30045FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING DIVISION
CONTAC :
APPLICATIONIPERMIT PLUMBING
11111" OF
"0011s .n
❑ Consultant Fees Paid by Applicant (Initial)
❑CZO
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LICENSED CONTRACTOR'S DECLARATION
I hereby afOmt that I am licensed under provisions of Chapter 9 (commencing
with Scene. 7") ofD vision 3 ofthe BUSinessand Professin and an"Neanscis
in full frmea ,office
Llccose Clas .. I,ic.N
Mule Contrrdla
AR CTS UrcC IO
I understood my plans shall be used as public commit
QTY
S!
APPLIANCES — RESIDENTIAL
C MUL'ri.UNIT
OZ
NIC
UPTO 200 AMPS
Fes.~.;
IL
Licensed Prrlexternal
OWNER - BUILDER DECLARATION,
IMPROVEMENT
OVER 10(OAMPS
a �"a 6
3 6 F
LL
=0
Y
u1..00
6 q e(
4X1 4'
[ry y
p dQ
at' r
I hereby affirm that 1 am exempt form the Caron 's license Law far the
following reason (Senian 703 1.5, Business and Pndestions Cade: Any city or county
which requires a permit to constmcl, alley, improve, demolish or repair any structure
prior 1. its issuaace, tok.mc ireslhe appliama for such permit to lileuvignedsemmem
that hers licensed pursuing to the provniomofthe Contractor's License law(Chapmr>
(commencing with Semion7000)of Divisiou3ofthe Businessand Professions Coda)or
that he is exempt Nerefmm and the basis for are alleged exemption. Any violation of
Section 7031.5 by any applicant fora pemtil subjects the applicant to a civil penally of
It., narc Nan five hundred dollars ISM)).
O Las ownerrl'tire property, or my employesswith wages on t heir arse compensation,
will dothework, and Ne.stmcture is not intended rroffered for sale (Sec. 704T Business
and Professions Code: The Conuacor.a License Law does not apply man owner of
property who builds or improves Hereon, and who does such work himself or through
BLDG
ELECT PLUMB MUCH,
❑
❑ ❑ ❑
COMMERCIAL
CNEWBLDG/ADDITION
his own employees, provided that such improvements are not intended or offered for
❑TENANT
CFOODSERVICH
sale If, however, the building or improvement is sold within one year of completion, the
C OTHER
owner- builder will have the burden of proving that he did not build or improve for pur-
pose of sale.).
1, as owner ar He popery, am exulusl vely mnconating with Ilcemal connector, to
commoner the projee5 (Sec. 7044, Business and Professions Coda:) 'I he Comemoor's Li_
se Law does not apply toan owner ofproµny who builds ur improves m ereon, and
who contracts for such projects wi$ a camnemr(s) licensed pursuant to the Contractor's
License Law.
0 I em exempt under See ,13& P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby ill maintain under pertly eperjuryone of are billowing Workers Co
1 have and will maimain eCertificate of the Lab to sole, fort for Workers Compcm
sober, as provided for an Section 3700 of the Labor Code, for the performance of the
work have and His permit is issued.
1 hove end will maintain Workers ante toation Insurance, h required by Section
3](0 of the Labor Rile, for the perfonnuna of the work for which His permit is issued.
My Worke . p� and Policy nt ape nt
�C Carrier._�jhQYF,Ce_1'alicY t}_
/� CERT TCATEO EXEMI "PION FROM ORKEI S'
COMPENSATION INSURANCE
(This section need not becompleted ifthe param is forone hundred dollars is 100)
or less.)
I certify Hot in the performance ofthe work for which this permit is issued.I shall
nut employ any person in any manner so as to become subject to the Workers' Compem
O Z .cot inn Lawsof C.1domin. Dare
Q Applicant
!q NOTICE TO APPLICANT If, after making His Cenifiram of Exemption, you should
a; become subject to the Worker's Compensation provisions of the Lather Code, you most
W forhwith comply with such provisions or this permit shall be deemed revoked.
Q
UZ CONSTRUCTION is. ciuL1iNDINGAGENCY
L)Q k hereby
whufEnn thaton,i isaed(Soairn leading agency limbs performance of
w the work for which Ihix permit Is issued (Sea 7097, Cis. C.)
O VLender's Name
{Z1 larder's Address
y I verify a that I have read Hiv application and store that the sMVe information it
U Z batmen. 1 agrce ro comply with all city and county ordinances and store laws relating to QTY.
V Z building eaconswcunnand hereby euthonzerrows. atives of this city mentor upon the
ohnve(we)agrepropene for imnify an keepe
(We) agree to cost, indemnify and keep harmless the City of Eugenio against
liahmoors,judgments, con vndof this pe which may in any way accrue against said City
- in conneyuence of the grunting of this permit.
APPLICANT UNDVRSTAN ND WILL COMPLY WITH ALL NON -POINT
SOURCE REGULATI
S roof Applicant /Cormomm Data
` HAZARDOUS MATERIALS DISCLOSURE
Willtheapplicnm nr fumm M1uilJing renmam smro nr IF nit, hazudons momdul
as carried by the Corinna, Municipal Cade, Chapter 9.12, and the health and Sorry
Code, Section 25532m)7
❑Yes E) No
Will He applicant or future building recupunt use equipment or devices which
it hazardous air components as defined by the Bay Area Air Quality Management
rich
❑Yes E:1 No
1 have mad the horealm, materials ragiremems under Chronic, 6.95 of the Celi-
fomiv Health & Safety Code. Sections 25505, M533 and 25534. 1 umkrstand del if He
building does rim ammonly have a tenant that it is my responsibility to notify the occupant
of the requirements which must be met prior to issuance of a Cenifcam of Occupancy.
ELECTRIC PERMIT
FEE
PERMIT ISSUANCE
S!
APPLIANCES — RESIDENTIAL
C MUL'ri.UNIT
PANELS
NIC
UPTO 200 AMPS
r CONTNOLp
201- 1000AMPS
IMPROVEMENT
OVER 10(OAMPS
C BATH REMODEVREPAIR El DEMOI.ITION
TEMP. METER OR POLE INST.
POWER DEVICES
SWIMMING POOL ELECTRIC
OUTLETS — S W ITCHES — FIXTURES
NEW RESIDENTIAL HLECTR SQ P-n
ALTER — DRAIN & VENT— WA'T'ER WA)
13ACK FLOW PROTECT. DEVICE
DRAINS — FLOOR, ROOF AREA. COND.
FIXTURES —PER TRAP
GAS —EA. SYSTEM -1 INC. 4 OUTLE IS
GAS — EA. SYSTEM -OVER 4 (HA)
GREASE/INDUSTRL WASTE INTERCEPTOR
GREASETRAP
SEWER — SANITARY — STORM EA. 201 FT.
WATER RHAi'lilt WNENTT I.HCIR
WATER SYS'I'EMOREATING
WATER SERVICE
NEW RESIDENTIAL PLMB. SQ. FT
MECHANICAL PERMIT
PERMIT ISSUANCE
ALTER Olt ADD TO MEC L
AIR HANDLING UNIT (TO IBM) CFM)
AIR HANDLING UNIT (OVER 10,000 CFM)
EXHAUST HOOD (WMUCT)
HEATING UNIT (TO 100,000 BTU)
HEATING UNIT (OVER 100,010 FIT U)
VENTILATION FAN (SINGLE RFSID)
BOILER —COMP (3HP OR 100.0110 BTU)
BOILER — COMP (OVER IO0A00 wru)
AIR CONDITIONER _
SQ. FE
,00
FI?E
JOB DESCRIPTION
e°rtmtl °V 30045
UNITARY NO.
APPLICATION SUBMITTALDATE
C PLUMBING RIi.PIM
C MUL'ri.UNIT
[]STRUCTURAL
NIC
MODIFICATION
r CONTNOLp
O CHIMNEY REPAIR
IMPROVEMENT
C BATH REMODEVREPAIR El DEMOI.ITION
BUILDING PERMIT INFO
BLDG
ELECT PLUMB MUCH,
❑
❑ ❑ ❑
JOB DESCRIPTION
RESIDENTIAL -
0SPOWL
C KITCHEN REMODEL
CADDITION
C PLUMBING RIi.PIM
C MUL'ri.UNIT
[]STRUCTURAL
MODIFICATION
C INTERIOR
O CHIMNEY REPAIR
IMPROVEMENT
C BATH REMODEVREPAIR El DEMOI.ITION
❑ OTI HoR
COMMERCIAL
CNEWBLDG/ADDITION
CDEMOLITION
❑TENANT
CFOODSERVICH
IMPROVEMENT
C OTHER
SQ. FT. FLOOR AREA
BUILDING DIVISION FF.BS
PLAN HECK FEE
ENERGY PEE
GRADING FEE
SOILS FEE
PAID Date Receipt ®-
TOTAL:
BUILDING FE
FEE SEISMIC FEE
ELECTRIC 1 §eE � v
PLUMBING FEE
MECHANICAL FEE
CONSTRUCI'IONTAX
HOUSING MITIGATION ME
PAID
Date Reaciptg
TOTAL: CG_
1I
agent Date - TOTAL:( (ISSUED
OFFICE
13RAINPOWER516NELEVATION: 191705TEVE1,15CREEKBLV0. ORCHARD VALLEY CENTER CITY OF CUPERTINO
13'-4°
:BRAIN POWER
5" THICK INDIVIDUAL CHANNEL LETTER5. NEON FOR INTERNALLY ILLUMINATION.'
ORANGE #2119 PLA5TIC FACE WITH GOLD TRIM-CAP.. RETURN PAINTED ORANGE
5CALE: 3 18 " =T-O' DATE: 6-6 -96
...I .................
CU
DATE
1 O90 _rN5 LREEK BLVD ..n..-
APPROVED
_ 20'-O'
STORE FRONTAGE
BRAIN POWER
CODES AND
ORDINANCES BUILDING ELEVATION-
Is set of
pans and specifications
be kept on the job at . all times and it is USTf
la Im
wful to make any changes or altered.,
an same w;thout *itlen permission front
.he bm.ding Oepl.,
fh City of Cupertino.
a stamp:ng;:f this P. ^n cnd spectficed.n.
SHALL NOT be hed to pe' or to be 8ry
+PProVal of the viola,, n of
APPROVAL PATE: DJE�1! fiance �, etaany Prod
All deciog & art works belong to Allen Signs any duplication is prohibited. COPY KIGHT-1996
a_
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iEf408 /280 -65fl0
La :; '
0408 1280 -8700
1932 S MA'E AVE.
A
SAA' - -- CA. 95125
Sia*— # 505655