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23533APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY Building Proect Identification Building Al U k-144 Pr - PERMITNO. 23533 ners ane - one: qnTA–E =A CITY OF CUPERTINO-BUILDING DIVISION APPLICATION / PERMIT TRICALUMBING-MCAMCAL �" L•V��lr ' contradnr NN. lienuc. Nm: IC- CATEGORY CO ( Architect/EngineerLie. No: QTY ELECTRIC PER MTT Eg BUILDING PERMIT INFO . Address: �' ' ❑ E �— PERMITISSUANCE LICENSED CONTRACTOR'S DECLARATION Ihereby affirm IngwRh In..7000)that Dimisi 3.fthesed Bur nevbloneofCsionsCocomment to= efeon3o(theguknessand PmfeaelonsCode,and Ilcenm is in full force and g(ect. Date Claes Com Date Gtelradol APPLIANCESRESIDEMIAL - ]OB DESCRIPTION i '^_��+1 S�A•9�f7o 1N1 ►� �/ - PANELLl S UP TO 2DOAMPS 201-1000 AMPS ARCHITECTS DECLARATION I understand my plane shall be used as public records. Lhcenred Professional OVERIOBOAMPS SQ. FT. FLOOR AREA r ® IN S/SQ.FT. SIGNS ELECTRICAL. -F1 KI _- OWNER -BUILDER DECLARATION I hereby affirm that I am exempt fromthe Contramor's Licenm Law forthe — ... I SPECIAL CIRCUIT/MLSC emirsfolloingreason. (Section 70iI,5, Business and rj proecCode:Anydtyor countmw a aitt lease TEMP. METER ORPOLE INST. ,� y� j, 4� mregrtoia ancomrutmuimstheaprovgdemolbh,or tto anya sucNre statement of t e floe a ac toed kalement that het 1lcenred pursuant it the tion M0ru of the hat he is licamed pursuant to the provisions ivi Con3ofthe LicenseandPreLaw apter9(wmmencingrthat with exempt Professions exempt therefrom and and gon3ohhethe POWER DEVICES , DAT SIV1Mh41NG POOL ELECTRIC - -Jlj VALUATION ' alleged the licks for the alleged exemption. Any violation of Section net on by any Any f subjectethe applicant loadvll penalty of net morethan OUTLETSSW[TC[dESFIX'IURES - D O iJ D , NEW RESIDENTIAL ELECTTi SQI,7. fiveapplicantdred dollars five L, ..rcd dollarshepr. - ❑ 4 owner of the property, or my employees with wages as their sole' STORIES TYPE CONSTRUCTION , compinto the k and the dere is or d for ion,0K ssb (Sec. s.. .In 5..a Busie Bu sinessandf suit Code: The onsC Coet ntractor scam , Law Lkeme Law property orimpdots does not apply to an owner of property who builds or improves thereon, and apply who does ork his provided that each e. OCC. GROUP RFS. UNITS ents amnetIntelf ndedoroughIl hoee, edor verthebuildigor improvements lntendneyear fcomoreioNthe ner-b deer ilI have improvementtseold withinoneyearo(compldlorytheowner-bullderwill have TOTAL: ' 'tl:e�urden of proving that he did not build or Improve for purpose ofsale.). L j L as owner of the property, am exclusively contracting with licensed mntractors to mmtmd the project (Sec. 7044, Business and Professions Code: QTY. PLUMBING PERMIT FEE FLOODZONE APN PpRM1T ISSUANCE The Contractors License Law does net apply to an owner of property who WIMs or improves thereon, and who contracts for such penjeds with a apt[ador(s) licensed pursuant to the contractors License Law. LJ I am exempt under Sec B & P C for this reason ALTER-DRAIN & VENT -WATER LEM FEE SUMMARY BACK FLOW PROTECT. DEVICE DRAINS FLOOR ROOF, AREA, COND. - SANITARY. Y_ N_ RECEIPT It - Owner Dare WORKMAN COMPENSATION DECLARATION ❑I hereby affirm that I have a certificate of consent to self -Insure, or a certificate ofWorkere' Compensation Insurance or a certified copy thereof(Sec. 3800, Lab CJ PoliryR FD(TURES-PER TRAP . SCHOOL TAX Y _ N RECEIPT R CAS EA, SYSITM-1 INC40UTLEI'S PARKFEE Y N RECEIPT R m y nrtBied .GAS EA.SYSITM-0VERd(EA) BUILDING DIVISION FEES copy ts hereby fumiahed. Certified ropy ts (ILed with the city inspection divlslon. GREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECK FEE GREASETRAP CERTIFICATE OF EXEMPTION FROM WORKERS' I , SEWF]i"SAMIARY"STO'RM EA'200FI'" COMPENSATION INSURANCE (Thlaaeciftm.nednctbecomplded ifthepermit bforom hundred dollars D f TO,) WATER HEATER W/VENT/ELECTR E RGY FEE Y N ($10(forless.) 1 performance comlythat in the perfounce of the work for which this permitts issued, WATER SYSTEM/TREATING I shall not employ any person in any runner so as to become subject to the Workere'Compensatlon Laws of Cahfornh. Date PAID - Applicant NOTICE TO APPLICANT: U, after making this Certiflrate of Exemption, you should become subject to the Workera'Compensatlon pmvhnbns ofthe Labor NEW RESIDENTIAL PLMB.SQ.FI. Date Recei t# ` TOTAL' BUILDING FEE 1 Code, you moat forthwith comply with such provisions or this permit shall be deemed revoked. SEISMIC FEE CONSTRUCTION LENDING AGENCY I hereby affirm that there b a construction Lending agency for the perform- ante of the work forwhich this permit is headed (Sec. 3097, Civ. C.) Leader. Na Lender's Address - I mAilythatl have readthis applicatlonand katethalthe above Information lecomet.I agreeto comply with all cilyand county ordinances and gate laws TOTAL: - ELECTRIC FEE PLUMBING FEE QTY, MECHANICAL PERMIT FEE MECHANICAL FEE PERMITISSUANCE - FEES PAID: relating to building construction, and hereby authorce representatives of this citytoenleruponMeabove-mentioned property for inspection purposes. Me) agree to save, Indemnify an it keep harmless the City of Cu penton. •agabst liabilities, judgments, coke and expenses which may In any way accrue ALTERORADDTOMECH. Date - Receipt# AIR HANDLING UNIT (TO 10,000 GEM) - SUBTOTAL: agairsl said Cl tylmmnsequenceoft granting olthis permit • AIR HANDLING UNIT (OVER 10,000CFM) CONSTRUCTION TAX nature of Appl ant/Contractor Data - EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT (TO 100,000 BTI)) Date Recei # Will the applicant or future building occupant store or handle hautardreus material as defined by the Cupertino Municipal Code, Chapter 9.1Z and the Health and Safety Code Section 25531(a)7 ❑ Yes No HEATING UNIT (OVER 100,000 BTI) TO VENTILATION FAN (SINGLE RESID) ISSUANCE DATE Will the appllcant or tore building ocmpanl use equipment ordevices which emit hamnlous air contaminants as defined by the Bay Area Air Quality Management Distrhd7 Yee Na p P I D BOILER -COMP OHL, OR 100,000 BTU) BOILER -COMP 100,Of10ITV), the fias materials requirements Chapter 6.95 of 4 have read zaod H the California Health & Safety Code, Sections 25505, 25533 and 25534. I u nderstand that if the building does not currently have a tenant, that It b my msponabBityto not lfy the occupant of the requirements which most be met prior to Issuance of a Certificate of Occupancy. JUL = 6 1992 r1 NEW RESIDENTIAL MECH, SQ,FI t F `t IVV, ISSUEDB Owner or authorized agent Data TOTAL: , OFFICE COPY if �$�jLJ els RECEIVED, � Ctro ® tuft , „GRQUND FAULT SYSTEM CITY OF CUPERTINO TEST REPORT TIENT: ����, CCE ev ENGINEER: /lidA ETI JOB NUMBER: 70 2 29 ism LOC TION: 9i✓D�m /93 3 Flt cc w C',//Fr>jJ WITNESS: DATE: 7 -So -9 SWITCHGEAFj,/S DJrES�13GNTl, N� TEST EQUIP. ASSET #, CALIBRATION DATE: FIELD DATA SWITCHBOARD MANUFACTURER SHOP ORDER NO. UL NO. ZF o.23S3o-000.�- I C- p(, /,5� MAIN OVERC RENT DEVICE MFGR. Cl RCUIT BREAKER ❑ FUSEDSWITCH ` ^^ JC�U/J%E J TYPE MODEL/CAT. NO. CURRENT RATING SYSTEM VOLTAGEVOLTAGE RATING X F /oe20o0 000 �/�o ✓ y�o/p � 7 GROUND FAULT SYSTEM ?-1-5 /a U114- MFGR. 11 NEUTRAL. -GROUND STRAP ZERO -SEQUENCE S ���i ,1 MODELCAT. NO. PICK-UP RANGE TIME RANGE SENSOR/C.T. 7�rE4ERAL ./o�-/aao0 hvsr,-rn„v,-/1j>. /I/a loE,�)oGr.�- ASFOUND SETTING✓CN AS LEFT SETTING //NS+AL(Nlb� SETTINGS SUPPLIED BV PICKUP PICKUP CURRENT TIME CURRENT /d100 TIME rnAX FU%fI51SOC/Nrf5 /1,2C . INSPECTION SERV ICE ENTRANCE CONDUUCTORS MAIN BONDING JUMPER GROUND ELECTRODE CC DUCTOR 3 PER PHASE O law Li .SoO/YICry v U S OLJ AWG ❑ MCM NEUTRAL -GROUND LOCATION CONTROL POWER TRANSFOR ©CORRECT 1:1MER INCORRECT ❑ CORRECTED BVCONTRACTOR U VA MONITOR/TEST PANEL OPERATION _ 1 )� OTHER ❑ CORRECT ❑ INCORRECT ❑CORRECTED ELECTRICAL TESTS BREAKERISWITCH REACTION TIME (RT)UCED VOLTAGE ST (55% RATED VOLTAGE) ❑ SECONDS 11 CYCLES CYCLES CORRECT ❑ INCORRECT PICK-UP CURRENT PICK-UP.LU MINUS 26%1_ AMPS) .t.Fj.fiNT Ll -NO ❑ [/J AMPS TRIP (CORRECT) TRIP (INCORRECT) SYSTEM NEUTRAL INSULATION RESISTANCE TO GROUND OTHER L/ 497 MEGOHMS PRIMARYCURRENT PERCENT TOTAL REACTION RELAY MFGR. Q AMPERE -TURNS PICKUP TIME TIME TIME TOLERANCE TIME -CURRENT �• 3 7 O. DL� 0• CALIBRATION�J TESTS d�/x /OCA U/ Soo 0,,37 Or o 0 REMARKS /)/7')/ ^1 .oE 1,117W G, f, u, SF> Z00a �lA• � Y7i/✓ � � DO /7fiG 'ES I�mo,, u r cA L N//L/ GSD r O 7- �v s E rE •C c o f /- f A r L l✓!l 5 a e Lln G E c urr IS /1 /bK a G F19 AfWAr,�-s r9 T/ //r To �/ N,Er(r,r s r 5� ✓ So.c wAs fou tea' �/2l4 GFSTR/90 , 0199D ETI Tf/rf �rpodCCrv' WAS (�oA2tci E�, rL) 0039?- /0 Doc=i- /NLo,e eZf e7r % S-,2o-93— PAGE _ OF