26750 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-P.LKCI'RICA], PERMIT NO.
APPLICATION/PERMIT PLUMBING-MECHANICAL /�[s C O
BUILDING DIVISION 1 s BE I LDING PROJEC'IA DENJIFICAI ION G O J
R(IIILLDaIING ADDRESS: ���/J c ��' SANITARY NO. APPPL[CCA''1'ION SUBMITTAL DATE
-0 1 �r `l J uWv/L UNIT# LOTH
OWNERS NAME: PITON � CONTRACTOR'SSNAME:
• , N/C CONTROL# /
HITEC17ENGINEER: LIC NO: ADT)7i� GGlVVN4V � JD El
CONTACT: PHONE:
���� ��//�I__����r, / ( �,,�, �7,� /] / �J QTY. ELECTRIC PERMIT FEP, BUILDING PERMIT INFO
NV#rT7 NNi .��C/�
/P7 ` ./�O_J PERMIT ISSUANCE BLDG ELECT' PLUMB MECH
❑ ❑ ❑
I.ICENSEDCONIkA OR'SDIICIARATION APPLIANCES.RESIDENTIAL. TOB DESCRII'I'ION
eu'z Hiembyoffirmtbatlwn licensed under poevisionxiAChapter9(commencing with ^�
WOO Section]0(Ifl)nf DivisionJoftha Businessnnd Professions Code,and my license is in PANELS ll./l I N
ed WC[' fa[if arce an I if f 1V 'v
L<zw License Cl a 1 Lic.N---?I UP T02W AMPS
m7y
Data Corrine. 201-1000 AMT'S
Z FOyaARC)II'IECTS DECLARATION OVER IOIX)AMPS SQ,IT.FLOOR AREA $/SQ.ML
0z TO Iundemlundmyplansshall he mens publicrecords.
r y 5, SIGNS ELECTRICAL
yy Licensed professional
M �6 OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
X O Iy F mf
1 hereby affirm that I am exempt from the Cmdracm/s License law for the
003following reason(Section 1031.5,Business and Professions Cole:Any city or coy TEMP.METER OR POLE INST.
M1 which.squirm a permit to summer,ober,improve,demolish,or repaif any structure
� priorto its issuance,also requires the licant forsuch it to lileasi nedsmoment POWERDFVICES
yto th pp pent g
Om thatheis licensedpursuantmtheprovisions of the Ce Busi Business
License Law(Chapter
o, e4 9(commencing hisscwith cinion2rXXBnf Division 3nOhe Busineas"nd Professions Code) SWIMMING POOL ELECTRIC VALUATION
_y or that he iseacmpuhcrefromend the basis(ooh<alleged exemption.Any vinladon of OUTLETS-SWITCHES-FIXTURES /O
zG Section 2011.5 M1yanyapplicant fcr"permit subjects theapplicant toacivil penalty of
[u mnot mumthan fivelhepro ny,orniyemdollars ). NEW RESIDEN'RAL ELECTR _SQ.FT. S'I'OR)13S TYPECONSTR CION
❑ I,the w work,
an [be
reoffered
burials(S c.compensation,
will dothewons and the he Coreisnot intended Law
dos not apply t tion Business
and Profe.aiuns Crate:The Ctumraeors License taw does not apply m en owner of
Tnoperty whobuildsor improves flu aon,end whodoea such work himulfor through his
own employees,providedthat such improvements am not inrandedorofferedfmade.If,
OCG GROUP RFS,UNITS
however.the building orimprovcment is sold within one yearofcnmpletion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
stile.).
❑ I,as ownerndthepmperty,amexclusively contracting with licensed contractors to QTY" PLUMBING PER IT M FLOOD LONE APN
orewct the project(Sec.2044,Business and Professions Code:)The Connector's PERMIT ISSUANCE
License law does not apply to an ownerof pty w
roperho builds or improves thereon,and
who contracts forsuch projects with aconvuctor(s)licenud pursuant to the Conuactale
License Law. ALTER IRA) 17EE SUMMARY
❑ 1 am exempt under Sec. ,B&P C far this reason BACK FLOW PROTECT.DEVICE OUTSIDE L :E
SANITARY Y_N
Owner Date RECEIP #
COND
AREA,, .
WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR, SCHOOL TAX YN
] ers'Co pensatsufflon,oat I Insura c eortificate anifie conunfroadf(Seuure,or a certificateich RECEIPT'N
orkers'Compensmionlnsurance orerenified copylherrof(Sec.Jggl,Lab C.)wNch N(TURESPGR TRAP PARK FEE YN_
covers all employee's unXer hist'd RECHIPT N
Policy# Iwf('I� W' bM)� GAS-EA.SYSTEM-I INC.40UTLP,TS BUILDING DIVISION FEES
Company
❑ Certified espy is hereby famished. GAS-EA.SYSTEM-OVER 4 EA) PLANCHECK FEE
❑ Certified copy is filed with the city inspection division. GREASWINDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATEOFEXEMPION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(Tlla,,.Lon need not becnmpleled ifewpofail is fortune hundmldollms IS Halt SEWER-SANITARY-STORM EA,200FT. ENERGY IRI3
or lees.)
I certify that in the performance ofthc work for which this Permit is issued,l shall WATER HEATER W/VENT/ELECR
not employ any pecan in any manner so as to become subject to the Workers PAID
z Compensationlawsof Califomi". Date WATER SYSTEM/IREATING Data Re ciptIf
Applicant
z 0 NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should NEW RISIDHNTIAL PLMR. SQ.MI. 'PO'TAL:
L') harcom sahjcel1.the Workers Compensation provisions of the Labor Code,you must
5 forthwith comply with such provisions or this permit shall he deemed revoked. BUILDING FEE
W O CONSTRUCTION LENDING AGENCY SEISMIC FEE
7 Z �1 heaby affirm thauhem is a construction lending agency for the performance of TOTAL: L'LECTR sP
V O the work for which this permit is issued(Sec.3W7,Civ.CJ
LL. Lenders Name y -
LendersAddress Q'I'Y..: _ MECHANICALPERMITI "FES PLUMB
U a I certify that 1 have read this application and state that Ne above information is .
correct.l agree m comply with all city and county ordinances and state laws relating to PERMIT ISSUANCE. MECO f11IFA 1 I/.F,
� buildingconsimciion,mdhemby"nthorizeap Mtativeaofthisciiyioenteruponthn CONSTAUCf10N v
L] Z above-mentioned property for inspection purposes. ALTER OR ADD I'O All
(We)agree to save,indemnify and keep harmless the Clry of Cupertino against
banal lities,judgmmuta.ams and capemn which may In any way accrue against said City AIR HANDLI NO UNIT(TO 10.000 CFM)
in em sefamee or rhe Smiting of this permit.
AIR HANDLING UNIT(OVER 10,00)CFM)
Signal=of ApplicaaVCommcmr Date EXHAUST I IOOD(W/DUCD
PAID
IIAZARure b MATERIALS DISCLOSURE
HEATING UNIT(TO 100,000 RTU) Duro Receipt#
Will the applicant or frau building occupant store or handle hawNh anmateriel
as defined by the Cupcninde.n Municipal CoChapter 9.12,and the Health d Safety HEATING UNIT(OVER 100,000 BTU) 'I'O'1'AL:
Code,Seairon Y� p32(aVENTILATION PAN(SINGLE RESID)
Will the"commit encs as defy d by the Bay Area Air
esanagement
BOILER-COMP UYIP OR 100.000BTU) ISSUANCE DATE
ozardoas air wmaminams as Aclined by the Day Area Ah Quality Management BOILER-CDMP(DYER IW,)(q BTU)
tisvict^ J
❑Y05 Vat NEW RESIDENTIAL MECH. SQ.t1'.
1 have rtad the hmmill moment,reyaire nems under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,2553]and 8534. 1 understand that
if the builmmidoes not turf if,hove"tenant,that it' y rtsponsibility,as rally the
oceupam of the re 'e e which t ma pat to seance of a Cedifieate of
Occupancy. ,�y. mg., 4
Owner ormhori
azcd egem Dae TOTAL: ISSUED BY:
x,. . OFFICE
,r.
t
L 06'ATI ol-4.
- NAY•: tf0+101�
4 { l Nf
y - K rt C '� i � ltil N Q
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ro _ 1 - • -
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L A,V r EZ:> 4 ''LtL>! !— " 417
f -
-
PLOT PLANS PtTe-tG C f�T'�GF-! r'1 I�T € s1
CHECKED By a t-
ISATE
• � • ; fig, 4;
C 11„ 7e/2�oiS u l
PLANNIN DEPT. - u
f
DATE
i
I,L ,
xk- .
!
f
0 3 4-
CHANNEL
CHANNEL CLASSIC
LETTER EDGEI t I ( t
PAN CHANNEL
REV.PAN CHANNEL(HALO)EXTERIOR -.—__ DE(L hTI.fCT!I46j W s'T�{
INTERIOR NEON i^ s 6Lu� s 4 RG7✓IJ E fLtDs - li: 1�
WOW SANDBLAST &I 5r-r•1 E—:; 3... E (
CABINET V f� , -� i�+ lli ! • � �Mp`�L UE % � ` k�I?�jtit' lam`tl t�, - N —
ILLUMINATED o
NON-ILLUMINATED ' L.OG'�NSP�Of a
CO
PLASTIC PY
b car cc
ALUMINUM w
SHEET METAL r o
ROUT OUT THIS IS AN ORIGINAL UNPUBLISHED DRAWING -' 4 - W
FLAT CUT OUT GL IN.93KNI � ' CREATEDFGR you R OUR PER SINAL IT s r JOBNAME Tt{` C r A.F_� ^: r F F. SCALE A✓ t-1` - tet- DESIGNN0. 1 �_ BEING SUBMfTfED FOR YOUR PERSOHAI USE M �BACK DECORATED 't LTi ~ v L �'- ✓`% SALES REP. �'1 ; DATE G
CONNECTION WITH A PROJECT BEING PLANNED ADDRESS �.• .
FOR YOU BY CAL-NEON SIGNS IT IS NOT TO BE n^ _r - -; / l J 4 './( k s!'i - - � ZZ
PAINTED SHOWN TO ANYONE OUTSIDE YOUR ORGANIZA � ;d J Gam; ��\1 s�IG 4 r:�r — 4 G DRAWN BY,1-A—
VINYL 1577 ALMADEN ROAD, SAN JOSE- 95125 TION.NOR IS IT TO BE REPRODUCED,COPIED
LEXAN OR EXHIBITED IN ANY FASHION 1 y T 7 ` SHEET
MODULE ( 408 ) 289- 1883 fax : 289-8024 d'
OF
OTHER CAL. CONTRACTORS LICENSE 385665