28234 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CIT12 OF CUPERTINO BUILD Ni-ELECTRICAL PERMITNO /1
APPLICATION/PERMIT PLUMBING-MECHANICAL. -/8 A
BUILDING DIVISION - BUILDING PROJECT IDENTIFICATION- L 8 f-I
BUILDING ADDRESS'
��+y7�/�/ SANITARY NO. APPLICATION SUBMITTAL DATE,
r2_0 19�.y Rb � ✓ r'✓ UNIT# LOT#
OW � %I _1 ` - �/�/. PypPyly� CONTRAQOR'S AM C1 LIC NO: N/C CONTROL#
RCHITECT/ENGINEER: VLr/O_ LTC N[O7 ADDRESS`:gJ����f YYY���� ❑
CONTACT: PHONE:
QTY. ELECTRIC PERMIT PEE BUILDING PCRMIT INFO
BLDG ELECT PLUMB MF.CH
PERMITISSUANCE
LICENSED CONT'RACTOR'S DECLARATION APPLIANCES-RESIDENTIAL F �
nmz I hereby officer that l um licensed underprovisions of Chapter9(commenaingwith
POO Secrien]0lttpof Division 3 offle Business add Professions Code,and my license is in PANELS
K Wfull force effect.
<OZW F- and Licensee and UP TO 200 AMPS
Lic.# `uvL
aiU oo
Dole Contractor 201-IOW AMPS
Fu, ARCHITECTS DECLARATION OVER TWO AMPS SQ.FT.FLOOR AREA $/SQ.FT.
�Z-M I understand my plan,shall be used m public records.
SIGNS ELECTRICAL
Lirw,W Profesxianxl
OWNER-BUILDER from
DECLARATION SPECIAL CIRCUIT/MISC.
O m o, 1 hereby,mut affirm that 1 am exempt from the E,,imcer9 e:License Law for the
Y{�l 3 p.rn following reavm.(Section"!W IS,Easiness and Professions Code:Any v'ity.,,carry TEMP.METER OR I'OLF.INST.
d� 1 which requires a permit m construct,alter,Improve,demolish,or repair any suucmre
2 prior to its issuance,also requires the applicant for such parmn to rile aligned statement POWER DEVICES
� GO that w o,licensed param nt a rho provisions rfthe Contractor's License Law(Chapter
0.0� 9(commencing with Section 9000)or Division 3 ofthe Business and Professions Code) SWIMMING POOL ELECTRIC VALUATION
W M,, or that he is exempt 0terefrem and the basis for the alleged exemption.Any violation of OUTLE'T'S-SWITCHES-FIXTURES
�'. C Section 9031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mare than five handled dollars 0500). NEW R6510PJJTIAL RLECI'R .
9Q.FT
W ❑ h;unwneroftheproperty,ormycmployeeswith wugesastheirsnl¢compensation, STORIES TYPE CONSTRUCTION
N will Onthework,.cd dissimilate isms froarraledproffered passed(Sec.70 ,Business
and Professions Code:The Comment's License Law Jou not apply a an owner of
property whobuildsorimpmves thereon,andwhodoessuch work hhrealforthrough Ids
I ens,provided Nutsuch ice r t intended oroffocal forsale.If, OCCGROUP RES.UNITS
amp ry pis soldnhin one in en -
huilder ,theavet a burden of improvement that
he did me
ror improve
for purpose f TOTAL:
builder will have the burden of proving that he did nor build or imprma for purpose of
❑ I,as ownuof rhe pmputy,omexcluslvnly contracting with licensed wnrracrorsm QTY. PLUMBING PEI2NllT- "��' : FEF, FLOOD ZONE APN
construct he project(Sec.9044,Business and Professions Coda:)The Contractor's
License Lawdoes not apply to an ownerufproperty who builds or improves thereon,and PE
who wmmcts lorsuch projede with acontracbr(s)litensed pureuemmthe Contractor's ALTER-
. License Law. DRAIN&VEM'-WA'T'ER(EA) FHE SUMMARY
❑ I am exempt unJer Sec. ,B&P C for this rc BACK FLOW PROTECT,DEVICE SANITARY ONY DE FF.F.S N
Owner Date pRAINS-FLOOR,ROUF,ARCA,GOND. RECEIPT#
WORKMAN COMPENSATION DECLARATION SCHOOLTAX YN
❑ Ihcreby uflirm thatlhvveewrtificem of coneenno self-insure,orae¢ ficib of FIXTl1RE5-PER'TRAP RECEIPT.#
WnrkenCompensation Insurance.,a terrified eopy0emaf(See.3800,Lab .)which PARKFEE Y N
rs nllemployee's ander Otis pemrit. GAS-EA.SYS M 4OUTLETS RECEIPF#
Policy# BUILDING DIVISION FEES
Company GAS-FA..YS 4(EA) 40VOOOJ PLANCI IECK FEE
❑ Certified copy is hereby famished.
❑ Certified copy is fled with the city inspection division. GR ,TRL WASTE INTPkCE4CV GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' ASE TR SOILS PEL
COMPENSATION INSURANCE
(This section need not he completed ifthepemrit is for one hundmd dollars($1 ) 9 WP.R- AN ARY-STORM EA.207.rENERGY FEE
or lens)
I certify that In the performance of the work for which this pamtil isissued,Ishal ATER HP.ATER W/VBNT/ELEC"
not employ any person in any manner so as m become eobject to the Workers' PAID
Compensation Lawson Califrmia. Dare WATER SYSTEmirREATIN pate Receipt#
Z Z Applicant
O NOTICE TO APPLICAM':If,after makingthis Cerlfiaae of Exemption, ou should NEW RESIDENTIAL PL S
CY Q PT, TOTAL:
F become
defthcmply dee Workers Compensation prmitshall bite Labor Code,you most
forthwith comply with such provisions or this permit shall be deemed revoked. BUILDING FEE
z CONSTRUCTION LENDING AGENCY SEISMIC FEE
I hereby affirm that there is a cnnshurTion lending agency for Oe performance of TOTAL: ELECTRIC FEE
U O the work for which this permit is issued(See.3099,Civ.C.)
Lender's Name
U Lender,Address QTY. MECHANICAL PERMIT . l ` FEE,
PLUMBING PEE
L) 1 certify that 1 have read this application and state that the above infotmatien Is -
acorrect.I agree to comply with all city and county ordinances and state laws relating to PERMIT ISSUANCE MECHANICALFEE
building construction,and hereby authorize represenmdves of this ail,10 enter upon the CONSTRUCTION TAX
U Z n -m
boveemioned property for inspection purposes. ECH.
ALIFITORADDTOM
(We).,,as to save,indemnify and keep harmless the City of Collection againsl
Ilablllda gmems,cnsts andexpeaws which may inany way accrue against said City AIR HANDLING UNIT(TO 10,000 CFM)
incomeen.e of the granting of this permi
AIR HANDLING UNIT(OVER IO,WO CFM)
SI mrei place ommamr • ate EXHAUST HOOD(W/DUCC
PAID
HAZARDOUS MATERIALS DISCLOSURE
HEATING UNIT('TO I0T00(1 BTU) Dam Receipt#
Will the applicant mfmure building otcopantsmm mhandlelemandous material HEATING UNIT(OVER 100,000 BTU) TOTAL:
m defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)9
1-1 Yes El No VENTILATION PAN(SINGLE RESID)
BOILER-COME(3HP OR IW,O00 BTU) 14#
G ISSUA DATE
Will tsit emicati or furore defireg by tha I,Area Air Quality
Mwhichemit �I R'9
aardous air comeminanb as defined by the Bey Area Air Qunlily Management BOILER-COMP(OVER 1(I0,W0 BTU) �/ ,g -
i,riaY y c
❑Yea ❑No NEW RESIDENTIAL MECH. SQ.FT.
I have read the hazardous materials requirementsunder Chapter 1.95 nl the
California I leoltb&Safety Code,Sections 25505,25533 and 25534. 1 understand that
if the building does not currently have a tenant,that it is my responsibility to notify the
receptor of the requirements which must ba met prior to issuance of a Certificate of T�
Occupancy.
Owner or authorized agentDare ISSUED BY: f
OFFICE
OFFICE COPY '
P
F+ y
v
the FRANKLIN 491er
A stove design as historic as the American
Revolution . . . a heater as modern as tomorrow. That's
the Franklin 49'er. It's an authentic reproduction
of early Pennsylvania stoves first used during the
period of the Revolution. It proudly displays
intricate carving and rosettes on its face. . . hallmarks
of the designer-craftsman who wanted beauty in
a functional, efficient stove.
OF CNO
JML
o WASHINGTON STOVE WORKS
m y P.O. Box 687, Everett, Washington 98201
. 'NCE ,��y.
the 49'er
A bit of history for a home or vacation retreat. Solidly
constructed, all cast iron to last a lifetime. Practical,
comfortable and economical for heating. Stove is simple
to install, no masonry required. Crate included. Shipped
with top outlet unless rear outlet specified. t' f'
DIMENSIONS
Depth, front to back. . . . . . , . . . . .25"
Depth, firebox, inside front. . . . .15%z"
Depth, hearth to front . . . . . . .9%z"
Width of top at back. . . .. . . . .24-5/8"
Width of hearth. . . . . . . . . . . . . . .38"
Width, front opening. . . . . . . . . . .25"
Height, floor to top of heater. . . .31
Height, floor to center
of back collar. . . . . . . . . . . . . .27h"
Height of legs. . . . . . . . . . . . .5-3/8"
Length of straight boot. . . .
Length of elbow boot. . . . . .
Diameter of pipe. . . . . . . . . . . . . . .8"
Weight, crated. . . . . . . . . . . . . .295 Ib.
Floor to pipe ring. . . . . . . . . . . . . .37"
Floor to pipe ring on elbow. . . .. . .35'
CLEARANCES
Minimum of 24" clearance from combustible walls
unless equipped with Code Kit (below). Kit reduces
clearances to 12"Floor below must be of incombustible
materials such as ceramic tile, brick, marble, or stone
at least 3/8-inch thick and extending a minimum of 20
Inches in front of fireplace opening and a minimum of
12 inches on either side.
Franklin 49'er accessories
1111�11�1�1111
Cast iron swingout
barbecue
3 or conking not,
ha.nmered lid. Spark R,,anl
Cast I.... notion,rail,bras,
Top rail,brass
s
CODE NIT Brass ball
Includes both back shield and
floor shield.
ICBG Code approved. (
1�
Log holders,
Cast iron Cathedral rlours
Ikass finial ® Frames for mics we alsoalso,i
'
cathedral doorsare v niluhle
brass plated,as an option.
107/51 t.