20535 PP„1�„CANTTO FILL IN INFORMATION WITHIN RED LINES _ USE BALL POINT PEN ONLY
.1 tlulldln Ym ed Idemificatlan PFRDETNO,
" uliding Address: 205351
0303 M% rite r p1.
MFFN ams: one;
CITY OF CUPERTINOIBUILDING DIVISION p o
C.olmol reN`�a"m"e: Lac.Na APPLICATION 1 PERMIT
La l� �J
4p Se.t \cq� S,4 BIIILDINC-ELECTRICALPLUMBINC-MECHANICAL CATEGORY CONTROLN
Architect/Engineer. Lie No:
QT1y ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address PERMITISSUANCE El El El
CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed under provisions of Chapter 9(rommenc APPLIANCESRESIDENTIAL JOB DESCRIPTION
Ing .lon 7f100)of Dlvielon3oftheBuelnneand ProfesaloneCode,anti my
carb
license in toll anddfect. PANES
Dloart CI as ME
ale Contractor
—der
ARCHITECTS DECLARATION OVER
AM
�$ ]understand my pisru slug be'used espublic reroMs, OVER 1000 AMPS - SQ.FT.FLOOR AREA $/9Q.FT.
k� Licensed Professional SICNSELECTRICAL
�6 OWNER-e UILDER DECLARATION SPECIALCIRCUIT/ML9C
ZF, IherebyalRrmlhallam exempt(romthe Conlradora License Lwfor the
W followingreason.(Section 70115,Business and Professions Code:An cityor
OZFmqunesa o TEMP.METER OR POLE INST.
aountynystm mpAortolts mit ,a r rc R,Wer,Imptovgdemou6 pa Pao
a any atmcturetatement that h Mice requWatuant to antfmsuions of lte POWER DEVICES
rNG V 0b a signed statement that he L licensed pursuant to the provisions of the - -
3w Contractor's License Law(Chapter 9(commenMg with Section 7000)o(DIW-
X03 900ofthe Busineasand ProfesahmaCode)orthat halt exempt therefroVALUATIONmand SWQd'WNCIWLELECfRIC
0 the basis for the alleged exemption. My violation of Section 70)15 by any OUTLEISSWIICHEesEXfURES �'2Svd
applicant fora permit subjects the applicant to a civil penalty d nm
ct arc than
Tiv6uno Owne of ars
M.
pro NEW RESIDENTIAL ELECTR SQ.FT. STORIES TYPE CONSTRUCTION
�n I,ae owner of the property,or my employee with wage as their sole
compensation,will do the work and the structure is not Intended or offered for
q sale(Sec.70"Bushes.and Professloe Code:The Contractors License Low
docs not apply to an owner of propery who Wilde or Improves thereon,and OCC.GROUP RFS.UNITS
who doessuch work himself orthrough his own employee,provided that such
Improvements are not Intended oroffered for sale.](however,the bulldingor - TOTAL:
Improvvr ntbwldwlthlnowyeSrofcompldbMtheowner-WIiderwill have
iturden of proving that he did not build or Improve for purpose of sale,), pry, PLUMB/NG PERMIT FEE FLOOD ZONE - APN
n{as most of the property,am exclusively contracting with licensed PERMIT ISSUANCE
contractors to mmtmd the project(Ser,7041,Business and Professloru Code:
The Cormador'a License Law does hat apply to an owner of property who ALTER-DRAIN&VENT-WATER(EA)
W thereon,
lids or Improves and who contracts for such p\ojects with a
cgp�(actorts)licensed pursuant to the Contractors Lice Law. FEE SUMMARY
5I em exempt under See A P C for this rcawn BACK FLOW PROTECT.DEVICE
DRAINS.FLOOR ROOP,AREA,COND. SANITARY Y_ N
Owner - Data RECE'T0
WORKMXN COMPENSATION DECLARATION
� pp(3gREcy PER TRAP SCHOOLTAX Y_ N_
I hereby, fit.that I have a certificate of torment to self-tore,or e
ce Iflale of Workers Compensation insurance or a cenRkd copy thereof
olmlq•aYny W C \3h�J3[�'�_Z+�1'1 thereof(See. BBC=
N0
31GA .SYM-1 CAOUITPARFER Y_ N
PT
CoCAS EA.SYSTEM-OVER d(EA) BUILDING DIV
ISION FEES
CertlRed copyis filed
the city CREASE/INDUSIRL WASTE INTERCEFECR PLANCHECK FEE
{rl Cerllfled ropy is(fled with the city inspection division.
Yom' CERTIFICATE OF EXEMPTION FROM WORKERS' CREASE TRAP PAID
COMPENSATION INSURANCE SEWER-SANITARY-STORM F.A. 0017(• Date Recei tp
('fhlasectlon need radWENSATI NI SURApermit lt(Drone hundred dollars P
($100)orless.) WATER HEATER 4V/VENT/ELFLTR ENERGY FEE Y N
I omifythal in the perfomams of the work fow
rwhich this permit is bed,
I shall not employ any person In any ma v to become eubjM to the WATER SYSCEM/1REATNG
Workers'Compensation Lawso b. Date PAID
—
0 Z Applicant NEW RESIDENTIAL PLMB._SQ.IT. Date .Refxi tat
Z O NOTICRTO APPLICANT.If,after makingthisCertificate of Bar mption,you
should become subject to the Workers'Comperuallon provisions of the Labor TOTAL:
N Code,you moat forthwith comply with such provisiom or this permit shall be UI 'E ♦�
W F3 .deemed revoked. _ SEISMIC FEE
CL C CONSTRUC710N LENDING AGENCY
Thereby affirm that them is;a pon ermit nstruction lentil mthe penomrt TOTAL: ELECTRIC FEE
Z anceof the work for which this pedt i 3097,Clv.C.)
U O Lendeh Name - - PLUMBING FEE
IL I— Lenders Addresses OTY. MECHANICAL PERMIT FEE MECHANICAL FEE
Iceriythatl have read this application and statethal theabowinfomnation
O W
4 is correct.I agree to comply with all city and county ordinances and pate laws :
ISSUANCE FEES PAID
>- Nrelaangto WlldingroiuWRion,and herebyauthorim,representatives ofthis
(— Z city to enter upon the above-mentioned property for inspection purpose. ALTER OR ADD TO MECH.
(We)agree to save,indemnify an It keep harmless the City of Cu Fenlon Date Recel tlt
L) against liabilities,fndgments,miss nd expenses which nay N any way acerae AIR HANDLING UNIT(T010,000 CFM) SUBTOTAL:
s,i.... a aiy rut,ald Cly In roe ence of the granting of this permit.
�/� AIR HANDLING UNII'(OVER 10,000CIM) CONSTRUCTION TAX
tAd1wt 1
Slgnamreof pllmnt/ omrador Miler— EXHAUSTHOOD(W/DUCT CONSTRUCTION TAX PAID:
s HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU) Date Recei tit
material as defined by the Cupertino Murdcipal Code,Chapter 9,12,and the
EIe❑all Ye and SalelyC Nhn 75532(a)7 HEATING UNIT(OVER 100,000 BTU) TOTAL:
WIIl the appllcentm tore building occupant use equipment or devices VENTILATION PAN(SINGLE MID) ISSUANCE DATE
which emit hazardous air dontamlnar m as de0ned by the Bay Area At,
. Quality Management bid T BOILER-COMP OIIPOR 100,000 BTU) '•
4 Vee o PAID
have trail the haze us materials requirements under Chapter 6.95 of BOILER-COMP(OVER 100,000 BTU)
the Gllfmi.lieaith&Safety Code,Sect .25505,25533and2S534. I JU�J 071990
understand that if the building dote not currently have a tenant,that It is my NEW RESIDENTIAL MECH. 'SQ.FT
respmulbility to notify the occupant of the requirements which must be met
nor to Lssuance ola IRcam 0,Occupanry.
n
sae or apron agen �Da .Q.I\
l/ TOTAL: ISSUED B
OFFICE COPY
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`:ORIGINAL❑ rrc POOL INSTALION,DIRECTIVE ORDER #
K r
REVISE��. e e '�r AL,,_'A-pqh%A5.<l - t a•:�,.{i�+p9 4i. flWr4«n,4,r�., u,Jio .: m4'ti.7r E',: �' } )y.:v ,xr,;.
"`•.".?'�'":. SIZING DATA "':I:/4AWTO 9h.0+.4W.`+ROOF SPECIFICATION 'EQUIPMENT
J-OOUAREA'4r�,$;,�'� . �;_ -.Q';',(y. ?�,ROOF;TaY,PE;' •!(;. +SNAKE..' PEi�ESTIMATB?.;;
0+; 'SHADE/POOL [�" %`•= ''-..PANEL.p"'% iS,F,{IJyGLE;' 1'N +TILfiy} irt .AWEI;t; /$ —
i b'
'WIN -2 2.3 3.5 rt;t'6+ 'a � !'COND;3 ,:4 �°' .°AGE: .3 . ' pgRTaNO: "1"Ay
- filEN7ATl0N; ;)' r 21? k 4 OO e21T.O ;Ls F- ANEW
.,� -•+ ,PITCH PANELS,, ' I' ..%y o m dyp �,r - ou • y
�y FMULTI-LEVELi�' :�.Y N : ra, x vf ;xc� PARfiNO$„w, {• `E''; , ;!'e ,OTY,,".r"�'I':.,t;.
` -REG/COVERAGE , " , SQ.FT;r VTOTAL4 PREM IUMS i,,"�
10 FT SUBSTRATE:QUANT, S—
;+ COV./SOLD 70 ,%' '.:'%, '" :` SG:FTI; '`,PRESITE B FS:SUBSTRATE:QUANT, '
EXISTINGP00LBLANKET''; Y MAQ K4 WWaW,WW2WG ROUN,Qra.ZACT.O;C6NT.ROL'yM01)EL
,RECTANGULAR DIM FOR POOL BLANKET, ±!'r•:M„� WpIVERS�' >+ ”' - -rte;`:= t RT;N0
It
:., x 8- �:`'3;.:•X "r • �c! +'`k`�^ •,ROORWAIVER:;�!'�, �n + r..•x„ ' - + . ,... rti'. '
}"�,`!:*`+ .x, _ ,. �A � �'.fa; STANDARD OPTIONS
'DESIRED TEMPS SEASON:. ' I`irn .:” - •
,. r ORIENTATION WAIVER;391' ?� . KS„
'.`l ,J-Z DEG.y�rf THRU S :`?;. ti AMENIP Or,?E:R •,IVER' , ,,r a,. ,,. +)?AR'ISNO;
..
POOL BLANKET USEREO'D Y%* ?'i,N" •POOLEOUIPi.WAIVER;';-[`,y?:k1;..0 ,HEATER BYPASS Y N
HYDRAULIC DATA : = ".�+� ':: TRENCHING d ARBOR ' DUAL THERMOMETERS Y N
PIPE:EQUIP TO POOL ",`10 -r '�+ FT: BASIC: >` :;;-^FT.'"' " GRD/DRAIN/VALVE Y N
SOLAR LOOP PIPINM ;', Q FTr" .'GRAVEL;.- '" "'4;t • it g FT: FIREMAN/SWITCH Y N
rfN:.n AX.WVER7.'f31SE„Q. :.a. 'SOD n.:y%t.k%I';CH.I;Ys' 's`Y;r,.i. FL ',': :: 'FLOWMETER Y N
PANELS BELOW POOL{,:;„; Y^ ". N OTAI' FFN; _ F.[;>'j; a�} :OPTION: NO.
uSUCTIONSIZE 1Y. `' IA • .''24}; :-TUNNEL';'+''r3�,y„,;"V,,}a FT : OPTION: NO:
ktl.
�RETURNSIZE 1y C1K '" 2.`:•r-E :vt5: •,SPECIALROUTING:i'`:',= Y N a;0'0,0h,BL'K78 X NO:
;.NO.'INLETS SIZE,-./ -! c/ � 'r ryr{a*;� `;.ARBOR:'"r`FENC/RF.A „GRD/RF . `k, :h+ ,fiT`NO ;• ° + �'•`
y 'IPOOL/SWP OV/SIDE. ,'t IG:' '°'<a -VERT ''z"-'FT.HORIZ • FT. MISC:.
` ';PUMP HP r M'!A E` : COND. TRENCH LABOR: jai SES I CUST REPLACEMEN EQUIPMENT
FILTER/TYP SO./FT 3 1 COND OPTION: - ,+ d ', NO i'i m MAIN BOOST • •.
PRESSURE CLEAN `~
...i7(""C,rr' „at`; i.kt i{ § ELECTRICAL" :r2}.>ti 9F`e Fjip,�'�SAIN :,'3`�•B7�'•3s'
r SPA/HOT TU x ' .(PUMPVOLT L_SWEEPtl +�
"" r`,v,•- ' 1., ,.. Y '.� � . IP
" B- FILTE "SAME SEP 't�,T' ,OIST:TO MAIN'BRKF %!Cy; .z,C?'P°FT"K�Yik . ,.Uh1 ,,t�%'"` MAIN BOOST•
BYPASS : Y N BRK#1 "t',}+,k{> ;AMPS�^h'.t-,yJ.:r` AWG. •� - HP rv) MAKE NO: •,
HTR/MAK BTU ` " CND •_ .'t'J ', MAKE's?.' Y;l TYPES
;.
,MNFLD/SIZE BYP/NEC•;: \',. N +' BRK#2 tr' yf)?AMPS`,l9 ,`."x' AWG.:: �pl[)TEFL'pN_4YM DE CA T SAND
CUT/POINT/SIZE PIPE/TYPE U, tFMAKE x "' PE ' "''SIZE SO,FT. NO:
•LEAKS
CONDUIT R.SIZE'.w` i,:'" CND. gOUMP,WFI'LTERSKID`:, HP
POOLBUILTBY: GFI Y,:�riN;'3'> �.AC/OUT 'Y `N".' �SIZE�r` SO.FT.NO:
POOL IN GROUN Y N .CREW CHECK LIST
POOL: GUNITE VINYL
PICKUP COD iN ' '"M OPTION NO
r'jlw -POOLAGE: - " '^ YEARS "" : PICKUPCMPCERTi Y N
' COMMENT$ ` �/p_ /•
6021 Blum Rd.,#2BC-0
DIABLO
SOLAR .Marlines,CA 94553•
SERVICES (415)939.8789
Calllomte state Contraabh Liwrua No.16a77�
'OWNER:. �` `:'ADDRESSi� D 3G 3
CITY PHONE HOME: y0e
t:L2
=4 6 WORK: Z25'Y-5
INSTALLATION• FUL :r,PLUMB ONLY ye'CPU�I'A DELIVERY?` � � `� APPROVED -
ka' 's
<: BY:
PERMITS:CITY '' -COUNTY❑ -VARIANCE REQ'D❑
GATE SOLD: DESIG_�g_ r n!ti a AREA# PAGE#:`
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