27254 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY \
CITYOVCUPERTINO HUMPING-ELECTRICAL. PERMITNO.
APPLICATION/PERMIT PLUMBING-MECHANICAL 27254
BUILDING DIVISION BUILDING PROJECT IDEN'TIFICA'TR3S'
BUILDING ADDRESS: rayvaayss.s�� 1 �51e SANITARY NO. APPLICATION SUBMITTAL GATT
vy'DT 2�, UNITN LOT JI V C(
n
les
OWNIiRRI IME: mw.al�.� 24- `1 e-PHONE: CONTRALTO 'S NAME: LIC NO: NJ
�� 1 s�� �,8"i-3�i 8 �, - ,!� 38S Ei5' N/C CONTROL k
RCHI'1'F,CT/I:NGINF,ER: -Id6)j3 LIC NO: ADDRESS:�\ �� ...� t . e sL El��rl Co 1�
CONTACT: PHONE: li�Ql'Y ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
PERMIT ISSUANCE ❑ F-1 ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
oy.Z I herebyaffirn that l am ficerstol under provlsionsof0apter9(commencing with w JOB DESCRIPTION
LLQCCq Section]000).d Division Sol'the Bmionaand Pmfenians Code,andmy license is in PANELS \1
Fa�3U full force and effect
(Q,Zel Loch Ins J Lic.4 - 1 UPT02MAMPS ,
lin Q h Date Comraz_1��N 201-I00 AMPS
ZOr` z ARCHIh'ECT'S DECLARATION ` OVER 1010 AMPS SQ.FT. RAR 3/SQ.PU
0 V_o I undersand my,l.n shall be used i s public records.
. Ful SIGNS ELECTRICAL
< P A
Q Y 2; I.i«x
nd Professional
LTtccQ OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
XOr 1 hereby affirm that 1 ran exempt from the Contractor's License Law for the Nov3Cm¢ requfollowing rca ore(Section 7031.5,Business and Professions Code:Any city or county TEMP.METER OR POLE INST. ®0,1CS which ire,.permit to construct,alter,improve,demolish,or reput,anymecum, �fl@/
,W}7 prior to its issuance,also requires the applicant(orsuch Permit to file a signed statement POWER DEVICES b
Ihat he is liccned pin—m to the provisions oI the Contractors License Law(Chapter �! 119,96
d Ko� 9(roadomemg with Section Division 3of the Busincmiurd Professions Code) SWIMMING POOL ELECTRIC vVp-y�r�3LUATION
WM, or that he is exempt therefrom and the basis for the alleged exemption.Any violation of /7/
FZ� Section 7031.5 by any applicant fora 't subjects the applicant to a civil OUTLETS-SWITCHES-FIXTURES //�
Q perms 1 penalty of V
not more than rive hundred dollars(SSIIB).
K o ❑ l,asownerofthepropM,orm loeeswithwaesasthcirsolecom NEW RESIDENTIAL ELF,CTIi SQ.FT.
a3L°_ yemp y g pBusinen, STORIES TYPE CONSTRUCTION
will domewors and the sv ctum C.narreo intendede Law duties
or apply 1.to Business
pro property
ons Crile: pr Contractors and
who Law does such
not apply lf as owner of
own edywyees.pdrvided mvesthemprover whxamnoucmeadedwork lmselfor through his
emplgebuildig.,initusuchim,ismAd itsamnot earafeoroffered formile If. OCC.GROUP RES.UNITS
however.ilderwthe buildingmimprovementissoldwithinarm wild
oimproefar thrower OTAL:
builder will have the bather of proving that be did not build or improve for purpose of
,ale.).
❑ Las ownerofthe progenm rm
y,eexclusivelyseaning with licensed contractorsto QTY. PLUMBING PERM FEE FLOO_ZONE APN
onmorn the project(Sec.TKa,Business and Profession Code.,The Conuazmrs
License Law docs not apply to an owner ofpmpeny who builds or improves thereon,sand PERMIT ISSUANCE
whocratmcts for such projects with acomraclods)licensed pursuant to the Contractors ALTER Luw. WATER(EN FEE SUMMARY
❑ I am exempl under Scc. ,B&P C for this reason BACK FLOW PROTECT.DEVICEnPARK
OUTSIDE FEES
Y N
Owner Dam DRAINS-FlAOR,ROOF,AREA.COND. RF,CF.IF'Pp
WORKMAN COMPENSATION DECLARATION YN_
❑ Ihereby.frirm thmlhuve cenificam of<onum to self-insure,oraceniricate of FIXTURES-PER TkAP RECEI—I
Wmkcrs'Compemaztion lnsuan or ceniried copy lhcmof(Sec.3AIXl,lab CJ which Y NPolicy Mlle 10 Irthis e�tit GAS-EA.SYSTEM-1 INC.a OUTLETS � BUILDING DIVISION FliF.S
Company6 ?� GAS-EA.SYSTEM OVER a(EA) EE
❑ Cenificd copy is hereby fitmishe .❑ Cenificd copy is riled with the city Inspection division. GREASFJINDUSlR6 WASTE INTERCEPTORCERTIFICA'11i OF EXEMPTION PROM WORKERS' GREASETRAP
COMPENSATION INSURANCE
(Thi,section need not be completed Hite permit is for one hundred dollars($100) SEWER-SANITARY-STORM EA.20(FT.
or less:) ENERGY FTE
I certify that in the performance ofthe work for which this permit is issued.l shall WATER HEATER WNENT/ELECIR
not employ any person in any manner so as to become subject to the Workers PAID
Z Compansmirn L.w,of California. Dae WATERSYSTEMITREATING Dam R eiptx
O Applicant
Z 0 NOTICE TO APPLICANT:If.fl,norming this Certificate of Exemption,youshould NEW RESIDENTIAL PLMB, SQ.ET. TOTAL:
rU71 become subject mlhe Worker's Compensation provisions of the Labs Code,you..It
04 > forthwith comply with such provision or this penstit shall be deemed revoked. BUILDING
DJ Q CONSTRUCTION LENDING AGENCY SETS C .1
Z Ihereby affirm that there is a construction lending agency for the performance of
U Q the work for which this Permit is issued Xce.3097,Civ.C.) TOTAL: ELECTRIC
Lenders Name
pU Lender,Address QTY. MECHANICAL PERMIT FEE PLU INGFEE
I certify that 1 have read this application and,tate(hal the above information i,
0. correct. I agree to comply with all city and county ordinances and sate laws relating m PERMIT ISSUANCE Mli ANICAL FEE
C.2 building construction,and hereby authorize mpirsenatives of this city to enter upon Ne
U Z above-mentimod,m,cny for inspection purposes. ALTER OR ADD TO MECH. CONS UCTIONTAX
(We)agree to save,indemnify and keep taintless the City of Cupertino against
.-. led,Iitica.jud encs,cost wd ex hick may yway«emeapurso said City AIR HANDLING UNIT(TO 10,011E CIsM)
I. f th,•gradi i pcnnn.
��s AIR HANDLING UNIT(OVER I0,00(i
`K,nT,ummfAplicamlCco.e,r 6/Z e�Guam 5_ EXHAUST HOLD(W/DUC)
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 108000 BTU) Date Receipt p
will the applicant or forme building occupant store or handle hazardous material
as Jefiocd by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety HEATING UNIT(OVER 100.000 BTU) TOTAL:
Cale,Section 25532(a)?
❑Yes ❑No VENTILATION PAN(SINGLE RESID)
Will the u,caturnnrr wore building occupantuse equipment Quality
Mwhichemit
BOILER-COMP CHP OR I00,0l BTU) ISSUANCE DATE
zardous air wmdminants as defined by the day Area Air Qualiy Mwagemenl kBOILER-COMP(OVER 100,000 BTU)
ict?
❑Yes ❑No NEW RESIDENTIAL MECH. SQ.FT.
I have read the M1mardoux materials requitemems under Chapter 6.95 of the
California Health&Safety CWe,S«tions 25505,25533 and 25536. 1 understand that
Hthe building does not currently have a tenant,that it is my responsibility,to notify the
mcupwn of the requirements which must be mel prior to issuance of a Certificate of
Occupancy.
Owner or auNonud agent Date
TOTAL: ISSUED BY:
OFFICE
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NOV 0 4 1996
BLDG.INSPECTION DEPARTMENT
CITY OF CUPERTINO
10
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E = 0 0 T'LOT PLANS
c' CBEIKIZED BY '
CHANNEL CLASSIC f DATE 1,11b
LETTER EDGE
PAN CHANNEL PL_� ,:-•' - _ i0 5(gt, 5
REV.PAN CHANNEL(HALO)
EXTERIOR NEON _ DATE V`
INTERIOR NEON
CABINET ►50�'fi-k e✓ l��>/P.TIDt�I t y = l •� t� SL'�l --- F�t3.i2 s - -
WOOD SANDBLAST
ILLUMINATED
NON-ILLUMINATED 1 Y t�LP. N z
o -
PLASTK - - a
ALUMINUM t cii
SHEET METAL OFRIC'SwoCOPY o
_- - ROUT OUT -- -THIS S AN ORIGINAL LINPIIBLSHED DRAWING QAL=
CREATED FOR YOU BY CAL-NEON SIGNS.IT IS JOBNAME OP t-I E T1t1�JT SCALE ALS Ivy^T E�� DESIGN N0. )?3.1r "'
Furc E ORA 1KNEON1 SIGNS '
BEING SUBMITTED FOR YOUR PERSONAL USE IN
BACK DECORATED CONNECTION WITH A PROJECT BEING PLANNED ADDRESSF{rjt�'1=�?���� �T�i L✓ ��T`��. SALES REP.hi11�Y_-TEXDATE 10- Z�;wj-�C p o
PAINTED - - - - - - FOR YOU BY CAL-WON SIGNS.IT IS NOT TO BE
SHOWN TO ANYONE OUTSIDE YOUR ORGAMZA- I Daf � f-!CNII�%*r F:1� �'G A - DRAWN BY J,1�0'M t tT�A O -
VINYL 1577 ALMADEN ROAD, SAN JOSE 95125 TION,NOR IS IT TO BE REPRODUCED,COPIED
LEXANOR EXHIBITED IN ANY FASHION H � tq SHEET
MODULE ( 408 ) 289-1883 fax : 289-8024 w
OTHER CAL. CONTRACTORS Llf -`NSE 385665 OF -