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S 3962APPLICANTTO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY a.uaa�ry urc-Tuw BUILDING DIVISION APPLICATIONIPERMIT PLUMBING -MECHANICAL S 3962 are, n1Nr_ mi rroa, rnamaT G ,,,a , 1N ARCHITECT/ENGI ER: LIC NO: ADP ESS: e Ale ❑ ❑MULTI -UNIT ❑STRUCTURAL CONTACT: MODIFICATION PHONE: �� ❑ Consultant Fees Paid by Applicant (Initial) IMPROVEMENT BUILDING PERMIT INFO SLUG ❑ ELECJ� PLUMB MECI LE IJ ❑ ❑ SEWER - SANITARY - STORM EA. 200 FT. I hereby affirm that 1 am licensed under pmvish of Chapter 9 (commencing - - 00 with Smoot 7")of Division 3 ofthe Business and Professions Cache, amt my license is a 0 in full tura and elrfce a Z W License—Lie. N 6 L Dae Contre as - /9 •'r ARCHITECTS DECLARATION OZ ern K 1 understand my plans shall he used as public surds OZ -1 r4` q Licensed ProfeWenel gg�CQC• OWNER -BUILDER DECLARATION QI hereby affirm that I am exempt from the Contractors License Low for the 0 following motion. (Section 7031.5. Business and Professions Code: Any city or county r C y which requires a permit to construct, alter, improve, demolish, or repair any snmcmrc prior m it, issuance, also requires the applicant for such permit to file a signed statement }Mthat he is licensed pm ursuant Ne provisions of the Cmuractm's License Lsw(Chapter9 adE5ao (commencing with Section 7") of Division 3 of the Business and Professions Code) (it t1 y e yr that he is exempt therefrom and Ne basis for the alleged exemption. Any violation of LLX1 W Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of rI.... ~ N t marc Nan live hundred dollars (8500), q Q ❑ 1, its owner of the propery.ne my employees with wages as their sole compensation. •0.0.dL'' will do the work, and Statmcmre is not intended or olTered forsale(Sce. 9044, Business 6 3 $ and Professions Cale: The Conoanors License Law does not apply to an owner of Profanity who builds Or improves thereon, arm who does such work himself or through his own employees, presided that such improvements arc not intended or offered far sale. If, however, the building m improvement is sold within one year of completion, the canerbuilder will have the burden of proving that he did not build or improve for pur- pose of sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions CMe:)The Contractor's Li- sve law does not apply to an owner of property who hurl& or improves thereon, and QTY, who contracts for such projects with a comractm(s) licensed pursuant to the Contractor's License Law. I ata exempt under Sec. ,B&P C far this m. her Data WORKERS COMPENSATION DECLARATION I hereby efhw under Cn ficof perjuryone ofthefollowing Worker's Co ❑ I have and will maintain a tion 37M of Consent mCode, to t for Worker's Compen- sation, as provided lar by Section 3]W of the Labor Code, far rhe performance of the work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, so required by Section 3700ofthe Labor Cede, fmthe performance ofthe week for which thispe. , ed. My Worker'{Compepvoyp_Insureitt cerin and Policy nC9a s� Cartier: J'1"t{.�X. i�—I Policy No.: J CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ('this sanian need troche amplemd ifihc permit is Tatman hundred dollars ($100) or less.) 1 certify that in the Performance ofthe work for which this permit is issued, l shall .of employ any person in any man cr so as m subject become subjeco the WorkeWorker,'C nnaen- O Z cation Laws of California. Data O Applicant ' y NOTICE TO APPLICANT: IE after making this Certificate of Exemption, you should (•-' [' became subject to the Worker's Compensation provisions of the Labor Code, you must W(4 forthwith comply with such provisions or this Permit shall be deemed revoked. Q G z CONSem is ac ONLENDING AGENCY V l frwhichwthatthere issued(ee.30lending agency (or the performance of FNe work for which this permit is issued (Sec. J09], Civ, C,) Lender's Nome O U kr' f<nJur'Address I V0.certify that I have mad this application and state that the areae information is 1 cumin, l agree to comply with all city and county urdinunccs and area laws s relating QTY V movemNm building hereby ouNonrerepresentatives of this city to enter upon thea move-mcntiorW propene for inspection fak (Wc) agree to cast, indemnify and keepeep harmless the City of Cupertino id Ctagainst inconsequent of the craning expenses which may in any way accrue against said City consequence of the granting of this pewit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCEIjEki}/1.AVIONS. /, / % 1V I l e -Y k9/ if ./ 7 G) ARDOUS MATERIALS DISCLOSURE Will alta npplt t or future building occupant store or handle hazardous martial as derinerl by the Cupertino Municipal Code, Chapter 9.12, and Ne Health and Safety Va. Section 255320)^o I3Yea Will the applicant or future building occupant use equipment or devices which area hamrdaus air conmerinan.. as defined by the Bay Area Air Quality Management District? ❑Yes XNo 1 have rtad the haaadous matador's requirements under Chapter 6.95 of the Cali- fornia Health & Safety Code. Sections 25505. 25533 and 255311 understand that if the buildine does not currently have a treat, that it is my responsibility to nodfy the Occupant ELECTRIC PERMIT PERMIT ISSUANCE APPLIANCES - RESIDENTIAL PANELS UPTO 20 AMPS SIGNS ELECTRICAL SPECIAL CIRCUIT/MISC. TEMP.. METER OR POLE INST. POWER DEVICES OUTLETS - SWITCHES - FlXTURES SO FT. FEE 70 70 FEE JOB DESCRIPTION RESIDENTIAL ❑SFDWL El KITCHEN REMODEL ❑ADDITION ❑PLUMBING RE -PIPE ❑MULTI -UNIT ❑STRUCTURAL OCC. GROUP MODIFICATION C2 INTERIOR Cl CHIMNEY REPAIR IMPROVEMENT (] SWIMMING POOLS ❑ BATH REMODEUREPAIR (]DEMOLITION ❑ OTHER SEWER - SANITARY - STORM EA. 200 FT. ENERGY FEE COMMERCIAL: ❑NEW BLDG/ADDITION ❑DEMOLITION ❑TENANT ❑ FOOD SERVICE IMPROVEMENT ❑ OTHER / r FT. FLUOR AREA I LSQ. IT BACK PLOW PR1`H7FACFMVICEa,,F I I DRAINS - FLOOR,R D. STORIES TYPEICONSTRU I FIXTURES-PERTRAP GAS-EA.SYSTEM-IINC.40UTLEfS OCC. GROUP APN GAS-EA.SYSTEMOVER4 . GRF.ASEIINDUSTRL WASTE, ll,TERWMR BUILDING DIVISION FE GREASETRAP PLANCHECK FEE SEWER - SANITARY - STORM EA. 200 FT. ENERGY FEE WATER HEATER WNEM'/F.LECITt GRADING PEE WATER SYSTEM/TREATING SOILS FEE Six L. WATER SERVICE PAID NEW RESIDENTIAL PLMB. SQ, FT. Date Receipt TOTAL: TOTAL: BUILDING MECHANICAL PERMIT FEE SEISMIC FE PERMITISSUANCE ELECTRIC FEE r O ALTER OR ADD TO MECH. PLUMBING FEE AIR HANDLING UNIT (TO 10.000 CFM) MECHANICAL FEE CO AS AIR HANDLING UNIT (OVER 10.0nal CFM EXHAUST HOOD(W/DUCT) HO INGM ION FEE Receiptp HEATING UNIT (TO IM.00) BTU) HEATING UNIT (OVER 100,000 BI'U) III VENTILATION SIAN(SINGLE RESID)PAID BOILER-COMP(JHP OR 100,000 BTI(] Y AL: BOILER - COMP (OVER 100.000 BTU) 11 AIR CONDITIONER ISSUANCE DATTE����rr 7 0 ISSUEDBY: J NEW RESIDENTIAL MECH. SQ. FT. TOTAL: OFFICE _, I «— S._»ZA _D 10 & \� m � --f — � ~— .. § \} _ / 22 ., «— S._»ZA _D 10 & \� m � --f — � Listed sign section (consists of insulating boots, Insulating sleeves, plastic face, tube supports and channel letter) suitable for outdoor location unless marked for Indoor only. Tube support per NEC 60033(b). Neon tubo. Spacings maintained per spacing table. Plastic face I Electrode insulating Letter bool, GTO Insulating height sleeve provided with sign. varies Conduit locknut (typical) —�IDepth varies Drain holes if used outdoors. Well varies in thickness and material n Listing marks: Listing mark sign section label shall be on each letter and transformer enclosure. The first blank space identifies the number of each sign section. The second blank space indicates the total number of sign sections 0 I r LISTED by qualified electrical testing laboratory ELECTRIC SIGN SECTION NO. XX-12r3-4�56 L—_t o1 #10 x 3' Lang screws Min. 3 per letter �— Primary electrical source (12 in. minimum conduit, metal shown). NEC 600.6 & 600-21 �-- Uslod disconnect switch in primary to be within sight (maximum 50 fl.) 01 sign. > (Many interpret transformer enclosure to be part of sign.) NEC 1103(b), 600.2, 600-4. 3181n. minimum listed flex (metal shown) �A-7 and listed GTOcable (secondary side the only and to the next section letter). NEC 116.3(b) 8 600.31. Installation of signs listed per UL48 Note: Installation requirements only. Manufacturing requirements contained in UL48. ILLUMINATED CHANNEL LETTER INSULATING BOOT AND SLEEVE Date: October 1994 Scale None. IAEI UL48-TlD Dwg. No.