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Home My WebLink About10120043CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10591 E ESTATES DR I OWNER'S NAME: KRISHNASWAMI SURESH OWNER'S PHONE: 4082429056 LICENSED CONTRACTOR'S DECLARATION License Class Lie. # 6S Contractor C f IC'c r�r G Date % I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. / Signat d Date: -7-/y OWNER -BUILDER DECLARATION CONTRACTOR: SPRIG ELECTRIC PERMIT NO: 10120043 1860 S 10TH ST DATE ISSUED: 12/07/2010 SAN JOSE, CA 95112 PHONE NO: (408)298-3134 BUILDING PERMIT INFO: BLDG r- ELECT r PLUMB MECH r RESIDENTIAL ! COMMERCIAL JOB DESCRIPTION: INSTALLATION OF ELECTRICAL CAR CHARGER & 40 CIRCUIT hereby affirm that I am exempt from the Contractor's License Law for one of he following two reasons: , as owner of the property, or my employees with wages as their sole compensation, vill do the work, and the structure is not intended or offered for sale (Sec.7044, 3usiness & Professions Code) , as owner of the property, am exclusively contracting with licensed contractors to :onstruct the project (Sec.7044, Business & Professions Code). Sq. Ft Floor Area: I Valuation: $1620 APN Number: 36925015.00 I Occupancy Type: I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above in is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, sts, and expenses which may accrue against said City in consequence of the .sting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 19.18. Signature Date PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 D OF PERMIT ISSUANCE OR 180 DAYS AST CALLED INSPECTION. n Issued by: Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code,,,;s : 15 , 3, and 25534. j y Owner or authorized agent Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional �, CITY OF CUPERTINO IVU 7;' CTTM A T(112 — RI TII .DING DIVISION APPLIANCE / EQUIP TYPE 1'LL Lv liX—xmi._. -- -- QTY UNITS ADDRESS: 10591 E. Estates DATE: 12/07/2010 REVIEWED BY: gs BP#: *VALUATION: $1,844 im APN: xPERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY TO t ;Ix l PENTAMATION 1 REAP? USE: SFD or Duplex I:1_C)€ IR l ill.' i PERMIT TYPE: WORK Car charging station PME Unit Fee: $126.00 SCOPE $42.00 APPLIANCE / EQUIP TYPE FEE ID �••� » - -- QTY/FEE QTY UNITS BP FEES Elec. Permit Fee: IEPERMIT Special Circuits 1BREMMISC OtherElec. Insp. 0.0 hrs $42.00 1 # $126 P i-Init Fcc: .S1f/y)1. 1"Iso Fce PME Unit Fee: $126.00 PME Permit Fee: $42.00 C ons,1iwcflon Tt:t -j,:011S,fiCf11 l cricw Work Without Permit? 0 Yes E) No $0.00 TOTALS: i Travel Documentation Fee: 1 TRAVDOC $126.00 Strong Motion Fee: IBSEISMICR _ _ __ __ —i —a n»1v an nctimaty_ Contact the Dept for addtl'l info. NUTS: These fees are Dasea on the pretir"murtary in FEE ITEMS (Fee Resolytion 09-051 Ef. ' 1/10) .guglurt ��«��« FEE �••� » - -- QTY/FEE Elec. Plan Check 0.0 hrs $0.00 t'lon C hcck 1'�{ Elec. Permit Fee: IEPERMIT ,4SIIPPl. PC1."C,c, OtherElec. Insp. 0.0 hrs $42.00 ( PME Plan Check: )J _ _ __ __ —i —a n»1v an nctimaty_ Contact the Dept for addtl'l info. NUTS: These fees are Dasea on the pretir"murtary in FEE ITEMS (Fee Resolytion 09-051 Ef. ' 1/10) .guglurt ��«��« FEE �••� » - -- QTY/FEE - - - MISC ITEMS t'lon C hcck 1'�{ ,4SIIPPl. PC1."C,c, PME Plan Check: $0.00 P i-Init Fcc: .S1f/y)1. 1"Iso Fce PME Unit Fee: $126.00 PME Permit Fee: $42.00 C ons,1iwcflon Tt:t -j,:011S,fiCf11 l cricw Work Without Permit? 0 Yes E) No $0.00 i Travel Documentation Fee: 1 TRAVDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $211.50 $0.00 TOTAL FEE: $211.50 Revised: 1210It20i u 5 ITEMS OF 10 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36925015.00 DATE ISSUED.......: 12/07/2010 RECEIPT #.........: BS000012167 REFERENCE ID # ...: 10120043 SITE ADDRESS ..... SUBDIVISION ...... CITY ............. IMPACT AREA ...... 10591 E ESTATES DR CUPERTINO OWNER ............: KRISHNASWAMI SURESH ADDRESS ..........: 10591 E ESTATES DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: SylviaM COPY # : 1 RECEIVED FROM ....: SPRIG ELECTRIC CONTRACTOR .......: PEPPER SNYDER LIC # 21974 COMPANY ..........: SPRIG ELECTRIC ADDRESS ..........: 1860 S 10TH ST CITY/STATE/ZIP ...: SAN JOSE, CA 95112 TELEPHONE ........: (408)298-3134 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW -------------------- BAL ---------- 1BCBSC ------------- VALUATION ---------- 1,620.00 -------------------- 1.00 0.00 1.00 0.00 1BREMMISC EACH 1.00 126.00 0.00 126.00 0.00 1BSEISMICR VALUATION 1,620.00 0.50 0.00 0.50 0.00 1EPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1TRAVDOC FLAT RATE 1.00 42.00 0.00 42.00 =--------- ---------- 0.00 TOTAL PERMIT ---------- 211.50 ---------- 0.00 211.50 0.00 VOICE ID DESCRIPTION VOICE ID -------------------------- DESCRIPTION -------- ---------------------------- 304 ROUGH ELECTRICAL -------- 505 FINAL ELECTRICAL INSTALLING THE EVSE-RS Basic Specifications: ■For use with Electric Vehicles ■Ventilation not required ■Rain tight � A V Power Disconnect switch Charging Dock 1. Choose wire entry location HOLE ON UNDERSIDE OF CHARGING DOCK Bottom View 2. Attach the mounting plate Mounting plate Large hole for conduit utility wires Charging Dock mounting holes mall holes for mounting plate wall stud Vall stud HOLE IN REAR OF CHARGING DOCK Rear View t Flatm?Oer ,,Lag gb�bolt ----------- -------- Wall stud -3. Attach the Charging Dock to the mounting plate Upper mounting hole Flat washer Socket head screw ------- ------------OMO 4. Wire the Charging Dock Terminal Block Ground Strip Ground Wire Two power wires 1,4 i Vis. 5. Install the front cover #10 Torx screws— Torque 12in/Ib '�► 4M 40 r - � Removing the trim ring l / y�4 Z IkCC hpk! C3UT1M +�� 6. Complete the installation i ____------ FRONT PANEL COMPONENTS POWER PRESENT The charging dock is receiving AC power. READY TO CHARGE The charging dock is ready to charge or charging is paused. VEHICLE CONNECTED The connector is properly connected to the vehicle port or the charge is complete. VEHICLE CHARGING The vehicle is being charged. TROUBLE There is an error. Try removing the connector and inserting back into the vehicle, If Trouble Indicator is still illuminated call Customer Service at 1 (877) NO GAS EV or 1 (877) 664-2738 or visit Customer Service on the web at wkaw.nissanusa.comlleaf. START Press to begin a charge. The PUNER PRESENT and READY TO CHARGE lights must be on. STOP Press to manually stop charging. The device will stop automatically when it reaches full charge. SE BUTTON to release the Connector he charging dock or the e port. CHARGING THE VEHICLE . .... 06rAKr a Press the button on the connector to release It from the charging cock. �500 ��-. �j t� •r v Unwrap the cable from around the cable haig{. Charging will stop automatically when complete. You can manually stop charging by pressing STOP. When the READY TO CHARGE light blinks, remove the connector from the vehicle charge port. If you have pressed STOP, you can press START to resume charging. F-6-] When the VEHICLE CHARGING light stops blinking on the charger, press the button on the connector to release. Pull to remove from vehicle charge port. Insert connector firmly into the POVRXI Ph�EWR OIrTAOU ncaovraanereneo WTW Chargingwilibegin vehicle charge port. When automatically. When fully inserted, the VEHICLE o charging begins. the CONNECTED I Ight on &is '"0a1Ke ° .E CHARGING fight charging dock will Illuminate. -a In to blink. There Is no need to press START. Charging will stop automatically when complete. You can manually stop charging by pressing STOP. When the READY TO CHARGE light blinks, remove the connector from the vehicle charge port. If you have pressed STOP, you can press START to resume charging. F-6-] When the VEHICLE CHARGING light stops blinking on the charger, press the button on the connector to release. Pull to remove from vehicle charge port. FEATURES • SAE J1772 compliant • Auto restart in event of power outage or ground fault • Americans with Disabilities Act (ADA) compliant installation • Integrated cable stowage, optional cable management • Underwriters Laboratory (UL) listed • Breakaway safety cable • Optional pedestal mount • Wireless communication option SERVICE AND INSTALLATION Will be supported by: • Expanding network of independent certified, trained electricians* • Convenient home site assessments and installation • Electricians with depth of local code and permitting knowledge 02010 Aerovironment, Inc. 1010_10147 Pre -production image shown. Production model may vary. The EVSE-RS Home Charging Dock charges all SAE J1772 -compliant vehicles — including both electric vehicle (4\4) andlug hybrid }b (PHEA els — e Anience Qf the garage, workplace, condominium, apartment, or retail parking structure. The Home Charging Dock safely and reliably delivers AC power to the vehicle's on -board charger and features a weather - resistant NEMA 4 enclosure for indoor and outdoor installations. The Home Charging Dock is installed by one of our independent certified licensed electricians who also facilitate necessary permitting and inspection, and provide information about EVSE-RS use to the customer. An optional module is used to enable WiFi, Zigbee, or cellular communication. INTUtTIVE USER INTERFACE GREE _ . --' rbcV I GREEN = ready to operate GREEN BLINK f "of jatyp(Jo a manual STOP GREEN = connected to vehicle GREE �Iale is charging (fast blinking = high charge when batte l3uvt=allew,blir►king =charge near cotnpletel RED = error has occurred; blinking pattern based on fault type *Installation services available in certain areas; contact AV for additional information. VYt1.DJJg 17J - nicutric vemcie supply r,gwpment AEROVIRONMENT INC 1610 S MAGNOLIA MONROVIA, CA 91016 USA EV charging station, Model EVSE-RS. Last Updated on 2010-09-07 Questions? http://database.ul.com/cgi-bir,/XYV/template/LISEXT/1 FRAME/showpag... FFWA.E336193 Electric Vehicle Supply Equipment Electric Vehicle Supply Equipment Print this page E336193 Notice of Disclaimer Page Too 3 I .ik, a ... • rr The appearance of a company's name or product In this database does not In Itself assure that products so identified have been manufactured under UL's Follow -Up Service. Only those products bearing the UL Mark should be considered to be Listed and covered under UL's Follow -Up Service. Always look for the Mark on the product. UL permits the reproduction of the material contained In the Online Certification Directory subject to the following conditions: 1. The Guide Information, Designs and/or Listings (files) must be presented In their entirety and In a non -misleading manner, without any manipulation of the data (or drawings). 2. The statement "Reprinted from the Online Certifications Directory with permission from Underwriters Laboratories Inc." must appear adjacent to the extracted material. In addition, the reprinted material must Include a copyright notice in the following format: "Copyright 2010 Underwriters Laboratories Inc.@" An independent organization working for a safer world with integrity, precision and knowledge. uoil A/�-�1 b _iia � ��` �'•_. ' 1 10/26/2010 12:05 PM Installation Notes 1. When required by the AHJ, install Safety Switches per the specification indicated. 2. Branch circuit wiring shown here is based on typical installations where voltage drop is not a factor. Conduit and conductor sizing shall be calculated based on length and sized to be compliant with NEC. 3. Labeling requirements: All junction boxes, safety switches and Charging Docks shall be labeled with the panel and circuit designation. Use Brady or equal label maker and adhere to cover of each item listed above. Additionally conductors shall be labeled with cloth mariners. NOT TO SCALE Single Wall Mount EVSE / Wall Elevation Surface Installation of Exterior EVSE Typical One Hole Strap as required by Code Typic;1,2-GaM Bekl�bx (or equal) with TO per Proof Screws Typical O e Holer�&rap,as required by Code S •S Typical %" EMT Conduit w/248 & 1410 Ground, THHN Copper 60 Amp, 250 Volt, 2 Pole, Fusible, General Duty, NEMA 3R EVSE Wall Mount Charging Station Typical %" Liquid Tight Flexible Conduit OCable Management E8 & 1410 Ground, THHN Copper Wall Mount Charging Station Typical %" Liquid Tight Flexible Conduit Cable Management Page 4 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: PERMIT # OWNER'S NAME: M� �r PHONE # - GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: Z)1 � o CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business ucense. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR ANDUBCONTRACT HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. /� /)--7—/o )- / _7rV 1 am not using any subcontractors: �f (( Signature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date Site Assessment Customer Acknowledgement Service Request # .15!2 92= Assessment Type: FW91derttial CLECTRICAL CONTRACTOR INFORMATION comp;;S Phone ,yp Employee Rep Name CUSTOMER Home Phone Address — 4^ Mobile Phone Address E -mall k,N City State 0 zip Contact Preference E -meq Phone ❑ ASSESSMFNT NOTES Use ods section to ldenaly (t) Cfrstomerrequest (2) !toms to be moved (3) Conpactoraf n0W.* \ ` ' ` o d Standard Installation ❑ Custom Installation Level 1 txt Customer tnode LOCATION Sketch an overhead floor plan. ff mo rm. Add other Rema to aid SOW - entryways. Ivi1 outlet, trench length,etc Drawing must Include: 1) Structure outline 2) Cer placement 3) EVSE hx* ton TT 3 + 4) Panel location Mrs huff distances ) ho A 'aret"vtCe. 1 agree to the placement of the Charging D'x*;M; to the do own the reaiderroe, en&pr the residence is subject to above. or n modScatlons, that a completed HOA consent Form rrn m the property owner wNbe required prior to srhedulNg the brs�torr. Cuatomerbrltla/s CustomerN2fe/s —UM NEXT STFPS 1 You w® receive a rwWmtlan to review yfwr quote vlo emd 2 Complete Customer Satlsfaoflon Survey. To p nctdw end schedule the Charging Dods aiste0at[on, lop onto the Masan LEAF- website 3 wvrw.nlesanuse.c�rnitear-electrbcar CUSTOMEROF i aret�loneersrakrdabove, nmrn�ea/eca�•�cor�ne�ortdarmrmdabor•p�,nod»,ec►�a,�,Qvodcs�arnmerude�,tedae�dve.era,eadodie.s�tedm�edebdve,endaem�caoray er�raaed are nerd slops M are S1te Assaesrnerrt arM cnararne �* �� P � Decir SfAe Aesaes+nent le arrf�ed to q+e 7emre ane Covrdltlorre and any appacabre 3mm Crr�bmurre ! was prMb d WM and agreed ro at are lane of ardeft are ChargbV Dfx* sae Aaseasm&jg aha 1 hereby auarortrs Aerovaomneny arc. m CWVh to she r>reds aerdaharg6rgprooeav agreed to t rmders�nd and aalerowledge tlutAeroV6munen4 arc wBl efearonloeay prdvld• me wah a wrAterr quamaon 6u are Chargarg Dads a�asaon based on art Charging Dock Sae Anownwit SaeAsseworName �f� �Cf ti S Date Customer Name S nature Date &LI J16) please note that customer records can be accessed ontlne any time at www. n1SWnusa.c0m/leaf-618cbt0-Gar For immediate quest OM. b1ba& feet free to cal! 1 -877 -NO -GAS -EV (8s4 273e) White - Contractor Yellow - Customer V5.0 �n Service Request # �57g Z Customer, _ Appointment Datemme Site Assessment Arrival Time 01 -:-Vft Departure Time.93 = _--^r•-•- ��••�••,• �•..•....�w.w.� yuovu�vnPleZ•'O:o/m: Olopmp(Ab 1�lAld M�IIIIO� b• CO1R?idNlAi lIL6A1�lJOR Fianna Rules: Emma D" sh raw, brbrlmum Mw 1. Type of structure: (case ane? le F Condo - Townhouse - Duplex - Mobile - Apartment Other 2. Size of house (used for load calculations Is the residence subject to HOA rules? Yes 4. Electric Utility Comparry:. 6. Pemtlttir>g Judsdictigrh , 6. Permit Fees (If known) Standard install S Ct�tom install adwel 1 option $ 7. Main Electrical Servke Capacity q � 6. Meter Number e. Manufacturer sub) panel that vdQ feed the EVSE 10. Is there existing capacity to support the additional Level If 2P. 40A load? No 11. Is there existing capacity to support the additional Level 11P, 20A load? No Ira 12a. Will tandem or twin breakers be needed? No 12b. If yes, quantity & ske? 1 J. Where Is the electrical parte! located? Inside or CIUM Garage Bas Branch obeli! Amp Pole Gramm ck" Amp Pole aesalmr alae a at Pone �y agWpmsnt and Heat P lank H4VH 15A ctreue class If Heater Tankless FNM an 20A.. r 1e F HVAC arAC neh waserSecbta Range !� Dryer W Waascripmons ll OranPOOMatTub (Microwave Bump Pump Freezer O�� , Dishwasher Spare spaces 14. Where will the Charging Dods be located insld or Outsid Attached Gare Detached Garage Driveway • Carport Other If other, explain: 15. is home wired for an EV charger (240V/40A circull)? Yes N I16a. Does home have a Level 1 Outlet (120V circuit)? Yes ® 16b. Is it grounded? Yes No Unable to test 20 17. Does the customer want a Laval 1 outlet quoted? No 18. is an equipment disconnect required by local Avladtc8on? No 18. Whet is the total length of the branch circuit nrun? 96 ft . ma. How will the branch circuit be run? EMT Roex PVC OF LFMC MC FMC GRC 20b. Length: 3d ft 8 IIft ft trenching v ft 21 a. Wig any enching be required? Yes form 21 b. Trench type and length: Concrete IIIAs ft 2Z Charging Dods Cord length requested: 2V 23. Charging Dods Mounting option: Pedestal 24.Other options requested: 25a. Panel Alteration rpul No 25b. Service Change required? Yes No 25c. Subpanal required? Yes No 26. Proposed Panel Size: A NOTES: Site Assessor Approval Contractor 1 cw* Met I omnpteted the She Asseaamwd as de=MW abM that al of No buarnrmft prodded bens is hue and amnale, andMd Lids Slla As nsnt was Cmdurxed In comp ,W= ! olAero s ! have oarngr/eted and Cu:eom•rArlarow/edgamarM Foram Prfnt N (,� u t... t7770w Slg�mtura: : Site Assessment Form v 10.06.10 Itim , EYE! lissmumm awmik, W_4'lill' a -4%�I, A; Silver Spring Networks 0013500200955CS? III HII III III 111,11,111,41r,#11 Frr, ID: OWS-NIC501 IC: . . . . . . . . . . . 1W loop. W TypeFOCUS AXR -SD FORM 2S C1 7111111 24AV1 31AI CA RE 114=3U Kn /.j IllllllllllllllllllilllllllillllillilllllllllliilnhlliillillllBIIIIIiiIBiliilNllllllllllll *NXL10059038140909* 1005903814 AR GO min PG&E $ D min. 102 848 107 -415 0909 Landis+Gyr PATENT PENDING 44 a 7 - FT 4 4ge 771 �i0381 er r �- L0AP.. CENTkR CAT. N0. MT100WA-8 100 AMP. 120.240 V.A.C. xrtsJ�► _ PRQDUCTS- Ah6GEL"ES 155 S AND ERVICE LE OFF I L "'i im SEE BREA •4._ f,l�. I ire e4 * f, 4 lie V IF- tk. 2r If) tit 6 e titi `i eti r • : :.. � � �. � ,�,� ',��' � ' � � � �' �' �'k .rte 0 _ .`.,► •,!�',s-'fie �.. Vit` •.•, • �' '. , ' As ��.� Alf NA 1 L --:i r �r A .�All. ' A�. r. h of it 6 qmb qw -.Or , tv " 40e 40 a► . vj' N . I --�,�;;, gf� ��N d ;� � ,.. �,. �� ib �F �..� � K .. .4 `�7b� � � � t� � tx k �' X.,•:' K .' �." .. W � .`� t �vs �3�� ^' J�=ti � �� i� �" C`l a% l �; ` %, �� e Y� ^m � � �� j' w: �� s � �; f � � �.,��A f :�? �. ^E"= �� k � T ��i�r, gf� ��N d j �; .. .4 `�7b� � tx k �." .. W f. �vs �3�� ^' �.in I ..... -.� .r �_ �'�.<�, w I �\ . CITY OF CITY OF CUPERTINO GENERAL BUILDING CUPERTINO PERMIT APPLICATION FORM /01200 APN # Date: 3(0c 25015- Building Address: Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes ❑ No HOA: Exterior work only) Yes ❑ No ❑ If es, rovide letter from HOA Owner's Name: Phone #: ^ �, l�tiJ�s�'✓ter t.� SL Z S+t q �,�{� LS -6 Contractor: Phone: 42)?, ` )-48 - � I3 1 Fax: y Q J,'�J SO Contractor License #: 2 -7 ),�3 — C)�,LO Cupertino Business License #: �I� `i Contact: Phone: -iO ..2cl 313 Fax: Residential 01Commercial ❑ Zt- q0 Job Description: (�f�u.•�T'� �ti v� J� �C�. C..1c< ClU r Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V -B Valuation: Square Footage: � - �, -�L� 16; ZC5 Project Size: Express ❑ Standard Lar e ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Points Achieved: For help, contact Build it Green at www.builditi!reen.org Revised 07/14/09