S 3963APPLICANTTO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
CITY Oy CUPE RTINO BUILDING - ELECTRICAL
BUILDING DIVISION APPLICATION/PERMIT PLUMBING -MECHANICAL
BUILDING PROJECT' IDENTIFICATION
PERMIT NO.
S 3963
BUILDING ADDRESS:
SANITARY NO.
APPLICAN NSUBMIITALDATI
�WN=Jj:GNAME: , pHONP
TIn (� I
CONT ACTON'S NAME: LIC NO: __
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NIC
❑
CONTROL #
ARCA ECI'II: GINEER; C N ):
ADDR 7SS
CON'T'ACT: PHONE
BUILDING PERMIT INTO
�J
❑ Consultant Fees Paid by Applicant (Initial)
BLDG ELECT PLUMB MECH
El LX ❑ F-1LICENSEDCo
ACTOR'S DECLARATION
I hereby nfrrm that 1 a... licensed order pro.t.ionx..f Chapter 9lcommcneNs
QTY. ELECTRIC PERMIT FEE
JOB DESCRIPTION
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PERMIT ISSUANCE Q
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with
hSction JWBf Division 3 of the Business and Professions Code. and my license,.
in -y
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Lisxnsc Chins Lic #--
s� —'��„f 1—/ _t/0
Uatc CSDE 17Sy..
ARC111TECI'S DECLARATION
I understand my plans shall he used as public rmvnds
RESIDENTIAL,
❑SFUWI. ❑KITCHEN REMODEL
CADDI'1']ON [D PLUMBING RE -PIPE.
❑MULTI -UNIT ❑STRUCfUNAL
MODIFICATION
APPLIANCES - RESIDEN PIAL
PANELS
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ywhich
Licensed Professional
OWNUR-BUILDER DECLARATION
1 hereby affirm In., I am exempt from the Contractor's License Law for the
following nawar. (Section 7031,5. Business and Professions Code: Any city or countySIGNS
requires a permit in construct, altag inmpnne, danolish, or repair any untmmc
prior to is issuance. also acquires the applicant for Such permit 0 file a signed statement
UPT0200AMPS
20LI000AMPS
❑INTERIOR ❑CHIMNEY REPAIR
IMPROVEMENT E)SWIMMING POOLS
❑BATA NEMODEI/REPAIR (] DEMOLITION
0OTHER
OVER IIXN)AMI'S
ELECTRICAL # 2 O
SPECIAL CIRCUIT/MISC.
C
that he is liccnwd ptommat m the provisions of the Commehm's License law (Chapter 9
(mnm¢neing with Semion 7000)of Division 3al I he Husincssund Prfcexionx Code) "II
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
EMP. METER OR POLI: INST
COMMERCIAL:
❑ NEW BLDG/ADDITION ❑ DEMOLITION
u'
y
60
mwd1do
Section 7031.5 by any appllcam for a permit subjects the applicant to a civil penalty of
not more than live hundmid dollars (S500).
Las owner ofthe property, or my employees with wages a% their sale corpcmmion,
the wmk.mdlhedre.De is not intended oro(fcat for sale Sec. 7014. Business
and Professions Code: He Contractor's License Law does not apply to na owner of
POWER DEVICES
[]TENANT ❑ FOOD SERVICE
IMPROVEMENT
❑OTHER
SWIMMING POOL ELECTRIC
011'HJ rs-SWITCHES*('�)
/
NEW RLSIDC L P.sale.
_
property who builds or improves thereon, and who docs such work himself or.thmugh
his own employees, provided hal-ch impruvemcnu am nom intended or offered for
IL however. the mildl,amprovnnent Nw,ld solution. ycurafcampininn..he
er-builder will have die burden of proving that he did not buil, or improve ft
SQ. FT FLOOR AREA
$SQ FT
t;oxo
fssie.).m ❑ 1, ns owner of the property con exdusivtly conaatling with Livens,, cnntracmmllUm the project (see. 7M4, Business and Professions Cnde:l TTc Contractorw
Law docs not apply¢) an owner of property who builds Is improves thereonUMBINwho
contracts for such projects with a eomfaetons) licensed pursuant w Ilene CommLicense
Law.
ex :npundur Sac ,B&PCfor thisrALTER
MIT . NCE
want — Dam
- DRAIN &VENT-
VALUATION
BACK ELM PROTECT. DEVICE
PWORKER'S
COMPENSATION DECLARATION
I hereby affirm under Penally of Fe jury come of the fallowing declarations:
❑ I have and will maintain a Certificate ofCon.,em )self -imam for Worker's Compen-
salon, us poonled h , by Section 3700 of he I.:.hur Cale, for the P-111 11 oT I. -
hework for which an, permit is issued.
we rk
DRAINS-Fl.00R. ROOF. AR N
STORIES
TYPE CONSTRUCT ION
FIXTURES - PER TRAP
1 have and will maintain Worker's Compenvlion Insurance, as acquired by Section
3 I of the Lubar CU te. for Ne tarfo.... roof the work for which Nis permit ie Uwed.
OCC. GROUP
APN
GAS-EA.SYS"TEM-1 INC.40UFLEIS
My Wnrkc' m n. do Iowagqcc comer and Policy mar . tui
Camcr�We�t[A Policy No:a-rt
GAS - RA. sYS'IT.M-OVER4(EA
GREASEIINDUS'I'HL WAS TF.[NTH TIT
CP.RTIIICA'I'E 017EXE1"IITION FROM WORK17RS'
COMPENSATION INSURANCE
BUILDING DIVISION FEES
Thsxaainnncedma be completed ifmhe permit is forone hundred do][. 5100)
I,r Ices)
GREASETRAP
PLANCIIECK FEE
SEWER - SANITARY - STORM EA. 200 FT,
ENERGY FEE
I verify Nat in the performance ofthe work forwhich this permit is issued, l shall
not employ any pein any manner so as to become subjecuo the Workers Counter-
person
WATER HEAT ER WIVENTIF,LECTR
GRADING FEE
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O
nation Lawsof California. Dot,
Applicant
NOTICE TO APPLICANT: If, after nmking this Comfivitc of Exemption, you should
bemesubja9 m the Worker, Compumotion provisions of Ne Labor Cotler you must
m
forthwith comply all such pmvislonson this permit shall be deemed ne,aked.
WATT:R SYSTEMOIREATING
H
SOILS
WATER SERVICE
•ZCONS'1'HUCTION
O
V
LENDING AGENCY
1 hereby affirm thatthem is a conswction lending agency for the perfumwnce of17
the work for whichNis permit is issued (Set. 3197, Civ. C)LIN
Lenders Num,
I Recept#
4(•'t
'TOTAL:Lenders
NEW HIiSIUIiNI'IA1. PhMB. SQ.
E-1za—
T
11
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Achli
0F.=RIC
certify that I have read this application and .state that the above information is
come".I agree mcnmply with all city and county ordinances and state laws relining to
building construction, and hemby authnow representatives ofthis city to enter upon the
oMwo-mentlon,d property for iropeetion purpnws.
(We) agree m save, indemnity snit keep hafmlcss the City of Cupeninn against
QTY. MEChIANICAL PERMIT
PERMIT ISSUANCE
el-
ALTER OR ADD TO MECH.sequenceof
Iiahilities,judgmemx, costs and expenses which may in any way scas against said City
the gruntingof this permit1
AIR HANDLING UNIT LTO 10,000 CFM)
MECHANICALIZE
APPLICANTUND!RSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURC I R(iULgIONS.
AIR HANDLING UNI'1'(OVER 10,000CFM)
CONSTRUCTION TAX
Signtuaof Applj at Co lrunnr Dam•
EXHAUST HOOD(W/DUCT)
HOUSING MITIGATION FEE
7 IALABDOU S MATERIALS DISCLOSURL
HEATING UNFT(To I(M) nad]I
Will the app icam or future building occupant some or handle ImaaJous inumd
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Cwle, Section 255320,1
1[EAT]NO UNIT (OVER I00.000 BTU)
Ye, No
PAID Date Receipt#
VENTILATION FAN (SINGLE HISID)
Wdl the applicant of luutre hoildin......pant use equipment or devices which
crit haaallous air co laminates as defined by the Bay Arca Air Quality Management
11011 -UR (3HV OR IIXI,IXNI B'T'U)
^
V
BOILER - COMP (OVER 100,000 BTU)❑Yes
District?
El No
AIR CONDITIONER
I have read the hmardous)medals requiaeunems under Chapter 6.95 of the Cali-
Burial Health & Safety Code, Section 25505, 25533 and 25534. 1 unde:umnd that d'the
ISSUANCE DATE
/ /T
NEW HESIDI:N UAL MECH. SQ. PI',
building dossnr cunenlly havea¢amnuhat it is my mspsmihility to mnify Netwcupam
/ yi
of t cire ut,whsh u.a x rocs pilar m ismuncc of u Cil nniO lc f amy
v.f� "e
111000
TOTAL:
ISSUED BY:
Odom, mpmh n agent Dat
L/ OFFICE
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Listed sign section (consists
of insulating boots, Insulating —�
sleeves, plastic face, tube
supports and channel letter)
suitable for outdoor
location unless marked
for indoor only, —�
Tube support
per NEC 600-33(b).
Neon tube. —�
Spacings maintained
per spacing table.
Plastic face—�,
I Electrode insulating
Letter boot, GTO insulating
height sleeve provided with sign.
varies
Conduit
locknul
(typical)
Drain holes
if used outdoors.
Listing marks:
Listing mark sign section label shall
be on each letter and transformer
enclosure.
The first blank space identifies the
number of each sign section. The
second blank space indic3los
the total number of sign sections.
Depth
varies
Wall varies in ra
thickness and
material �
8
LISTED
by qualified electrical
testing laboratory
ELECTRIC SIGN SECTION
NO. XX-12xr34556�6
=u
Of
- #10 s 3' Long screws
Min.3 per letter
- Primary electrical source (12 in.
minimum conduit, metal shown).
NEC 600-6 8 600-21
- Listed disconnect switch in primary to
be within sight (maximum 50 ft.) of sign.
(Many interpret transformer enclosure
to be part of sign.)
NEC 110.3(6), 600.2, 600-4.
- 3181n. minimum listed flex (metal shown)
and listed GTO cable (secondary side
only and to the next section letter).
NEC 11U -3(b) 8 600.31.
Installation of signs listed per 1.11-48
Note: Installation requirements only.
Manufacturing requirements contained in UL48.
ILLUMINATED CHANNEL LETTER
INSULATING EfoDT AND SLEEVE
•
Date: October 1994
Scale
None
IAEI UL48-T1D
Dwg. No.
•