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25039 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINORIJIL"ING-ELF,DHCAI PERMIT NO. BUILDING DIVISION APPLICATION/PERMIT 'PLUMBING,-MECHANICAL 25039 BUILDING PROJECT IDENTIFICATION°.' ' BUIWING ADDRESS: _ /� r - J SANITARY NO. APSPLLIICCATIIO'N SUBMITTAL DATE 4JAl � ` L „1.1 UNIT LOT It `�AK.i O F.R. AM: ON TRACTOR' N M^ LI; 0 .J V 5C N/C CONTROL# ,RCH / GINEER: ILIC NO: / ADD S' CONTACT: PHONE: $2Y,°t �' +A t"#+' Ss . I'V , 818 HTC P.EFMITT a `•I'LE a� �`��`_'�BUILDING PERMIT INFO"- 1.�i . %%�..OA�b#�4�A �&� �" B D ELECT PLUMB MECH PERMIT ISSUANCE ❑ 11 LICENSED CONTRACTOR'toominARATION APPLIANCES-1112JOB ESKON p y��y Iherehy affirm thmlam licensed mnderproFred "OChupter9(wmmenaingwilh "`-a I� r Ia /Ia I �r�jj�'-7T)w'D V VF00 Section)WO)af Division 3afthe Buynessa Pmf Bions Code,andmy license is is PANELS y�— fnllfarce. 4 ­44e lr Lic. a License [ Lic.# UP T0200 AMPS H Date - Convacmr 201-1000 AMPS SQ.FT.FLOOR AREA $/SQ.FT. F ARCHITECTI D TI N Z ^�j OVER 1000 AMPS �B — G and stand my plans shall be used us public records. SIGNS ELECTRICAL 0 ® Y V Licensed Professional Ifs �(s�� a� 1'... Y Il U OWNER-RUILDER DECLARATION SPECIAL CIRCUIT/MISC. 0.OaU IhereM1y affirm that 1 nm exempt from the Connazmu's license Law for the W'3 0.ti following reason.(Section"1031.5,Business and Professions Code:Any city of county TEMP.METER OR POLE INST. 0 C which requires a permit to construct,alter,improve,demolish,or repair any structure '"Y7 pri 1.its isconce,laine,meas thepplictial far such permit to file.signed statement POWER DEVICES DAT - W try 0 that he Is licensed pursuant to the provisions of the Contractors License Law(Chapter a4oF 9(commenciag with Scott.7MB.f Division 3 of the Business and Professions Cale) SWIMMING POOL ELECTRIC VALUATION ul m or that he is exempt therefrom and the basis for the alleged exemption.Any violation of CUTLET$-SWITCHES-FIXTURES F ¢ Section 70315 by any applicant for a permit subjects the applicantto a civil Penalty of O not mora than five hundred dollars($500). NEW RESIDENTIAL ELECTR _SQ.Ff. o ❑ I,asownemOhepropeny,ormyemployeeswithwagesas@eirsolecompemation, STORIES TYPECONSTRUC ION will Bathe work,and the strucmnisnotimendedoroffefed ficande(Sec.9044,Business and Professions Cade:The Contractor's License Law does not apply to an owner of properly whobuildsorimprrves thereon,and whodoes such workhimselforthrough his own employ.......idea Estonia improvements are not itnendedmoffered far.]].If, OCC.GROUP EA NITS however,the building orlmprovementis sold within one yesfofeompletion,the owner- TOTAL: builder will have the harden of proving that he did not build or improve for purpose of salol "111 Z949;4"­ #< "4 ❑ Las ownwo0he propony,amexdusivel [Gorlin with licensed contractor [ TY.<Kga qx rPLOMBINCPERMIT gp.I. }FE13{ 'w FLOODZONE y coo 6 .4$Yhia � d+pY Eft 3.{ Ss overset the protect(Sec. Business and Professions Code.)The Contractor'sPERMIT ISSUANCE Li cense I.aw d lies nm apply man an owner of property wh o sedids or i mproves ecq Iherandnd whoconvacts for such projects with acontmaor(e)licensed pursuant mhe Convector's ALTER-DRAIN&VENT-WATER EA) �r _i: License Law. THE SUMMARY. ❑ 1 art exempt under Sec. ,B&P C for this reason BACK FLOW PROTECT.DEVICE N SID FEEg SANITARY YN Owner Date RECEIPT'# GRAINS-FLOOR,ROOF,AREA,COND. WORKMAN COMPENSAITONofcon DECLARATION SCHOOL TAX Y N ❑ Ihereby'Compafirmthat lhave rance or ificareofcopytherof(Ser.sent to re,or380,ash C.) hicktic of FIXTURES-PER TRAP RECEIPT# Workers'Compensa[ion Insurance or acenifiedrnpy thereuf(Sec.3800,Lab CJ which PARK FEF. Y N covers all employee's under this permit. GAS-EA.SYSTEM-I INC.4 OUTLETS RECEIPT# Policy# BUILDING DIVISION FEES Company GAS-EA.SYSTEM-OVER 4 RIO PLANCHECK EEE ❑ Certified copy is hereby famished. ❑ Certified copy is filed with the city inspection division. GREASE/INDUSTRI.WASTE INTERCEPTOR GRADING PEE CERTIFICATE OF EXEMPTION PROM WORKERSGREASE TRAP SOILS FEE. COMPENSATION INSURANCE (This section need nolbe completed ifthe Penni[is frrons hu°dreddollats(SIM) SEWER-SANITARY-STORM EA.200FI. ENERGY FEE or less.) I cenifythat in the performance f,ha work for which this permit is issued,I shall WATER PRATER W/VENT/ELECTR not employ any Person in any manner so as to become subject to the Workers' PAID Compensation Laws of California. Date WATER SYSTEMTREATING Date Receipt# O Z Applicant Z 0 NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should NEW RESIDENTIAL PLMB. SQ,FT. TOTAL: F V) become subject to the Workds Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shell be deemed revoked. �a BUILDING FEF. (� CONSTRUCTION LENDING AGENCY SEISMIC FEE UZ thamby.M.that these is a conisation lending agency for the perfonnanaem'work TO ELECTRIC FEB O the for which this permit is issued(Sec 31399 Civ CJ pr Lenders Name y i W Lenders Address Ty,• RY3$MEEtfANIGAL-PERMIT �'""y-x TEE; ;, , PLUMBING EEE U I rectify ma[I have nautilus...Real.and snm Net the above information m 's` RE i s L F- I 6Wi correct l agree to comply withal]city and county ordinances and state laws relating to PERMIT ISSUANCE MECHANICAL FEE �-+ huildingeonstruction,andhereby authorize representatives ohhis city memerapon the CONSTRUCTION'1'A3I U above-mentioned property for insvec[ion purposes. ALTER OR ADD TO MECI I. (We a save,had y and eep harmless Ne City of Cupertino against liubih ,judgmets,costsana hichmayi ay aremmisgainsiseid City AIR HANDLING UNIT(TO 10,000 CFM) o equenc flthe gran' Sof is not. AIR HANDLING UNIT(OVER 10,000 CFM) Signa fA ant/ r en EXHAUST HOOD(W/DUC9) PAID HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100.05)BIT) Date Receipt# Will the applicanl or future building occupant store or handle hazardous material HEATING UNIT(OVER IW,OW BTU) TOTAL: as defned by the Cupmnino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(x)9 VEN'T'ILATION FAN(SINGLE RESID) ❑Yes 11 No Will the applicant orfuwrebuilding occupant use equipmenmrdevicee which emit BOILER-COMP(3HP OR 100,000 BTU) ISSUANCE DATE. .hu inner,air containment.as defined by the Bay Area Air Quality Management BOILER-COME(OVER 100,000 BTU) District? YFy A ` ❑Yes ❑No NEW RESIDENTIAL MECH. SQ.Ff. P D I have and the hazardous..and.],requirements under Chapter 6.95 of the ��� 19 California Health&Safety Code.Sections 25505,25533 and 25534. 1 understand that m �(]93 if❑uo builtling Jon not currently have.renan[,that Itis my responsibility notify the occupant of tun requirements which must be met prior to issuance of a Certificate of Occupancy. MII Y I• E, Owner crauthorized agent - Date TOTAL: ISSUF.DBY: t t 2 � '� y 5 � ?� L (--it E -I- R®VLD IN AMMOA ICE WITH THE CITY OF i 6�U-rP(e) 0""00 C IDES AND ORDINANCES 81ANE �j lhll llt of plana rand specificati ons M T A kept on the job at ell times ait is u nd IAWfUt to melte any changes or alteredo s A lama Without written permission fro the building Dept., City of Cupertino. fltl Rimping of this plan and specificadon S11All NOT be held to permit or to ba f-et-the viafadbif of an — �� an Cit A Y Ptoitilioa8 _ IWAe. ALTEN PAODUCt$ CO. 470-D SAN ANTONIO RD, r✓c c .�-��.v� 9 �/y PALO ALTO, CA __(415) 493-0455 Lrz-,tt - 9?, i L , (D- f/YIZ oN woo1J rw,4iw a.. i�vLecic.�GJ O�� �CQ/a+. Jl� � �1AY 4 ��. B[p� INS �99,� D ffiCE CoPY C,ryp C�l14RIJ fa L!U{YI/4�v COMPOOLi SOLAR CONTROL • Achieve optimunt pe�fi)rmanceftom your solar heatingsystem with a Compool LX-220. • Easy to Use Controls •«••�•.,• • Adjustable Thermostat 6 • Reliable Solid-State Circuitry L�--- • • Rugged Polycarbonate Enclosures e o • Hi-Temp CPVC3-Way Valve • 10K Thermistor Sensors • Easy Plug-in Connections • U.L. Listed • 1 Year Warranty Heating your swimming pool is one of the most cost Keep Your Pool From Overheating effective uses of solar energy. Your family can enjoy a During long hot spells you may find your pool getting comfortable pool without those astronomical utility bills too warm,even when the solar system is completely shut • normally associated with pool heating. off. To bring the pool temperature down,you simply switch An LX-220 Solar Controller provides the intelligence the LX-220 to the manual on position and run your filter necessary for maximizing your solar system's overall pump at night. As mentioned earlier,the solar panels will performance. And Compool makes it easy. Simply set the act like a radiator and cool the pool. LX-220 to a comfortable temperature and adjust your filter time clock to run when the sun is out.The rest is automatic! Reliable Self-Diagnostic Electronics As the originator of automated pool/spa controls, Enjoy a Warmer Pool Compool has outfitted the LX-220 with advanced micro Day in and day out the LX-220 monitors the amount of electronic circuitry. For example,the control board contains solar radiation hitting your solar collectors. When the sun's a self-diagnostic feature which lets you know if any prob- intensity is sufficient for pool heating,the Compool system lems develop with the temperature sensors or low-voltage automatically sends pool water to the collectors. In most wires. Having the peace of mind that everything is cases there is no need for a separate solar pump because the functioning properly is another Compool benefit you'll LX-220 uses your existing filter pump to supply water to the appreciate down the road. collectors. Maximize Your Solar Power 6 __A The LX-220 offers As the pool heats up,the LX-220 continues to keep tabs = n advanced features like on weather conditions. If wind or cloud cover threatens the = sensor status indicators. solar heating process,the controller automatically diverts •Y� water away from the collectors until conditions improve. Extend Your Swimming Season LX-220 SOLAR CONTROL Spring is the time you'll probably want to start raising your pool's temperature. However, it's also a time of ,,..•, ;t® WAM • uncertain weather, in which your solar collectors could auTo, KK •a ,� inadvertently end up cooling the pool, much like a car's a.�• radiator cools the engine. Fortunately,the LX-220 recognizes changes in air temperature and automatically WATUR FLOW WATERT makes the proper adjustments. For your family it means a INTO PAN ` y� .a10 TOIPERATURL chance to start swimming earlier in the season. Easy Maintenance-Free Operation The valve and motor drive included with the LX-220 Model LX220/2T Includes: system are the same top-quality components used in • Compool's more expensive pool/spa control systems. LX-220 Solar Controller Heavy steel gears,a tough polycarbon enclosure,and a CVA-24T Valve Operator no hassle maintenance-free valve assure you years of FRE-2T Solar Valve 2"-2 1/2" trouble-free operation. TS-5T Solar Temperature Sensor TS-5T Water Temperature Sensor Alternate Versions: LX220/IT Same as above with 1 1/2"-2"Valve. LX220/2Y As above with 2"-2 1/2"Super Flow Y-Valve. LX220/f As above w/o Solar Valve. LX220B Solar booster pump control,2 HP. Optional Features: Pool Cleaner Protection Recommended for pools which utilize a pool cleaner pump. This feature (RLY-SC),automatically turns off the pools cleaner pump for a few minutes whenever solar is initiated. This protects the pump from damage caused by air in the panels at start-up. Solar Booster Pump Control Recommended for use in systems utilizing a booster or independent solar pump. The pump can be controlled . . . With Compool's motorized valve independently(LX220/B),or in conjunction with the solar your existing filter pump supplies valve(RLY-SC). This feature automatically activates the • water to the collectors,so there's no booster pump whenever solar energy is available. increase in your monthly electric bill. Options: RLY-SC Relay Kit. For pool cleaner or solar booster pump control. PDD-K Panel Drain-Down Kit. Drains solar collectors whenever filter pump shuts off. HW-5B Electric Drain-Down Valve. Drains solar collectors to a zero pressure point whenever solar shuts off even if filter pump remains on. Recommended for high temperature glazed collectors. MOD-V LV Valve Module Kit. Allows the use of up to four valve and motor drive units operating in tandom. Dimensions: LX-220 Solar Controller: 10"H x 9"W x 5"D. CVA-24T Valve Operator: 6.5"L x 4"H x 3.5"W. FRE-2T Solar Valve: 2"IDX 2.5"OD. Electrical: Compool Quality. Built to Last. Field Selectable: 115/230 VAC. Since 1975,Compool has supplied homeowners with Relay: 20 AMP,2 HP Ca 230V. Ca WIN Me 5 T over 50,000 control systems for pools,spas,pool/spa U ( 0 Cartputertzed Pool Systems combinations and solar applications. ®L LISTED a uMEMEEP Compool's commitment to innovation and qualityC CORPORATION P is u© 5999 FAIRCHILD DRIVE your assurance that you have purchased a state-of-the-art NATIONAL NALOL A SPA MOUNTAIN VIEW,CA 94043 solar controller. INSTITUTE (415)964-2201 943-0809 ®°Solar Industries AQUA THERM SP SOLAR COLLECTOR "Built to perform, built to last" • Proven Performance In All Climates heat trap design gives better all-day performance even on windy days. • Patented Tube and Curved Web Design • relieves stress caused by expansion and contraction for longer life. • Stainless Steel Mounting Hardware - greater strength and rust free with fewer mounting points for easy installation. • Made In The U.S.A. - Since 9976 and C _ nI backed by a Lifetime Warranty, AQUA-THERM SP CROSS SECTION-ACTUAL SIZE Technical Data DIMENSIONS MATERIALS • Model Number 11051 11001 11002 11011 Nominal Size-ft. 4 x 12 4 x 10 4 x 8 4 x 6 Absorber Plate Overall Panel Length-In. 144.0 120.0 96.0 72.0 Propylene copolymer with synergistic Panel Width-In. 47.0 47.0 47.0 47.0 antioxidants and Uv screen Including carbon Manifold Length-in. 51.0 51.0 51.0 51.0 black Manifold O.D.-In. 1.9 1.9 1.9 1.9 Manifold I.D.-In. 1.5 1.5 1.5 1.5 Hold-Down Straps Gross Collector Area-f? 47.3 39.3 31.4 23.6 Net Collector Area-ft- 47.3 39.3 31.4 23.8 Polypropylene coated stainless steel frype 302) WEIGHTS Connecting Hoses Dry-lbs. 21.3 17:1 14.3 11.5 EPDM(ethylene propylenedlene-terpolymeq Wet-lbs. 48.0 41.6 35.1 28.6 Wet-lbs./ft' 1.01 1.06 1.12 1.21 Clamps and Brackets Fluid Capacity-gal. 3.2 2.9 2.5 2.1 Stainless steel(Type 302) FLUID FLOW RATES Maximum-GPM 10.0 10.0 10.0 10.0 APPROVALS Minimum-GPM 3.0 2.5 2.5 2.5 Recommended GPM 5.0 4.0 3.25 3.0 Florida Solar Energy Center, Dade and Palm Max. Panels with Single Beach County, Fla.,City of Ft. Lauderdale, Feed ® Recommended Arizona Solar Energy Commission, New Mexico Flow Rate 10 12 12 12 Solar Energy Institute,State of Wisconsin, International Association of Plumbing and PRESSURES Mechanical Officials,City of Los Angeles Pressure Drop 0.30 ft. head(0.13PSI) pressure loss recommended flow rate 0.20 ft. head(0.09PSQ pressure loss o minimum flow rate Max. Fluid Pressure Greater than 85PS1 ® 817F Recommended Max. Operating Pressure 35 PSI ® 140° AQUA-THERM SP THERMAL PERFORMANCE RATINGS • Thermal Performance Equation- n=81.8-3.28x Florida Solar Energy Center Certification Incident Angle Modifier.Kgr = 1.0-.016 (BTU's per standard day) Time Constant. 1 minute 4 x 12-44,000 4 x 8 29.500 (Rated In accordance with ASHRAE standard 96.80) 4 x 10-36,800 4 x 6-22.100 Specifications subject to change without notice, FLO—DIRECTOR SYSTEM DIAGRAM VACUUM RELIEF VALVE FOR OUTDOOR POOLS , SP SOLAR COLLECTORS SOLAR SENSOR—y VACUUM RELIEF VALVF. • ImMoRELIE O1END CAP I - INLET LINE TO SOLAR COI.LECtOR OUTLET LINE FLOW METER ELECTRONIC CONTROL THERMOMETER w,.•rr VALVE CONTROL ISOLATION CHECK VALVE LINE mnno�.rr 1201240 V LINE ISOLATION ' OUTLET TEE BALL VALVE y�! HEATER BY FILTER BALL VALVE I Y Wlmn.p MOTORIZED DIVERTED VALVE' -1— CHECK VALVE I NEATER ITrmnarr PUMP POOL WATER COOL WATER TO SENSOR SOLAR HEATER HEATED WATER �—TO POOL THERMOMETER POOL INSTANTANEOUS EFFICIENCY OF HEAD PRESSURE LOSS OF MULTIPLE 4' x 10' SP SERIES COLLECTORS SP SERIES COLLECTOR 1� 1b m �? 15) -.4 PANELS B PANELS e TO c BPAN E 9 LS Y 91d1 IO PA NELS WU F B 12 PANELS 5e LL U UWu,. 7(3) u do d 6 W 30 5 ZD = (2) 4 3 m7 0) 0 —ELI 1 00di I- -.05 0 .05 .10 .15 .20 .25 0 ,I,r.r .E_HR_ri• I Btu 0 10 20 30 40 50 60 FLOW RATE-GAHOR9 Per Minnie TESTED IN ACCORDANCE WITH ASHRAE STANDARD Y&SO SP GUIDE SPECIFICATIONS Conseclor to supply and install _panels,nominal size(4'x12,T x10, Header length shall be 51 Inches. 4" v 0'1 with overall frontal area of (47.0, 39 3, 31.4)square feet mach. Panels shall be Panel mounting shall consist of 18-8 chromium nickel simmers steel mounting hardware with fabricated from a propytene copolymer with stabilizer comhinalion providing long term Iwo continuous transverse straps having black polypropylene coaling.Transverse straps shall esismnre to heal and light. The weight of collector when filled with water shall be no more be laslened with 18 8 chromium nickal stainless stool clamps and brackets. then 1,12 pomnds per square fool of frontal oma. the panels shell be capable pl withstanding Water connections shall be made with hose sections extruded from EPOM (ethylene. an informal stalk pressure of 85 psi at operating lemporahrte and shall be resistant to propylene alone derpolymef) 70 duromater minimum hardness, Hese Clamps shall he all corrosion,freezing and internal scale acrumulationstainless worm gear type with 18 8 chromium nickel stainless band Panels shall be capable of thermal performances of at least 81%efficiency when inlet fluid The panels shall comply with the requirements specified in the Intonational Association of In comone,equals ambient temperature and be capable of collecting solar energy when the Plumbing and Mechanical Officials' Uniform Solar Energy Code, latest Edition and eemr inlet]fund temperature exceeds the ambient temperature by 60 F with 250 BTU per square applicable nationally recognized standards,and shall be manufactured in the U.S.A. fool poi hour. Pressure head lass of a single panel must not exceed 0.30 feel wafer at recommended flow rale. Solar Industries A Division of Aquatherm Industries, Inc. • 1985 Rutgers University Blvd. • Lakewood, N.J. 08701 (908) 905-0440 • 800-227-7657 • FAX (908) 905-9899 PT.NO,19280 REV. 12190 SP Copyright 1990 to 04 n o $ SIT �Iz v � = u cl ; z � z W Z iA� d z Q CAI a e Qj Ile o at a w v ;E°� W Vi W Ir z n ,D kk C O �v tt " Y z APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILTNG.ELECT �RICAL PE 1'I'NO. BUILDING DIVISION APPLICATION/PERMIT .unulmc-MI?OBANIGA, BUIhIIING PROJECT IUKNTIFICATIl1N 0270 BUILDING ADDRESS: SANITARY NO. AI'I'LICA'TION SUISMl7"fAL DAPI t, 2Z3 �VPj2sjD� q pµs •G PHONE: CONTRACI'O ;9 NAMP IJCN NIC CONTROL# ARCHITECT/ENGINEER: LIC NO: H'S'. 1:18 CfkK.N.tELt'r64 04 A4 CONTACE PROBE. ITU ILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT' PLUMB M-ECH ❑ ❑ ❑ �pf LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMIT FEE 1 hereby affirm That I mu licensed under provisions of Chapter 9(commencing JOB DESCRIPTION O�Z with Su,ion7")ofDivisinn3 of Ne Businca.amd Professions Code,county licensers RESIDENTIAL: W Q PERM r ISSUANCE E.00 F in full force Ind eff?...W 3 0 SFDWL ❑KITCIIHN REMODEL UU License Class CC.• Lic.p APPLIANCES-RESIDENTIAL El ADDITION ❑PLUMBING RPPIPE h<y DnmCnmmcmv ❑MULTIUNIT ❑STRUC'T'URAL F',n A HI"fECTS DIiCLARA N PANELS Z p j9,,a 0 1 understand my plans shall the used us public records - MODIFICATION OZ-O UlIT02WAMPS C)INTERIOR E3 CHIMNEY REPAIR F� W.�j Licensed Professional 20LI(g10AMPS IMPROVEMENT E]SWIMMING POOLS H 0.6 OWNER-BUILDER DECLARATIONeConnector' OVER 1000AMPS ❑BATH RHMODEUREPAIR ❑DEMOLITION RyyI hcrehy alTnn thin 1 oro exempt from the Cnnuador's License Low lie the )d d U following reason.(Section 703I.S.Business and Profession.:Cale:Any city it canlntY SIONS ELECTRICAL []OTHER Y 3 w, which inquires.permit,i cormuum,blmr,improve,demolish.or repair any structure 0, pnito its issuance.also requires the applicant for such pem,inn file asigneJ etammen, SPECIAL CIRCUIT/MISC. a�} that he is licensed pursuunnnahe provisions of the Comment's license Law(Chapter 9 ayQO (commencing with Section 9110()of Di,urn 3nf l he Bumac,,and Professions Code)or 'TEMP.METER()It POLE INST. COMMERCIAL' tai Gyx qo eG thin an,is oxcmpt therefrom and the hick for the alleged exemption.Any Aalntinn of ❑NEW BLIDOADDITION ❑jYumou'f10N Warn Section 7031+5 by any applicant for a permit subjects the applicantto a civil penalty of POWER DEVICES ❑TF.NAN'I ❑FOODSIiRVICF. not more than five hundred dollars($5001. IMPROVEMENT E?C ❑I,as ownerof the property,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC W 3 will do the work.and the structure is not intended ofoHered for sale(Sec.RHy Business ❑OTHER � and Profci,nos Code.'The Com ewho"License Law docs nm apply to an owner of OUTLETS-SWI ITCHES-FIX'I'USES 44 a' property who build.,or imp mv,s toereon,and who does inch work himself e,through his own employees,provided thin such improvements am ma intended m onered for NEW RESIDENTIAL ELECTR SQ FI'. sale.IL howeem the building or improvement is sold within one year o(completion.the 'Q.FT.FLOOR ARBA 8/SQ.FT. owner-builder will have the burden of proving that he did not Wild or improve for pur- pose of utle.). 1,as owner of the property,am exclusively contracting with licensed connectors to TOTAL: constru t the po ce,(Sea 9844,Business and Poafessions Ci cO The Convactora I.i- - Aw cera,L,w docs not apply net an owner of property who builds or improves thereon.and QTY. - PLUMBING PERM IT FEE ry who contracts for such projects with acommmor(il licensed pursuant to he Contractor's O License Law. PERMIT ISSUANCE G� ❑1 am exempa under Sec. .B&P C for anis reaxon AUGER-DRAIN&VENT-WATER IPA) VAI UATI n_ Owner Dure H I►`f(/I] WORKER'S COMPENSATION DfCLARAI70N RACK FLOW PRIG'IiCT.DEVICE LU Iherehy affirm under penalty of perjury one of the following declarations: — ❑ Ihave anJ will maimein uCenihmte of Cinunuo self-insuinfor Work,Oi Compen- DRAINS-FLOOR,ROGER AREA.COND. STORIES CONXI'RUCTR:R onion,m Provided for by Section 377 of the Labor Code,far the perforoaanec of the work fir which this permit is issued. FIXTURES-PER TRAP ❑ 1 have and will mtinmio Worker's Compensation Insurance,an required by Section ' 37M of the Luhor Code,for the perfonnnnce of the work for which this Permit is iswed. GAS-EA.SYSTEM.I INC.4(Ill'ILFTS Worker, OCC.GROUP AI'N Worker's Cnmpensatinn Inxurence wanu rier and Policy mber are: y Policy No.: GAS-EA.SYS'I'LhLOVER 4(HA) CERTIFICAM OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASFIINDUS'I'RI.WASTE,INTERCEPTOR BUILDING DIVISION PELTS fl'Lis sectiin need not be completed if the Permit is(mane hundmd tattoo LS 100) it less.) GREASE TRAIT PLANCHECK TE (certify ohm in,M1e Performance nfthe work mrwhichda,peranniOutted.[shall SEWER-SANITARY-STORM IiA.200 FT. not employ any person in any manner so as to hewn subjlyt rn t rs'Compen- ENERGY FEB 0 Z :inion LawIII !,ore id I WKIER GRATER WNENTTLECI'R 0 ApPlicLaGRADING THECE TANT:IL aft Inokt t Is C,rti talc of Exemption,you should WATER SYS'I'I?MII'ItGATENG SOILS FEE Worker's Compens ion provisions of the I'mor Code,you musth such provisions or this Permit shall be deemed revoked. WATER SERVICE Uj 0. Q CONSTRUCTION 1.1; DING AGENCY NEW RESIDENTIAL PLMB. SQ.Pr. ' PAID V 0 I hcrehy affirm door there iso com roue on lembro,agency mane,performance of TR, ,pt p the work for which,his pencil is issued(Sec.10)7.Civ.C.1 Lender's Name TOTAL: Q Lender's AJArexs TOTAL: I cccify,hat 1 have read this application ad state that the above information is - IIUI G PEE V0.) correct.l agree to comply with all city and county ordinances and state laws rcllningm QTY. MECHANICAL PERMIT FEE U building construction,and hereby celomic representatives ofthl.s city to enter upon the SETS IEE alcove-Ineniioned pmperly l'nr inspeclion puTtisas. 11EIt MIT ISSUANCE (00,1 ogre,o save,indemnify and krep harmless the Ci,y of Cupcnino again,, IiLISC'1'RIC I IN liabili,ies•judgments,costs and expenses which may in any way accrue against said City AI.TEiRORADD'I'OMECH. in consequence of the granting of this permit. - PLUMBING Ii i ' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000 CFM) SOURCE RU,U ATIO f 7-F-47 s as J MECHANIC V. TE • 7Glint 1-2.0 ,P¢ AIR HANIILING UNIT(OVER 10,000 CFM) CONST tUCI'10 TAX Signature phemucimtinctnr Data EXHAUST 11001)(WIDUCT) HOUSING MI'1'IG TION Oi1i HAZARDOUS MATERIALS DISCLOSURE i ,he applicam nr future builJing aewupam Wore mhanJle haza,dnus mamdal HEATING UNIT If01W,00s9 RJUR as do o by the Capertfeu Municipal Code,Chapter 9.12•and the Health and Safety Coda,.urian 25532(a)9 HrA'TING UNIT(OVER Ushao)BTU) yesNo � VENTILATION PAN(SINGLE RES 11➢ PAID Uwe Receipt# Will the applicant or future building occupant use equipment or devices which ,mid hazardous air cnnmmimams as defined by,he Bay Area Air Quality Management BOILER-COMPOHPOR 100.00OBTU) TOTAL: District? ❑Yrs [:J No BOILER-COMP(OVER I00d X)B BTU) - Ihave read the hazurdoormacrals rcgniinmems uask,Chapter 6.95 of,he Cali- AIR CONDITIONER ISSUANCE DATE (omit Health&Safety Cale,Se tions 255(15,25533 and 25500.1 understand that if the NEW RESIDENTIAL MECH. SQ.1--n building distinct carnally owe a asnim,that it is my responsibility m notify the necuNm ,f the rcGhirements which must Is,me,prior la issuance if a Certificate of Occupancy. Owner or authorized agent Dam 1 ISSUED BY: OFFICE