B 0430 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINORUILDINC-ELECI'RICAI,
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECRANICAI.
BUILDING PROJECT IDENTIFICATION
RUILDINGADDRESS,. SANOARYNO, APPLICATIONSUBMITTALDAI'I
Ctree —Z`J-�
IS NAME: PHONE: J CUNI'RAC'fOR'S NAME: LIC NO:
/!VI NIC CON1 Ito],of
n HITEMENGINEER: LIC NO: 2S ADD ISS: 11
)NTncT: PHow.: BUILDING PERMIT INFO
A r� ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECIi
_[J. /N N SI ,537-10/03 ❑ � ❑ ❑
LICENSED CON'IRACIOR:S DECLARATION QTY, ELECTRIC PERMIT FEE
hereby afrrin that 1 am licensed under pmvia,ns of Chapter 9(eo minoring _ _ JOB DESCRIPTION
❑az with Section 7000)of 3 of(lie Busineasand professions Crdaawmy uecnsnis _ RESIDENTIAL,
4100 PERMIT ISSUANCE �,�
IY�F- in,full force and el• / ❑SPDWL ❑KITCIIGN REMODEI.
QUU Lcense Lic.M APPLIANCES-RFSIDEN'I'IAL ❑ADDITION ❑PLUMBING RE-PIPfi
I-ZW Dam Coatmm,r
rn 611
CI MULTI-UNIT El STRUCTURAL
ARCHITCCI"S DECT.ARAT' N
UP TO'2 MODIFICATION
OZ- iuMemmnd.nY plans shall he usW as pontic records UP Tb 2W AMPS
O Zt-0 C1 INTERIOR El CHIMNEY REPAIR
a4�ad Licensed Professional 201-10WAMPS IMPROVEMENT [I SWIMMING IDOLS
yy� OWNER-BUILDER DECLARATION
a a W Q I heroby u)imm that I am exempt from the C,mmcui I.,evele Law for the OVER]Bud AMPS El
El BATH REMOUEIJRIiPA1R DEMOLITIONgyp(,O0.O following reason(Section 7031.5,Burinoss and Prmlea,mes Cade:Any city or wanly SIGNS ELECTRICAL D
OTIIER
413 LL y which requires a permit to contract.utter.improvm
e,demolish,or repair any stclure
0sA prior to its issuance,also requires the applicaatfor such person to rile a signed statement SPECIAL CIRCUIT/M ISC. — V
that be is licensed pursuant to the provisior,of the Con,racmrs License law(Chupmr9
41800 (eOtuncraingwith )
Seetlou700nf Division Sof the Business slid PmfeAsinns C:dc)nr I EM P METER OR POLE:I NST. COMMERCIAL'
the is pt ourro d nh
i al anc bests tot rho alleged exampo...i Any viohuinn of [NEW BLDGIADDI'fIUN [I DEMOLITION
at hexem
�mSection 7031.5 by any upphcam for a permit subjects rhe applicant le u civil penalty of POWERDI.VICES ❑TENANT ❑FOOD SERVICE
not, m mothan Five hundred dollar(5500). IMPROVEMENT
1-Z,
0 ❑1.asownerofthe propeny,,rmy employees with wages as their role compensation, SWIMMING POOL ELECTRIC
p( wJl do the work,and the.wc,ureisern imendeJ ondfcred For sole(Sec.70,1,11.Business
[]OTHER
[y"' and Profession Code Too Contractor's License law does not apply to an owner of OUTLIO. SWI'[HES-FIXTURES
properly who build or improves Ibarnm,and who docs such work himself or thna.Sh 1!
his town employers;provided that such improvements are net intended or offered fur NEW RESIDE1 13LEC'TR SQ FT.
sale.If.however,the building nor impromprou is sold within one year of comple.inn.Jhe ' SQ.14.FLOOR AREA $/SQ.FI'.
mer-builder will have the burden of proving that he did nm build or improve for par- S% k✓ 2Z-2,0puna,(
I,as,theer of the ouport,.Easiness s and enntruction with:, he J shoe contractile m OfAI.: S /.
close La d canon (Rcc.]Oliowncoand ProfessionsCWeJ The Comremrn. lid
who
wdts Forsch plyman with
who
sedprvdism impmvhs Contractor's QTY, PLUMBING PERMIT' PF.E
who contracts for such projects wish a contractions)licensed Purauam m the Contractor's
Licemc I... PERMIT ISSUANCE
Ian oxempl under Sec. ,II&P C for this neat)
ALTER-DRAIN&VENT'-WATER(EA) VALUATION
Owner Dote
WORKERS COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE ar n U
I hereby affirunder penalty of perjuryone of the following declarations: �SQ U V
I huvc and will mninmin aCedlfinne of Consent to self-insure for Worker's Campcn- DRAINS-FLOOR,ROOP.AREA.COND. STORIES I I'YPIi CONSTRIIC'I'ION
niton,as provided for by Section 3710 of the Labor Code,for the performance of the
.ask fm which this permit is named. FIXTURES-PER TRAP ' CJM
I have and will maintain Walker's Compensation Insurance,as required by Section
3700 or the Labor Gale,for the perlinnance of the work for whiclifis permit is issued. GAS-EA.SYS TEM-I INC.4 OUTLETS OCC.GROUP APN
My Win .',C,., ovation Wnmcc outer and trolley now,wp' (y,o„� GAS-EA.SYS'1'P,MAVER4(EA)
Camcr:winrrr.. Policy NnUu•'� S�--dam+ 5
CERTIFICATE Of EXEMPTION FROM WORKERS' GREASUINOUSTRI.WASTE INTERCIJ90R
COMPENSATION INSURANCE BUILDING DIVISION iR6S
(This section need not be coniplded ifthe permit is forms,hundred dollars l Sl m) GREASE TRAP
lir Irsv.) I'LANCIIECK IEE
I certify that in the performance rots,work lir which this Penni,is issued,T shall SEWER-SANITARY-S'I'ORM EA.2W IT.
not emsubject ploy any person in any manner so as to become subjeco the Workers'Cmnpen- ENERGY PER.
.Z union laws of California.Date WATER HEATER W/VEKf/ELECO!
O APPlian, I GRADING FEE
NO][(:It rO APPLICANT Jr.Idler making Orris Crnificam of ExemP,iton,you xh uild WATER SYS]'IiM/1'REAT'INC,
a; become subject to the Worker's Compensation Peoi,sms oflha Iabmr Curd you.nus, SOILS FBE
fonowith comply wi@auloprovisions o,,his permit shall be deemed reviled WATER SERVICE
Q
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMIi. SQ.FT. PAID
I work
arwhichi Ito, there is.
sued Sco.30 landing agency lot th,performunce of ole Itccciptk
thr work far which This permit is issued(Sec.109],Civ.C.)
I'laU Isnders Name TOTAL:
Lenders Address TOTAL:
yI certify that I have read this application and state that the abtwe information is BUILDING FEM
h ornm,,,I agma m comply whir all oily and county onllnunocv sand limo laws elfroug m
QTY, MECFIANICAI.PERMIT FEE
U holdir,onmruainnund hereby amhorno eprewmm�ives ofthts city frontier upon the 50:0500[FIiIi
aMwcmen,ioned pspeny for inspection purpnvo. PERMIT ISSUANCE
(We)agree um save,midenmify and keep harmless,he City o'Cuper in,against ELECTRIC FEE
liabildies,judgments,c,s¢and expenses which may in any way accuse against said City ALTER OR ADD TO MECIL
in consequence of the granting of this perms. PLUMBING FEE
APPLICANT U A.RSTAN S AND WILT.COMPLY WI'1'll ALL NON-POINT AIR HANDLING UNITTO 10,000 CPM) MECHANICAL FEE
�CSREGU All S
\��/{�✓JX/ S/- /y.� AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCT ION TAX
umm ofAPPlicnrriCom cfrr `[✓Date EXHAUST HOOD(W/DUC`O I IOUSING MITIGATION THE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant orfumre building occupant Mom orhanlle hamrd,usmaterial HEATING UNIT(TO 10,000 B LE
as defined by the Cupertino Municipal Cede,Clmpmr 9.12,end the Health and Safety
✓ CWe,Sermon 25532holy HEATING UNIT(OVER 0(0,(X0 BTU) tea_
/ El Yes 12<1� VENTILAI]ON PAN(SINGLE RESID) PAID !�� —
Uwc I1un.p,K
AdWWill the applicam or future building occupant use equipment or devices which BOILER-COMP CHP OR 100,000 BTU)
mit hamrdous air<omamimm,s a�defined by,he Bay Area Air Quality Management TOTAL: S 7•
isvieYf
❑Yes 12<11 BOILER-COMP(OVER 110,010 B 11
AIR CONDITIONER /�]/�✓�
have 4dA
hamrdom materials
,,ns x5505.requirements under .l.lid 6.95 of 0t Cali- ISSUANCE DATE
forme Health ode,Ss,ios n 505.255A send 25534.1 unticrsmnd,ha,if rhe NEW RESIDENTIAL MECH. SQ.FT. i/!/qv /_ \/I
huilJiredres nion ,ha,it is my responsibility m noufythevocupam \-/oft yrw prior in icarree of a r f ham o lqup cy. —//� y�
Ilmerizr a8rm [Dal TOTAL. TSSUGD RY: `�®� • "N 7oL
OFFICE
19H1 06 1999 163-4 FP FYER PROPERTIES 4156=62767 TO 1510537F:72S P.O_ U_
- --- —` q.Ipr,E No. : 962 a37 6075 T£C: 01 19% 10:�9cart Pa
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MAY 06 1999 09149 510 537 9726 PAGE•02
+ TOTHL PNCE.O_ **
SPACING TABLE
Listed sign or sign section(consists of channel letters A. Between primarywiring and insulated high voltage wiring.
attached to enclosure,power supply,insulating boots, B. Between insulated high voltage wiring and dead metal where wiring
insulating sleeves,plastic face,tube supports, Bushing optional parallels dead metal for more than 1'within sign sections.
and disconnect switch if provided)suitable for outdoor locations C. Between neon tube and nearest surface.
unless marked for indoor only. D. Between uninsulated high voltage conductors or components.(Mid-
Grounded continuous sheet metal point-grounded transformer)and dead metal(ground),low voltage
f Depth enclosure(.sheet metal raceway") rimuitconductors and high voltage conductors ofopposite polarity.
varies I with sheet metal cover.
Nottage A B C D
Listed disconnect switch in primary
to be within sight(maximum 50 ft.)of sign. 1001 to 5000 12 inch 12 inch 3/4 in
Plastic face (Switch may be integral with sign as shown.) 5001 to 10000 3/4 inch 3/4 inch 1-12' 1-1/8 in
NEC 110-3(b),600-2,600-4. 10001 to 15000 1 inch 1 inch inch 1-12 in
Tube support 'Some power supply manufacturers require greater spacing.
per NEC 600-33(b). See manufacturer's instructions.
Neon tube.
Spacings maintained Raceway
per spacing table.
Example"
Primary electrical source BOBS
Letter (t2 in.minimum conduit. One piece Sin listing )
height °'`--� metal shown). sign ( 9 stin mark
varies
NEC 600-6&600 21. Joint in
raceway
GTO cables and insulated sleeve Example'B'
i
&G BOBS
provided between electrode and Two place
power supply sign L Two raceways—�
connected together
Electrode insulating ,�` - (Two section listing mark)
boot and sleeveElectronic power supply
provided with sign.' a ih Example'C' I BIG TF=B0=B=S =T
a Two signs �— Separate raceway
Drain holesr for each sign
(One sign listing mark on each sign
if used outdoors.
Installation of signs listed per UL48
Note: Installation requirements only.
Manufacturing requirements contained in UL48.
LISTED All rights reserved.No pan of this work covered by the copyright hereon may ILLUMINATED CHANNEL LETTER
Listing marks: by qualified electrical be reproduced or used in arty form or by any means-graphic,electronic,or CONTINUOUS RACEWAY
Sign or section listing mark. testing laboratory mechanical,including photocopying,recording,taping,or information storage
Required on sign or sections. and retrieval systems-without wrdten permission of the publisher,except INSULATING BOOTS AND SLEEVE
Sae examples A, B, 8 C. ELECTRIC SIGN SECTION that angle copies of individual pages may be made by a bona fide electrical
The first blank space identifies the number of NO. XX-123456 sign installation firm for the sole purpose of providing guidance on the Date: October 1994
each sign section.The second blank space installation of electrical signs or outhne fighfirg,without the permission of the
indicates the total number of sign sections. of 0 publisher. Scale IAED9 UL48-E38
None w No.
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P�NSTRUCTION. W.
'PLOT PLANS
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CHECKED BY.
DATE 2a R ONI T INT- 10,L" , CHWNEL- LI TTE12l6
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PLANNtNI P IzAcE:- VA,(P iKrrI;V TO "Arrc4t Dj-
�,ar 5 6661. 0 9 AVVd
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OF (�'1
DATE II '3Pg8 JOB/PROJECT: REV DATE DESCRIPTION Br CLIENT:
SALES REP. l�
40fi
SCALE
DRAWN By • 20600 �TevgJs ®�® ��®�
DRAWING NO. 12,07 pC�I�.-�j✓E
SHEET G 7 �r ✓F•�(!`!� Tnbb.n wlo1wb40^wwta lM..alwlwura 776 LWAIW Aw
1 0 J IM cwlanrr.Untll InMhrrH M ub•II rl6�b N �.Cdffo 11b 61611
rw�w1•na n M na ro e.npoEuwOln 41r TM.M (610)677.1603
JOB NO. ~ tMP•��•• A•pO APPROVAL: �A7(6t01677.67p
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