S 0246 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PE MITNO.
I APPLICATIONIPERMIT PLUMBING-MECHANICAL 0 2 4 6,�
BUILDING DIVISION
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
2oo7s sot1..�N Ro�rA �'z-2
OWNER NAME: PHONE: CONTRACTOR'S NAME: LIC NO:
�X�O14 C y, ' NIC CONTROL#
RCHITECTMNGINEER: A/ LIC NO: ADDRESS: ❑
CONTACT: PHONE: BUILDING PERMIT INFO
I � 1 g Cin X�7—'M, ❑ Consultant Fees Paid by Applicant(Initial) BLDG E� PLUMB MECH
t �I G ❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
1 hereby affirm that I am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
aizZ with Section VUW)ofDivision Sof the Busimessand Professions CWa,and my license it RESIDENTIAL:
1400 in full force and effect'. PERMIT ISSUANCE
f WVr„' ❑SFDWh ,�KITCHEN REMODEL
�Uy License Class -Lic.N APPLIANCES-RESIDENTIAL ❑AUDITION ❑PLUMBINGRE-PIPE
In Q L
Dion—Com
ARCHITECTS DECLARATION CMULTI-UNIT ❑STRUCTURAL
Z O�? I understand my plans shall he used as public records PANELS MODIFICATION
pZ G UPT021MAMPS El INTERIOR CCHIMNEY REPAIR
543 M Licensed Professional ]111-IIXI(IAMPS IMPROVEMENT C]SWIMMING POOLS
Via{ OWNER-BUILDER DECLARATION Connector's
OVER IhX)AMPS C BATH REMODEUREPAIR [:1 DEMOLITION
I hereby affirm that 1 1. exempt from the Comrns Cas License city
o for the
OyU which imgreamn.Permit
ata...5,Business and Professions Code:Any city or cnnmY SIGNS ELECTRICAL COITIER
a 0. which its int s n perm m cu as the,aper,improve,demolish, file
repair any atement
poor to ilia isxuonce,also requites the applicant far such permit 8leasigneJ statement SPECIAL CIRCUIT/MISC.
�} Lha he is licensed pursuannohe pmvisinnx of he Comracmh Littnse law(Chepnr9
(commencing with Section ID00)af Division 3 ofthe Business and Professions Code)or TEMRMETERORPOLEINST. COMMERCIAL:
6 y that he is exempt theefrom and the basis far the alleged exemption.Any violation of C NEW BLDG/ADDITION C DEMOLITION
+ ^4Section 701 Ll by any applicant for a permit subjects heapideant to a civil pcnultyof POWER DEVICES ED TENANT [I FOOT)SERVICE
ynot
more than live hundred dollars S500). IMPROVEMENT
F 6 El Las owner of the property,or my employees with wagesns their sole compensation, SWIMMING POOL ELECTRIC N CGTHER I
eta
will do the work,and the suacture is not intended oroRered for sale ISm.70g4,Business
L 3 and Professions Code:The Comment's License Law does not apply to an owner of OIITLEI'S-SWITCHES-FIXTURES
property who builds or improves thereon,and who does such work himself or through `
his own employees,provided the inch improvements proveenTI
ts arc not intended or offered for NEW RESIDENT ELIi SQ FII
sale.IL however,the building or improvement is sold within one year of completion,the SQ.FT $/SQ.FT.
owner-builder will have the hurden monism,that he did not build or improve far par.
poseofeole.e.
C 1,as own r of the property,um exclusively contracting with licensed rontrvcnsrs nm TO'IA1. Jul.
Eva
conswm the project(Sec.7*L Businessand Professions Co..;,The—no."..s sl��/a R[{g u
cerise law does n n apply to an owneof pmPetty who builds or improves thereon,and QTY. PLUMBING PE FEE
who contracts for such proje[ts with a consonants)licensed pursuant tothe Communes CITY OF UUPEHIAO
License Law. PERMIT ISSUANCE
(] I ma exempt under Site .B&P C initials reason
AI:1'IiR-DRAIN&VENT- rER VALUATION
wner Dae
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DN-VTC 1I
1 hereby affirm under cemhy of perjury one of the hAleasing decimations: 4
]Ihaveand will maintain.Cenilcamof Conant to scl6insure for Wafers Co.,.- DRAINS-FLOOR.ROOF.AREA.GOND. STORIES TYPE CONSTRUCTION
,. sation,as provided for by Section 37M of the Labor Cole,for the performance M the
work for which this permit is issued. FIXTURES-PER TRAP
C 1 have and will maintain Worker's Compensation Insurance,as required by Section
3700.1'the Labor Coal.,for the performance of the work for which this permit is issued. GAS-PA.SYSTEM-I INC.4 OUTLETS OCC.GROUP APN
My Worker's Compensation Insurance carrier and Policy number are:
Car ice Policy Nn: GAS-F.A.SYSTEM-OVER 4(EA)
CERTIFICATE OF EXEMPTION PROM WORKERS' GRf•ASI%INDUSTRL WASTE INTERCEPTOR
COMPENSATION INSURANCE: BUILT 'BUILI)%Q DIVION PETS
(This section need not 4 completed if the permit is formic hundred dollars(S 100) GREASE TRAP
or less.) PLANCHECK FEF. 6'11.--
I candy that in the p menterve of the work fim hichihis permit is i...ad,[,hall SEWER-SANITARY-STORM EA.200 FT.
not employ any per, irony mvnner so as to become suhject ,,the Wmke,s i mpen. ENERGY PIiE41
Z cation Laws of California,Date WATER HEATER WNFNI'/BLECTR
z O Applicant t GRADING FE
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you shaold WATER SYSTE I TREATING
;Na becanmc subject m the Workers Compensation provision,of the labor Cade,you must, SOILS FEE
forthwith comply withsuch provisions or this permit shall he deemed revoked. WATER SERVICE
CONSTRUCTION LENDING AGIiNCY NEW RESIDENTIAL PLMII. SQ,PI'. PAID
U O )ate Receiptp
1 hereby effirte that there is a mnstrvdion lending agency for the performance of
E+ the work for which his pemtit is issued(Sec.3092,Civ.C.)
Lender.Name TOTAL:
W Lender's Address TOTAL:
1 certify that 1 have read this application and state that the above information is BUILDING FEE
(0.7/1 correct.[agree to comply with all city and county ordinances andante laws miming m QTY. MECHANICAL PERMIT FEE
V G buildingcon.aortion,vad hereby aahnrim represenotive,ol'this city in enter fair he SEISMIC FEE
above-mentioned property for inspection purposes. PL'RMIT ISSUANCE
(We)agree to rove,indemnify and keep females,the City of Cvpenino against ELECTRIC FEE
liabilities.judgments,costs and expenses which may in any way accrue against said City ALTERORADDTOMECN. is
I.conseq
uence of the granting alibis pc.i,. PLUMBINGI r
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000CFM)
SOURCE ,GULATIO.NS / CONSTRUCT
IEE
-�,�H.�(,_/ AIR HANDLING UNIT(OVER Io,IX10 CPM) CONSTRUCT' NTA#
957
Signature f npplicaa..snr��—nt/CoeDee EXHAUST HOOD(WIDUCD HOUSING MI TION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will theapplicantor furore Wilding oerapanumreor handle Incautious married HEATING UNIT LTO I00,000 BTU)
es defined by the Cupertino Municipal Code,Chapter 9.12,and the Health ami Safety
Cale,Section 25532BU? HEATING UNIT(OVER intake BTU)
C Yes 0N VENTILATION FAN(SINGLE RFSID) PAID Uure Receipt#
Will he applicant or future building occupant use equipment or devices which
emit hazurdoas air contaminants as defined by the Be,Arca Air Quality Management BOILGR-COMP(3HP OR IIXI,q)B BTU) OT
District? BOILER-COMP(OVER 10k010 BTU)
❑Vias 0N
I have read the countries materials requirements under Chapter 6.95 of the Cali- AIR CONDITIONER ISSU NCF DATE
fomis Health&Safety Code,Sections 2.5585,25533 and 25534.I understand that if the NEW RESIDENTIAL.MECH. SQ.ET.
building dues not currently have u tenant,that it is my responsibility to notify the nccupam
of the requirements which must hz met prior to issuance ol'a Certificate of Occupancy.
10ovirproxisidmirivelagen Data TOTAL ISSUED BY:
OFFICE
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71 f $ 05/09/915 08:28 002
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LUMINAIRE ORDERING GUIDE UL a GSA Usteo.
" Model CEI-small sizet6=EPA
( ) CEII-large a(EPA=2.9)
nting PM
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"Gii
Pole Mount Wall Rraekef
Lamp small size
Type/ largi I size
Warts 5100 5150 5250 5400 M175 M250 M400 S4011 51000 M400 M 1000
Reflector 1-asymmetric III-asymmetric IV-forward throw VS-symmetric square
Voltage 120 208 240 277 347 480 MT-multi-tap
Options PC• photoelectric cell 120-277v, up to 400W.SF-single fuse
PR -photo receptacle (less cell) DF-double fuse
VG-polycarbonate vandal guard CS•house side cutoff shield
Colors for D82 Sse RRH SGB WHT FGP TBP RBIT care SOS
Luminaire • .—
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and Pole Jl /1
dark bronze beige rucket red black white laced yreen teal blue at blue burgundy silver
Luminaire MOUNTING uW TTfc
Ordering "0"1. MOOC IV Wan's NefL[CTON — vON=O{ — OfTMN\f oe\O= O
mple: FA- FS400 — MT PC SOS
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POLE ORDERING
Refer to Poles/Brackets Section for ordering Information.
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BLDG.INSPECTION DEPARTMENT
CITY OF CUPERTINO
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C:\AGI\KATHYD\GRADRALS.AGI
05-07-1996 (� PAGB 1
UMINAIRE : B
-----------------------
PAULDING CAMBRIDGE 250W MH IY
AD SYMBOL : RDl.SYM
AD SYMBOL SIZE : 3
ILENAMS : C:\SPLZES\L3712
OMENS = 23000
LF .72
PIN 0
BI/AM/CI-II/DL/MUII/
KI/SFII/S&II/WWII-M250-IV
712
AMP-250
ILT.NONE
MiPS - i LUMENS/LAMP = 23000 PHOTONWIRIC TYPE = 1 WATTS 280
OMINOUS DIMENSIONS (FRET) :WIDTH . 2 LENGTH = 2 BRIGHT 1
ACTORS • MULTIPLIER = 37 BALLAST s 1 BALLAST-LAMP . 1
OMBRR OF VERTICAL ANGLES 15 0 TO 90 DSGRSBS
OMBSk OF HORIZONTAL AIBGLBS c 19 0 TO 180 DXGRBES
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