20300APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Buildins Proed Identification
Wildig Address;
10100 Torre Ave. Manager's Office
PERMITNO.
20300
water. Ve one:
�^^a=-=r ro erties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION I PERMIT
BUILDINGELFCTRICALPLUMBINGMFL LAICAL
.
5/10/90
Contractor's Name: Lk. N°:
738-4444
CATEGORY
CONTROLN
Architect/Engluer. Lk. Nm
;,qn ELECTRIC PERMIT PEE
BUILDING PERMIT INFO
Address:
® ® X
�y
PFRMITI55UANCE ,V�
LICENSED Is CONTRACTOR'S DECLARATION
Ihereby Sedlo 70l0)of Dl Licm3ofthe under
usimvisions mdPmfe aon,9de,and c
end my
Inensei in full
license tree anaeffed.
force and
License Chss Lk.N
Date ContnRor
ARCHITECT'S DECLARATION
I understand my plan shall be used u public racceda
Licensed Profeulolul
OWNER -BUILDER DECLARATION
I hcrcbyalRrmthat I am exempt from the Contrador's License Law for the
following reason. I5cct1on 7031S, Business and ProleuicreCode: Any city or
countywhich mquim a permit to muM1d
u, alter, Improve,m
deolish, or repal r
any structure prior to Its bsuencealsureq.h,a lheappBunt foreuch permit to
file a clgne i statement that he b licensed pursuant to the provisions of the
Contranor's License law(Chapter9(commencing vks�tbh Section 7DOO) of Divi-
sin 3 ofthe Business and Pmfru eselaCode) or that h>IJ?xexempt therefromand
the basis for the alleged exemption. Any vlol of Shin 7MIS by any
applicant Lure permit subjects theapplici toad) pwltyofnatmorathan
flue 1, as ed owner of he pr).
ere sole
I, as owner o! the property, or my employes ofvith Intended r offered
sale (See 7094, Busies and f property Code: The C Improves the me Law
sale &compeeaHory wilBu mess anddo the Pmfod the aW dere at Contractor License
eLaw
docs not apply to an owner of property who builds oyees,pvvided t oryand
who does such work himself orthrough his own empluyces,pmvided that m[h
Improvements are not intended or offered for aSIe. If, however, the building or
Improvement lesold within one yearufcomplatlon, the owner-bullcierwill have
(tlLkurden of proving that he did notbultdorlmprewfurpurposeofele.).
1_f L as owner of the property, am exclusively contracting with licensed
contractors to construct the projoI(Sec. 7044, Business and Professke Code:
The Contractor's License Law does not apply to an owner of property who
or Ire
mpravu thereon, and who contracts for eap
ch tojede with a
c"gacor(s) Licensed pursuant to the Contrador's License Law.
L -i I am exempt under See B & P C for this reason
APPLIANCES -RESIDENTIAL
JOB DESCRIPTION
MANAGERS OFFICE/COMMOrV
P Q L
ED
XIl-]
OV
SQ. Ff. FLOOR AREA
28,335
,
S/SQ. FC.
74.92
9GNSE CAL
SPECIAL CIRC
IFMP.MEITR OR POLE INST.J
POWER DEVICES
SWIMMING POOL ELECTRIC
11TLEISSWITCHFSEXIFURES -
VALUATION
858
$2,122,858
x x
NEW RESIDENIIAL EFCTR SQFT.
STORIES
TYPE CONSTRUCTION
.•� ' /
ly
TOTAL:
QTY PLUMBING PERMIT FEE.
OCC.GROUP
RFS. UNITS
FT.00D 7ANE
MN
PERMRISSUANCE
' �. �%O
�,� DRAIN & VFN'I' WATER (RA)builds
FEE SUMMARY
BACK nOWPR(Y=.DEVICE
DRAINS FLOOR ROOF, AREA, COND.
FIX.IURES PIER TRAP p' &M
O V
SANITARY Y_ N_
RECEIPT N
Owner Date
WORpNAN COMPENSATION DECLARATION
[]I hereby affirm that I have a certificate of consent to self-Inwre, ora
mrtifiateufWorkm'Comperuatimlnsmnm ora cerllfkd copy themof(Sec.
3WD, ab CJ
Policy 11
S LOOL T� Y_ N_
RECEIPT N
GAS EA. SYSTEM -1 INC40UILETS
PARR Y_N
F' RFC= #
GAS EA. SYSTEM -OVER
Coy
DING DIV
ISION FEESmifiad
copy is filedth the city
Ified copy b Klee hereby fu the dry inspection division.
CERTIFICATE OF IXEMPEION FROM WORKERS'
COMPENSATION INSURANCE
Tfhlssectlon need not be completed tithe permit is (Drone hundred dollars
($100)orlcss.)
I mnot emplohat in y is Issued, the
I shag not empty any penes In any manner at u to become subject to the
any perhe son I. any mannehe k so as to becomesh this subjrmitect
Worker Compensation lawn of California. Date
NOTICApplicaE
NOTICE co APPLICANT; If, after rs'ComakinthisCertificate
pro iaomoftheof Lyons
should bac me subject to the Workers'Compensation i n s ar blou of the Labor
Codeyou dinvo =9 forthwith comply with each provisions orihat permit shall
deemed revoked.
CONSTRUCTION LENDING AGENCY
I herebyaffirmthat there ba mutructlon lending agency far the perform
arm ofthe work for which this permit 6 baued(Sec. 3097, Civ. C.)
Lender'.Name
Lender's Addmx
I mitifythat I have read thisappllotlonand statethsttheabove information
boo.d.Iagm to complywlthallcityand countyordlnanmandstatelaws
relating to building comtmctlon, and hereby authorize representatives of that
city to enter upon the abovo-mentloned property fm inspection purposes.
(We) agree to save, Indemnify an d keep harmless the City of Cupertino
against liabilities, judgments,costeand expenses which may In any way accrue
agaWtsal It 1 naeque ce he tin afthb ro�ut/
��, " Late
SignsWreaf Applicant/Contractor Late
HAZARDOUSMXTMIALSDISCLOSURE
Will the applicant orfuture building occupant store or handle hazardous
material as dented by the Cupertino Municipal Cade, Chapter 9.17, and the
Health and Safety Code SMloon 25532(aI7
Wlllthe zpplka oto,utum building occupant use equipment or devims
which emit hazardous air ountaMnants as defined bythe Bay Area Air
lily Management District?
�J Yes Na
Ihavc read the hacap us materials requ lrements under Cha pier 6.95 of
the Callomb Health & Safety Code, Sections 25505, 25533 and 75534. 1
understand that lithe building does not currently have a tenant, that It is my
reiponsubllity to notify the occupant of the requirements which must be met
prior to Issuance of a Certificate of Occupa ocy'
GRWIVINDUSTRL WASTE INTERCEPTOR
PLAN' FEE
PAID
Date - Rccel t#
GREASE TRAP
SEWER -STORM EA 20UFT
WATER HEATER W/VENT/RLECTR
ENERGYFEE Y' N
PAID
Date Recei [#
,
WATER SYSTEM/,TREATING
NEW RESIDENTIAL PLMB._SQ.FT.
TOTAL:
1 DN
57.85.
SEISMIC FEE
s 48.: fig
TOTAL z.Op
ELECTRIC FEB
ELECTRIC EEE
_
QTY. MECHANICAL PERMIT" FEE
V
MECHANICAL FEE
.Z. 0
' PERMTTISSUANCE J2, tip
FEES PAID:
ALTERORADDTLIMFCH.
Daft ReCel [#
AIR HANDLING UNIT CFO IO,"CFM)
SUBTOTAL:
AIR HANDLING UNIT (OVER 10,000CFM)
CONSTRUCTION TAX
EXHAUST HOOD (W/DIX:T)
CONSTRUCTION TAX PAID:
HEATING UNIT (TO 300,000 BTU)Date
Recei t#
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
( .
VENTILATION FAIN (SINGLE RESID)
ISSUANCE DATE
PAH
`t 177
Ctttf of ClIIp,Tllflo
ISSUEDBY:• �• Ya (% U
_
BOILER -COMP DFIP OR 100,000 BTU)
BOILER -COMP (OVER 100,000 BM
NEW RESIDENTIAL MECH. SQ.FT.
Owner or authorised agent Date
^a-/ - �
TOTAL v
OFFICE COPY