30252APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING - ELECTRICAL
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BUILDING DIVISION APPLICATION/PERMIT PLUMBING - MECHANICAL
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30252
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BUILDING PROJECF IDENTIFICATION
BUILDING ADDRESS:
SANITARY NO,
APPLICATION SUBMITTAL DATE
2 9 55 Fs STS-�WS'
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OW ME: 1'I3ONE ,r� CONTRA TOR" M LIC NO:
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P. 770Qv 1 g7
N/C
CONTROI.n
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RCHITECf/[NGINEER: LIC NO: ADDRESS:
i l�Y/-c aeon g
ONTACt. PHONE:
; /'75� ❑ Consultant Fees Paid by Applieant (Initial)
BUILDING PERMIT INFO
BLDG ELECT PLUMB MUCH
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LICENSED CONTRACI OR'S DECLARATION Q'TY ELECTRIC PERMIT FEE
I hereby afTirm Nat I am licensed under provisions of Chapter 9 (commencing
with Section 0(1a0)nf Division 3 of the Businessand Professions Code, and my license is
is WE force rould"d.e PERMIT ISSUANCE
Lman Class Lic.x
DaaCmm�cmr APPLIANCES -RESIDENTIAL'
JOB DESCRIPTION
RESIDENTIAL,
CSEDWL C KITCHEN REMODEL
❑ADDITION ❑PLUMBING RE -PIPE
CMULTI-UNIT []STRUCTURAL
MODIFICATION
El INTERIOR [D CHIMNEY REPAIR
AR PI'CT'S DECLARATI N
1 understand my plans shall be used as public records PANF.IS
UP TO 200 AMPS
Licensed Professional 201-100GAMPS
ON OVER NPXAMP$
I hereby affirm that 1 em exempt from the Conuucmr's License Law fur IM1c -
Oat I am exempt f DECLARATION Contractors
following.... (Section 7031.5, In sinesx and Professions Code: Any city or countyIC- e.SIGNS ELECTRICAL ��
which requires a permit to conswet, other, improve, demolish, or repair any swcture
prior to its issuvnce, also requires the npplicantfor such permit to files signed omenta., SPECIAL CIRCO IT/MISC.
that he is licensed pursuant to the provisions of to Comratnr. License Law (Chapter 9
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IMPROVEMENT
❑BATH REMODF.IIREPAIR ❑DEMOLITION
C OTHER
COMMERCIAL
C NEW BLDG/ADDITION []DEMOLITION
❑TENANT ❑FOODSERVICE
IMPROVEMENT
DOTTER
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Wit,
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(commencing wit Section 7000) of Division 3 of the Bromess and Professions Com) or 'I EMP. METER OR POLE INST,
tat he is exempt tereGom and the basis I'or to alleged exemption. Any violation of
Section 703 L5 by any applicant for a Permit subjects the applicant m a civil penalty of POWER DEVICES
n nmm tan rive hundral dollars($500).
01, as owner of me proprty, or my employees with wages as their sole compensation. SWIMMING POOL ELECTRIC
do to work, random sumbare is not intended oroffamdI for sale (See 7114, Business
nwill
W �
�'
end Professions Calc: Thmm
Tire Coamr's Lirense Law does not apply m nn owner of OUTLET'S-SWUCHIES-FIXTURES
property who builds at improves thereon, and who does such work hirmalf or through
his own employees, Provided Nat .such improvements are not intended or offered for NEW RESIDENTIAL ELECIR SQ PC
SQ. FI'. FLOOR AREA -
$/SQ. FI'.
sale. If,however, the building or improvement is sold within one yeanrfcnntpletion,the
ncrfb lider will have me burden of proving that he did not build or improve for par-
pose o
E] 1, as owner of the property, am exclusively contracting with licensed amtmcuusto - L;
construct the Project (Sec. 704,U lavishes and Professions Code:) The CnmmctorI Li-
cause Law does nm apply to on owner of property who builds or improves thercer.and Q'TY. PLUMB INC, PERMIT FEE
who contracts for such projects with a contmm
egpursuant m th
s) licensed e Contracmrs
22 1JI1
JUL p
�xii
License Law. I PERMIT ISSUANCE
I am exempt under Sec.' , B 5 PC for (his maom
CIT Y Ur UUPLriI m(
I '
ALTER -DRAIN & V - ATER IEA)
Owner Date
VALUATION
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTF.C'f. DEVICE
1 hereby affirm under penalty of perjury one of the following dselarations:
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I have and will maintain it Cetifcate of Consent to self -insure for Worker's Compen- DRAINS- FLOOR, ROOF, ARBA. COND.
random. as provided for by Section 37W a] the Labor Code, for to Performance of to
- STORIES
TYPE CONSTRUCTION
work for which tis pent is loaned. FIXTURES - PER TRAP
C 1 have and will maintain Workerx Contras....... Insurance, as required by Section
-
37100ofte labor Code, fur the pcdnmmnce afte work for whichou, pe unit is issued. GAS -EA. SYSTEM- I INC.4 OUTLETS
My worku' n da rap nc conwared Policy
OCC. GROUP - -
APN
No.;[,O�'.�J1I7n/ GAS -EA. Sys 'I'EVE-OVBR 4 (EA)
,
CERTIFICAT :OF EXEMPTION FROM WORKERS'
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COMPENSATION INSURANCE GREASI%INDUSTRL WASTE INTERCEPTOR
CUrs.metion need nal be completed if the permit is fronts hundred dollars ISI W)
or less.) GREASETRAI'
I Error Eye that in the performmme of the work lou which this permit is i.svrst I shalt SI?WER-SANITARY-STORM EA. 200 IF nal employ any n in any manner so as to marine subject m to Workers' Compete- -
Dom
sarApplicant
D ���
. BUILDING DIVISION THUS
PLANCHECK FEE
ENERGY FHH
WATER HEATER WfVHNT/ELF.CTR
Applicant
GRADING I'P.P.
NO'TICET APPLE AN7T ter makmgt Cem6cn cu ExempOon, you should WATER SYSTEM?BEATING
become smbjem to the notice"Compensation provisions of to Lnlmr Cade, you must
forthwith comply with such provisions or this Permit shall be deemed revoked WATER SERVICE
y
f-'
SOILS FEE
Q
V.Q
CONSTRUCTION LENDINGAG,,.cy NEW RESIDENTIAL PLMB. SQ. Ff.
I ml tel there isaral(Sect30?7.leading agency fire he performance of
PAID
Data Receipt ft
Rs F
OU
farwhich
to work (or which this permit is issued (Sec. ..097. Civ. C.)
Lenders Name
Lendefs Address TOTAL;
TA
TOL:
Or
1 certify tat I have read this application and state that the above information is
BUILDING FEE Q
14
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conal. I agree to comply with all city and county nrdmrerocs and slate laws relating m QTY. MECHANICAL PERMIT
building
construction.ilding consction. and hereby authorize representatives of this city to enter upon the
SEISMIC FEE
above-mentioned PI.Peny for inspection purposes.
(We) agree to save, indemnify and keep hand... the City nl Cupertino against PLEEMITISSUANCE
ELECTRIC PER
liebilitics,iudgmems rosimedesNmes which may in any way accrue sgaimt and City ALTER ORADDTO MECH.
PLUMBING FEE,
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT AIR HANDLING UNIT(7010.0W CEM)
SOURCE REGULATIONS.
MECHANICAL FEE
AIR HANDLING UNIT (OVER 10,000 CFM)
CONSI'RUMIONTAX
Signnmre of Applicant/Comractor Date EXHAUST HOOD(W/DUC1)
HAZARDOUS MATERIALS DISCLOSURE
HOUSING MITIGATION PEP.
Will theapplicant or future building occupant store or handle hazatJom material HEATING UNIT (to Usk" BTU)
as derined by the Cupertino Municipal Code, Chapter 912, and the Health and Safety
-
Com. Section 25532(x)? HEATING UNIT (OVER 100.000 BTU)
❑Yes []No
VENTILATION FAN (SINGLE RESID)
Wilton, applicant or future building occupant Ease equipment or devices which
rdous air canmans as defined by the Bay Area Air Quality Management BOILER - COMP(3HPOR IW,(gO BTU)
mait hazatin
District'!
PAID
Dan IteceiptM
'
TOTAW
Dy. ❑Nr BOILER - COMP (OVER IW,W(IBTU)
I have read the hazardous materials regoiuemem, malar Chapter 6.95 of to C.li- AIR CONDITIONER
fomia Heal a4 Salary Co e. Sections 25505.25533 and 25534. 1 undmswnd ohm .the NEW RESIDENTIAL MECH. SQ. IT.
build, amt Inner all a minor. amt itI, my resemnxlbil ity m unify thmweupant
ISSUANCEDA
oft nth t t m of.cen cafe f
�r� 2-� p6
.
OwneroraEtance at Date TOTAL:
ISSUED BY:
OFFICE
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VERN,-,BURGESS.�
PH: (408) -267-56W-, AW Y&WW-GLEW�,
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FAX- (408) 267-5505 SAN JOSE, CA -95125
.. NOTES: -
A) Access for Installation in front of and behind wap must be available at time
of installation.
B) Through wall installation is assumed to be on normal stucco, wood or soft
brick facing.
C) System will be connected to on approved electrical sign circuit which must
be available within 6 unobstime of installation.
1) Custom fabricated sheet metal construction sealed to eliminate fight leaks.
interior to have white reflective finish. Exterior to be automotive enamel over
primer undercoat, colors as per approved plan.
2) Acrylic plastic face with trim cap edge.
3) i Neon gps intedot illumination system
4) Conduit system with flex crossovers between letters and transformer boxes.
5) PK housing.
6) Y4.1'A ' Nylon anchors (or) '10=1'h lag bolts.
CHANNEL - LETTER DETAIL,
U.L;. APPROVED (PK HOUSING)