26748 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-FLEE I HICAI. PERMIT NO.
APPLICATION/PERMIT PLUMB NG.MECHANICAL n�+ n O
BUILDING DIVISION ' ,, 'BUILDING PR07EC I IDEN I IRICATIONr_"•= GO 4v
BUILDING ADDRUESS A ITFAtl SANITARY NO. APPLICA'DON SUBMIEFAL DATE
UNIT# LOT# 1
OWNERS NAME: PHONE: RACPOR'�NryME- LIC NO: l
4 tLL of �I aW -30_4 J. CO�p�,1" 1`I`CG1"� '385665 N/c colvraoL#
IiCHI'IECr/ENGINBER: LIC NO: ADDRESS G 'aI ❑
16677
CONTACT". PHONE:
QTY. - 'ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
PERMIT ISSUANCE 11-
❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL. JOB
I hereby affirm that l am licensed ander face t l) c mmencin LOB DESCRIPTION
q0z ye provisionso per hd eis th
r`]UE fall
orce ndefDivision 3 of the Business and Professions CUJe,a dmy license is in PANELS
QU, LirenreCand effect
F2m License Classy Lic.# �R5"191._4� UP T02n0AMPS
m67 Dam GnnTSD 2O1-IOW AMPS `
OZ—Z.4 ARCHITECT used DECLARATION OVER IWO AMPS SQ.Fr.FLOOR AREA $/SQ.PT.
O2.••O I understand my plans shall be used m Public records.
m ; SIGNSELECTRICAL
...I ucensedPodesvionvl
�ttvv6 OWNan sc ILDERDFC ContraON SPECIAL CIRCUIT/MISC.
OycUc++ i hereby affirm that I E exempt from the ORATION License Law for the
W 3 tL be following reason.(Section 703 1.5,Business and Professions Code:Any city or county TEMP.METER OR POLE INST.
EI�; which require a permit to eonsrtuct,alter,improve,demolish,or repair any atrunure,
}� prior to its issuance,also requires the applicant for such permit to file a signed statement POWER DEVICES
Hop
that he is licensed pursuant the provisions of the Contractor's License Law(Chapter
d0.o�' j9(commendng with Section 7000)of Division 3 of the Business am Professions Crae) SWIMMING POOL ELECTRIC
or X VALUATION
t4. Section
by my applicant
the basPermit
subjects thedexemplion. civiny l penalty
of OUTLETS-SWITCHES-FIXTURES
��¢ Section]031.5 by any applicant for apermil subjects the applicanuo acivil penalty of
amnot more than five hundred dollars($SW). NEW RESIDENTIAL.ELECPR _SQ.PI'.
. ❑ I,asownerofthepropeny,ormyempleyeeswithwagesasthei(solecompensation, STORIES TYPE.CONSTRUCTION
willtlm the work.and lheswcmre is not intentledoroffered for sale SecAM4,Ausines
and Professiom Code:The Contractor's License Law does not apply In an owner of
property whoutildsorimpraves thereoa,andwhodoes such workhimaelouthrough his
wapicyces,pmvidedtbat each impmvearealame not imendedomDered hostile.If. OCC.GROUP RES.UNITS
however,the building orimprovement is sold within one yearofcomplefoo,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
a❑)1,as ownerofthe property,am excluslvelycontracting with licensed contractus[ QTY. f it' 3; tPLUMBINC"PERMIT'v t - `4 w'FEg FLOOD APN
ensue,the project(Sce.7044,Business and Professions CedeU The Contractor's
License Lavedoesnot apply loan ownerofpropedy whobuilds mimproves thereon,and PERMIT ISSUANCE
who commits forsueh pr ice's with a eommoda(s)beemedpanamm I.On Commmou's License Law. ALTER-DRAIN&VENT-WATER(EA) - FEE SUMMARY
❑ I nm exempt ander Sea ,B&P C for This reason BACK FLOW PROTECT.DEVICE OUTSID FEES
SANITARY Y N
Owner Dale DRAINS-hLOORROOF, RECEIPT#
WORKMAN COMPENSATION DECLARA , , , .TION SCHOOLTAX Y_N
❑ I hereby affirm that l haveacenificale ofconsenftoself-insure,maccrtifcaroof FIXTURES-PER TRAP RECEIPT#
Wnrkeri Qrmpensotlonlnsurenccoracenified copy thereof(Sm 3800,LabCJ which PARKFEE Y N
nv rs all empl Ye�e,S a 1. GAS-EA.SYSTEM-1 INC.4 OUTLETS RECEIPT#
Policy# �AL�n s1 BUILDING DIVISION FEES
Company zmI Camt GAS-EA.SYSTEM-OVER 4(FA) PLANCIIECK FEE
Certified copy is hereby furnished.
❑ Certified copy is filed with the city inspection division. GREASE/INDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPT ION FROM WORKERSGREASE TRAP SOILS HE
COMPENSATION INSURANCE.
This section need notbe completed iflhe permit is for one hundred dollars SINE SEWER-SANITARY-STORM EA,20OFT. ENERGY FEE
or less.)
I certify that in Om perfemtance of the work for which this permit I,mated,Isha11 WATER HEATER W/VENT/F.LECTR
not employ any person in any m as Io become subject to the Workers' PAID
CompomaOon Lnwsmf Califomin. Date so WATER SYSTEMOMEATING Z Applicant Date Rweipt#
Z 2 NOTICE TO APPLICANT:IL much making this Cenificaleof Exemption, Q Er.
Z pi ynua a,, NEW RESIDENTIAL PUSH. S . TOTAL:
Fy becomeh comply the Worker's Compensation provisionso be he Labor
poked.umuss
� ; forthwith comply with such provisions or this permit shall be deemed revoked. BUILDING FEE
pW Q� CONSTRUCTION LENDING AGENCY SEISMIC FEE
�i z l hereby affirm that here is a construction lending agency for the performance of
00-0
ICJ' O the work for which this permit is issued(Sec.3097,Civ.CJ TOTAL: ELECTRIC PEB
,er Lenders Name PLUMBING FEE
F I Lena Address QTY t 'MEChIANICAL PERMI7. "4 PEE'
V I c
b
omfy that 1 have read This application and state that theabove information is `
r�'t PWi cerrect. Iagrce In comply with all citymd county mdinances andsmte laws relatingm PERMIT ISSUANCE MECHANICAL FEE
building construction,and hereby authorise representatives of this city to cmerupon the CONSTRUCTION TAX
L) Z above-mentioned properly for inspection purposes. ALTER OR ADD TO MECB.
(We)agree to save,indemnify and keep harmless the City of Capenino against
habilities,judgerents,costs and experewswhich may in any way accrmemplasl said City AIR HANDLING UNIT(TO 10,000 CIT?)
fe consequence of the grating of this ectad.
AIR HANDLING UNIT(OVER 10,000 CFM)
Signature of Applicam/Comnmtor Date EXHAUST HOOD(W/DUCT)
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000BTU) Date Receipt#
Will the appli.m.,future building oceapainmm or handle hazardous material HEATING UNIT(OVER 100,000 BTU) TOTAL;
as defined by the Cupertino Municipal Cade,Chapter 9.12,and Ne Health and Safety
Code,Section 25532(e)2
ElYes El No VENTILATION FAN(SINGLE RESID)
_ ❑
BOILER-COMP THE OR 1 W,oW BTU) ISSUANCE DATE
Will the applicant orfumrehuilJingoceupvm usaegoipmcm ordevices which emit BOILER � ,
ihacomilme air commitments as defined by the Bay Area Air Quality Management BOILER-COMP(OVER 100,000BTl1) P t,
District?
❑Yea ❑No NEW RESIDENTIAL MECH. SQ.FE NOV
0 1 have read the hazardous materials orpmeements under Chapter 5A5 of the ,5 198
California Heabh&Safety Code,Sections 25505,25533 and 25534. I understand that _ }v y
if the building does not currently have atenant,Ihet it ism rcsponsihilily to nmify the - - '1
ecupam of Iliyyy requ' mens wldch mus met p'or mance of a Ce tificem of 'lI! U/` L(Jr'� _
Occupancy. s N// _
owner n I d t Date e— TOTAL: ISSUED BY:
OFFICE
of
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PLOT PLANA
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BLDG. DEPT. ---- - i - -- — -
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CHANNEL CLASSIC ---
LETTER EDGE -- - - - -
PAN CHANNEL ---- _ - ` ----- _ ---
REV.PAN CHANNEL (HALO)
EXTERIOR NEON
INTERIOR NEON - -- -- -
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ROUT OUT THIS IS AN ORIGINAL UNPUBLISHED DRAWING 9
FLAT CUT OUT CREATED FOR YOU BY CAL-NEON SIGNS.IT IS JOB NAME L I E I t , IGS-' SCALE AL-_ 'r >-I, DESIGN N0. Lu
GL INSON1
S ' G N S BEING SCBM TIED FOR YOUR PERSONAL USE IN tr • rFr -
BACKDECORATED CONNECTION WITH APROJECT BEING PLANNED ADDRESS =u=' `�'��"-t' � �=�-�-!� ��•=`1� - � � SALES REP. DATE 0- ice- �'s
PAINTED FOR YOU BY CAL-NEON SIGNS IT IS NOT TO BE O
SHOWN TO ANYONE OUTSIDE YOUR ORGANIZA• _! r1E 2^ DRAWN BY �: '�- I`T_�'' z
VINYL 1577 ALMADEN ROAD, SAN JOSE 95125 TION,NOR IS R TO BE REPRODUCED,COPIED p
LEXAN
MODULE ( 4 O 8 ) 2 8 9- 18 8 3 fax : 2 8 9-8 0 2 4 OR EXHIBITED IN ANY FASHION SHEET
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OTHER CAL. CONTRACTORS LICENSE 385665 OF ¢