22825 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY
Building AddmH uildln IT Project Identification - PERMNO.
Q5o .+ i2o0.d 22825 :
arr
weer r �•5 —O ono CITY OF CUPERTINO-BUILDING DIVISION r _` _q> /
Contractors me: ueNo: APPLICATION If PERMITAm - —L-.D (' l
BUILDINGELECTRICALPLUMBINGMECHAMCAL CATEGORY CONTROL It
Archlted/Engineer. _ Lic.N.
QTYt t ' ELECTRIC PERMIT - �� FE.Em.' BUILDING PERMIT INFO
Aid. ' PERMITISSUANCE VV ❑
LICENSED CONTRACTOR'S DECLARATION
Iherebyafflrmthat l amlicesed under provhionsof Chepter9(comme APPLIANCFSRESIDENHAL- - BDP M'ITON
IngwRh Section 7000)of Dlvlslon3ofthe BuvneaandProfealon.Code,and my 1p
Lima 1.insoli fora end .# PANELS ��`rc 'a" ` Sey-
Date Clan Lontr - V
Dale 2onkactor
ARCHITECTS DECLARATION WI-1000 AMPS C -Q
q�v cc0 O I understand my plan shag be used as public remrde. OVER 1000 AMPS'
SQ.FT.FLOOR AREA S/SQ.
Fi Limned Profeasional SIGNS ELECTRICAL
6 OWNER-BUILDER DECLARATION,
{"is Ci SPECLILCIRCUIT/MISIZ
E, Iherebyafl.that l am exempt from the COntadoe.License Law for the
following mason.(Section 7031.5,Business and Professions Code:Any city or TBMP.MEfEt ORPOLEINST.
F, 1' cointywhkhrequU.aNe ttommtmMaltegimpmv,demolish,orrepiir _
anystmm.prkrtoltsissuance,aLwmqulrestheapplimntfonuchpermitta
aN x4,a file a signed statement that he is licensed pursuant to the provlslow of the POWER DEVICES
30� Contractor's License Law(Chapter 9(mmmendeg with Section 7000)of Divi- SWIMMING FOOL ELECTRIC
r sion3 otthe Business and Profealoru Code)orthat he is exempt therefromand VALUATION
O the balls for the alleged exemption. Any violation of Section 7all.5 by any OUTLIHSSWITCHESE7XTUI6FS
applicant for a permit subje ntheappllcant to a civil penalty of not nnre than
$ foe undred dollars($500,
I,as owner of the property, NEW RFSID=AL ELFGTR SQ,Ff. STORIES TYPE CONSTRUCTION
p perry,or racy employes with wages r their door
Cz6 , compenrol(on,Business and
Pwilldothe ,andthes Code:e is The ot Cotractodo License
d for
Law
D dile(Sec. ppy to alnowandf property
Code:The Contractorsthemelaw
$$ does not apply torn owner ofpropertyiso n improorst that suchOCC.GROUP RFS.UNITS
who does
renexa no tinself ndedorough fferedowne.If,hoes,providadildlegor
Improvementsasold wntendreyearferompletale.ILhowevequilder ill have TOTAL: 1t
Improvement Vsold withinoneyearo(completlon,theowner-bu0darwill have
Aturden of provingthat he did not build or improve forpurpose ofsale.). QTY PN„` PLUMBING PERMIT FEE4� FLOOD LANE A
u 1,as..at of the property,am exclusively contracting with licensed pp(h(IT ISSUANCE
cordactod to construct the project(Sec.7014,Business and Profealoru Code: '
The Contractor's License law does not apply to an owner of property who ALTER-D It& rl
_
Wilds or Improve thereon,and who contracts, for such ptojecis with a
co actor(.)licensed Pursuant th Contractor's License Law. t' FEE SUMMARY:
_- I am pt under See B &P C for t In reason BACK FLO LT.DEVICE
e DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N—
or Date RECFRTN
V KMAN COMPae ATION DECLARATION FDOURFS.PER TRAP SCHOOL TAX Y_ N
❑1 hereby of roc that I have o la um to of consent m.pythmere,ora RECERxr If
certificate of Workers Comperuatlanlruuranaoraertlfled ropythereof(Sec. GAS FA.SYSTEM.INCA OUTLETS PARK FFR Y N -
7800,IabCJ � -
Policy N GAS EA.SYSTEM-OVER 6(EA) RECFIlT 0
om any BUILDING DIVISION FEES
CCertinedmpy is heed withfurnished.
ecity _ GREASE/INDUSRiL WASTE INTERCEPTOR PLANCHECKFEE
❑Certified'copy b filed with the city Inspection division.
_ CERTIFICATE OF EXEMPTION FROM WORKERS' GRFASETRAP PAID
COMPENSATION INSURANCE
fo SEWER-SANITARY-STORM EA.20OFT. Date Rewi ttl
RMa section need not be completed If the permlt V for ane hundred dollars
($1mle
I mWATER HEATER W/VENT/MrCTR ENERGY FEE Y N
ttify that in the performanceolrhe work forwhlch this permit Issued, —
I shall not employ any person In any manner m as to become subject to the WATER SYSTEM/TREATING '
Workers'Compensation laws of California.Date PAID'
0 Z 'Applicant - NEW RESIDENTIAL ELMS. S&T. Date Reoei tW
Z O NOTICETO APPLICANT:If,after nuking this Certificate of Exemption,you
Hshould becones, b)dttothe Worked'Compensation provisions ofthe Labor - TOTAL:
CN Code,you=at forthwith comply with such provisloaor this permitshall be
> decreed revoked. BUILDING E
LU
FEO CONSTRUCTION LENDING AGENCY SEISMIC FEE
I hereby affirm that there is a construction lending agency for the perform ELECTRIC FEE
7 Z ance of the work for which thin permit b Issued(See.3097,Civ.C.) TOTAL:
u2 Lender's Name - PLUMBING FEE
LLH landce.Addma QTY. •MECHANICAL.PERMIT '! MECHANICAL FEE . OD
U I retifythat l have read this appliad tl.... Mate thMthmbave lnfemutlon
O W is correct.IagreetoemptywithallcityandcountyordinancesandMatelaws PERMITISSUANCE S;aD r--Ess PAID:
} (L relating to building construction,a rad hereby authodice representatives of thin
Zcity to enter upon the above-mentioned property for Impeelion purpose. ALTER OR ADD TO MECH. ,Date RCCCI t#
— (We)agree to save,indemnify an d keep harmless the City of Cupertino - - P _
agaiet iia Ides,pdgmenb,met d expenses which may In any wayaccrue AIR HANDLING UNIT(TO 10,0011 CFM) 'SUBTOTAL: V
againeI City In consequencgbyyyfaf he granting of this perm .
' 1 / O lqj AIR HANDLING UNIT(OVER IO,000CFM) CONSTRUCTION TAX
14
SignatureofA plicant/Contractor ale EXHAUSTHOOD(w/DUC'D CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous 1 HEATING UNIT(TO 100,000 BTU) t QQ Date Reuel tp
material as defined by the Cupertino Municipal Code,Chapter 9.1 7,and the ...-/�
He.lthand SafetyCade Section25532(a)7 HEATING UNIT(OVER IW,000 BTU) TOTAL'
❑Yes (n No
Will the applicant orfutum building occupant use equipment ordevices VFNTILATTONFAN(SINCLERESIM' ISSI epATE
which emit hazy W ous air contaminant.a.deflnrd by the Bay Area Air _WATE
Quality Management District? WILIER-COMP(31IP ORIOEOW BTI) T
4Ye gNo OCTE
have read the Nazar our miterlala requirement.under Chapter 6.95 of BOILER-COMP 100,0001171) 4
the California Health&Safety Code,Sections 25505,25533 and 25536. I
understand that if the building does not currently have s tenant,that it is mys NEW RESIDENTIAL MECH. SQ.rT
responsibility to notify the occupant of the requirements which must be met /tt�sa asF p�ss,sa�ehs�
prior to issuance of a Certificate of Occupancy. Y11L ir`Y Y�1E_�a
Owner or authorized agent - •Date
. TOTAL: .OD ISSUED BY—_ �
OFFICE COPY
(;d g u
irV
< WITH HORIZONTAL EXHAUST TERMINATION.:
P { L Locate proper position for type"PL"wail thimble(F). Use a saber saw or keyhole sawto cut a7-Inc Giamete '
hole through the wall (G)(for 3 inch pipe.) For 4 Inch p!pe, cut 8 inch hole..Install wall thimble In the hole;
s R" ;
i i he wall on floor pad. Push type 'PL pipe'(D)'through
£2.,,Position stove approximately 12" from twall
w'thimble (F). Squeeze a bead of high temperature silicone (RTS sealer (A) around end`of:machhnedtportion _
.of the 3" pipe connector on the back of the stove (B). Firmly push on section of type PL pipe](D) unteii
7 FAC �A ff>• YL .
inner.pipe Liner pushes into the bead of RTV sealer. +�dc c
a
3: Push stove (with pipe attached)towards wall. Pipe (D)will go through the wa-I thimble( Po51Uor Move
no closer than 1 inch to the wall. ` 5 lyiaglj '
4. Install type "PL" 45 degree elbow(H)with rodent screen cap(optional)on outside end of pipe OTE: ,
end of the exhaust pipe must extend a minimum of 12 inches from the outside of the building Rodent screen;
s should not be less than 3/8" in mesh. 'r `
5. If installing with combustion air from outside: cut a separate hole through the wall,fortha fresh�eirtube:(E).
kr, This tube must be 15/8 inch(min.)diameter, steel only! Conner o nis
e�� p �(r n stove(C) �Tlii
d : f tube must be terminated with a 90 degree elbow or hood (s g1 tt LoU � AIRU 4�;x 110 7 '
UQVI i n
TION DENR '
a "
' ,r'6 pttimlgA�00�11�1 D F
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•kr. .. .+qW �J' r ,
h
f' • i f
•� canmx� w-Fx�naw ce+xraxa fix}.': �� �l '
MEN
111;h un
ifflff COR
111/2
.�•
44
y'' �• H L - ,.
(DIMENSIONAL TO
`� �"^'• SS `
i r ,a VENT ALIGNMENTa
v
r^
C.
< :31 x3
T�� •_ • ;L.-,; i � .. 'h °loo' $ }�^ � y.
?Iitfleld ° VANTAGE II" pellet stove has been independently tested and listed by Warnock Hersey an
,��2eddestingYabotatory, in accordance with the specifications and procedures outlined in UL 1482 for •5` ,
Olid'fuel room.heaters, stating requirements for installation as a freestanding room heater, or hearth insert .
F asonry�o4smetal(zero clearance)fireplaces. The safety listing label is located inside the hopper,on the
d, see exannoWbWow.' S
eappliari els dsigned specifically for use only with pelletized fuels. Itis approved for residential installation
accordmg't0°currenfnational and local building codes as:
>.n
1 FREESTA�DINWROOM HEATER. See pages 14 & 15
;2. W+HTH I SERI WHEN INSTALLED ON THE HEARTH OF, OR INTO A MASONRY OR FACTTOOR�rYY BUILT
(REPLACE ice N 6k7,h. ;. Y µ
a A BUILT IN HEATER Seepage 19 " "
OCT 4 1l1 111 II' 111"'AAA
4 A MOBILE HOME HEATER. See page 13 " ja
age ♦
�bfry.:v,ISr.
NOTE :THIS STOVE NOT APPROVED FOR COMMERCIAL INSTALLATI0A1 G. INSPECTION DEPARTS
• 'CI'1,1(, OE CUPERT(NQ.�
The sto e,wlll n"ot'operate'using natural draft, nor without a power source for the blower and fuel feeding
systems:�The apphence is provided with an exhaust connector fora 3 inch type"PL"double wall vent pipe with F
It, -as 7saawer o
stainless steel-Inneer liner or single wall, stainless steel rigid or flexible pipe.
4711
S,.
'' se
lar '+"'"an'I`USTFD ROOM HEATER,PELLETIZED WOOD FUEL TYPE i}�
ALSO FON USE IN MOBILE HOMES,AND AS AN INSERT FOR MASONRY FIREPLACES d y !
ANC FACTORY BUILT FIREPLACES,OR AS BUILT-IN
!e. MODEL•.WPA ADVANTAGE TESTEDTO: UL1/82/U"27/CSA R3662w ULC-SS28(REPORT 110:6515(APRIL 1086) ,
Instep and uw only 16 sadannwBhthe mmullcWrar's Installation Instruction.Contact local budding for lire officials about raldWonsand lfi Batch Inspection In yaw are Do rot
.emnad this unit to a chlmrey lWe writing another appliance.See local bupdng page and manufacturer's Instructions lot precaution rapuired for pastng a chimney through a combintlblli
MFI crW�.�linL4;.�'�p7�y' NE IIraglipplWpru been tasted and lalad lot ua in manufactured Mme In acomarce with Oregon AdmlNSlrstM rude BI427ADO Ihiouph et 423.900
•'�+�5'Hd iflIMUM CLEARANCES TO COMBUSTIBLE MATERIALS F r•<:P N
4tlIWALL ALCOVE YCx WALL A61110ENT WALL
tF INSTAl1ID A8
—MOBILE HOME OR RESIDENTIAL INSTALLATION
/.FPEESTANDIN06TDVE" 'v'_Np11Al1iA,iL NE,WRfGILY WTERINSTALLATIONIOR I£Rf14LiWE B E ` B C
edx LTO UNMIV pA ,-u LW/71Mu IIN/71LW y L
...Lla WR 1 IIN 171AW alNl71dAA1
D]IWER TO WRS^ a WrtsaEM ux/xsAw 3 A i 4 y:-
AIOOwTOFUELHOPPEA L O 1W/tlkwr 1W/71Mu
Maryce Authaii A E r INN/e0MAN WA IIr I I c 'a
RU TO�WrAl1gl F WA SINITeMM D I D—{
SP's-^FWTi.vmn:i+Tx inn"' ��' ��•
DO.NOTgREMOVETHIS LABEL Combuglblefloor muedbeprotected by Nontpmburtlblematerial In n
- +5.ar y„- ry.-,�:, Canada and IOMM(3/BIN)asbestos millboard or eluwilend ron
� WN MR P ;:-• compatible in USA edendingbeneath line lwterand tothe front and
y v
sides a iWinted or to the nearest terminad combustible rroaral K r(
Components ragubM lot reidenlal lr•allalign or moble home Imnalatlon: + 61N(150MM)
Model PL writ W mney and eomporcma-7/75MM W 4'11 DOMM diameter. Intuited as an Inter ,
6 Padesttl Wee,pambustbn ear dux Un 7175 MM nca
Pyro Industria,nl PL chimney component,or laced single wall chimney
�F'CenUon rak of MUSNI tempeatura. Keep an door closed during firing of Ne hater. liner, Seal the area between me fireplace camper and the men.Flue may ca Installed in a
Toyuaixah pastbpa wood fust only.Replan glass only in ceramic glass. morryfireplace IN(mean nsNpnal and local building art requirement. Do nW temp" m°M'r
Electrical NAUrp Val%110,"a 3.0.Ni 60. oroksorm Nr. Maybe instaliedinatclorybulft fireplace. DorotaSerormoonythe
73^ k 'y,•>: ?
WNIMUM CLEARANCES TO COMBUSTIBLE MATERIALS: fireplace.
LS: Opsit on7ywith uxclMlrpnce OperanphiyweM
h awop Door ,
a 'pJ INSERT OR BUILT-IN elgae. InsoPr OleIrecueWN Clean hal eanngarsM flue
be it goo is preveW accumulation aW The hair and flue man !'
G. SIDEWALL 3'/75 MM 1 .;�
be a pond coMilion. ROGnrW cpmpp enw Oampa falIno pat /
,M, I. SIDEFACINGt'/25 MM for ipfam,hingsand, ne,ioalrompanenn:Shroud mrinsro
an I.TOP FACING 1'/25 MM Keeplurnifhinpsand nihrcompatible msteriaawall away from
J. MANTLE . 17/305 MM heals. :: w
PYHD INDUSTRIES,INC., EVEflETr,WA
r
Whitfield'pellet stoves and fireplace inserts are safety tested and listed by ;
Warnock Hersey Professional Services, Ltd.: Coquitlam, B.C., Canada and r,
Santa Rosa, CA, U.S.A.;;ICBO #TL116:)
F
iT.f„JY�+.:NfiS IGT •+(I .-:Y..: - �!„ L'm%4�.