 5ign5 any duplication i5 prohibited. COPY RIGHT 1998 r PLOW PLANS CRECTMD g$' DAZE BLDG;, D ' FE1408/280-6500 Fax908/280 6700 B g , 19H-' 21E AVE. SAN .4 J0L5 ® f •tet # 505655