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20321APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY Building Project Identification Building Add..: PERMIT NO. 20321 10100 Torre Ave. Unit 121 (D1.1) ners arae: one. A A ie CITY OF CUPERTTNO-BUILDING DIVISION APPLICATION /PERMIT BU DING-EIECnUCA4MUMBINGMECHAMCAL 5/09/90 copra Mame: Lk. N. 738-4444 CATEGORY CONTROLk Architect/Engineer. Lk. No: QiY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Add.. PERMITISSUANCE 12 LICENSED CONTRACTOR'S DECLARATION I herebyfbmthat [an Bunder Wonafhr nc APPLIANCESRESDENTUL JOB DSRe1TON ingwithSedion7000)ofDTvidm3oftheBusiundlmlNmsCe,andm Ilcense I'in full to=and effect PANELS � License Claes Lk.e ,,�J ltl.❑ Date ContractorUP TO 2DOAMPS �r 201-1000 AMPS ARCHITECTS DECLARATION - I understand my plane shall be used as public records. OVER100DAMPS SQ. FT. FLOOR AREA E/SQ.FT. SIGNSELECTRICAL Licensed Professional ', SPFOIALCIRCUIT/MLSC OWNER -BUILDER DECLARATION I hereby affirmam exempt I aexempt from the Contractor's License Law for the 669 74.92 TEMP. METER OR POLE INST. following reason. i5ection 7011.5, Busineseand Profmbns Code: Anycity or county which requires a permit to wea utt, alter, Improve, demolish, or repair anyswre ctuprior to Its issutrn,a[so requirmthe applicant for such permit to file a signed statement that he is licensed pursuant to the prov/slons of the POWER DEVICES SWIMMING POOL ELECTRIC Contractor's License Law (Chapter9(commencing with Section 7000) of Divi- sbn3 ofthe Business and Pmd.tons Code)orthat be b exemptiherefromand VALUATION the basis for the alleged exemption. Any violation of Section 70115 by any applicant fora permit subjectethe applicant to a civil penalty of not more than OUTLETSSWTTCHESFIXTURES 50,121.00 five j undred dollars ($500). - �I I, as owner of the property, or my employees with wages as their sob NEW RESIDENTIAL ELECTR SQFP. STORIES TYPE CONSTRUCTION compensation, will do the work and the structure is not Intended or offered for sale (Sec 7044, Business and Professions Code: The Contractors License Uw V_N does not apply to an owner of property who builds or improve thereon, and who does such work himselfarthrough his own employees, provided that such OCC.GROUP RFS. UNITS Improvements are not Intended or offered for sale. If, however, the build Ing or Improvement is sold within one yearo(completbe.the owner-bu iderwlll have TOTAL: R-3 tlB:j(urden of proving that he did not build or Improve for purpose of sale.). U I, as owner of the Property, em exchulvely contracting with licensed contractors to construct the project(Sec. 7014, Business and Profemioru Cade: QTY, -. PLUMBING PERMIT FEE FLOOD ZONE APN Papp ISSUANCE 12 The Contractor's License Law don not apply to an owner of property who builds or Improves thereon, and who contracts for such In,," with a cgNfador(a) licensed pursuant to the Contractor's License Law. I� I am exempt under Sec. B h P C for this reason AL]ER-DRAIN A VENT• WATER FEE SUMMARY BACK FLOW PROTECT. DEVICE DRAINS FLOOR ROOF, AREA, GOND. FD('TIJRF.S PER TRAP SANITARY RECEBxf R . Owner Date WORKMAN COMPENSATION DECLARATION- ❑I hereby affirm that I have a certificate of consent to self-Inaure, or ordiflate ofWorkeri Compensation Insurance ora certlfled copy thersof(Sec. 3800, lab C.) SCHOOL TAX Y_ N_ RECEIPT M GAS EA. SYSTEM -1 INC4 OUTLETS PARK FFP Y N RECEIPT M C. Com any Wdivitiled copy bhereby lumlehed. ertlfled copy b filed with the city Inspection sion. GAS EA. SYSTEM -OVER 4 (EA) GREASEANDUSTRL WASTE INTERCEPTOR BUILDING DI VISION FEES PLANCHECK FEE GREASE TRAP CERTIFICATE OF EXEMPTION FROM WORKERS' PAID SEWER -SANITARY -STORM EA 200FT COMPENSATION INSURANCE (This section need not be completed If the permit is for one hundred dollars 0400)orlen.) - I certify that In the performance of the work forwhich this permit Is Baued, Date Recei t# WATER HEATER W/VENT/ELECTR ENERGY FEE Y_ N_ WA.I.PR SYSTEM/TREATING , I shall not employ any person In any manner An as to become subject to the Workers' Compensation Lws of California. Date PAID NEW RESIDENTIAL PLMB. SQFf. Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' Compensation provision of the Labor Date Recei t# TOTAL: BUILDING 1 9.00 Code, you most forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY SEISMIC FEE 3.57 I hereby affirmthat there is a construction lending agency for the perform once of the .,it for which this permit Is I.ned (Sec. 3D97, Clv. C.) Lender. Name Lenders Addmes I certltythatl have read thisapplicatlonand statethattheabove Information Is correct. Iagreeto comply with all dtyand countyordinances and state laws TOTAL: ELECTRIC FEE QTY•"t'P1ii;iMECHANICAL. PERMIT, -. FEE PLUMBING FEE 9R 1 MECHANICAL FEE PERMIT ISSUANCE 12 FEES PAID,. relating to building construction, and hereby authorin representative. of this city to enter Pon the above-mentioned property for Inspection purposes. (We) agree w rave, Indemnify an d keep harmlen the City of Cupertino Against Rabfitin, judgments, ".and nparanwhlch may In any wayaaru, ALTER OR ADD TO MECH. Date RKe1Pt# AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL: SD agaWtuld�C 'n copse ence t gof this permit �� s��6 AIA HAFrouFIC UNIT (OVER 1o,0BocFkt) CONSTRUCTION TAX Signature of Applicant/Contractor EXHAUST HOOD IW /DUCT) CONSTRUCTION TAX PAID: . HAZARDOUS MATEEEEERRRRR(((((ALS DISCLOSURE Will the applicant or future building occupant store or handle haaardous material as defined by the Cupertino Municipal Code, Chapter 9.11, and the I InIth and Safety Code SSection 75532(a)7 1Yes uNo Ill the applicantmr mrebullding occupant use equipment or devlrea HEATING UNIT (TO 110,000 BTU) Date Recel t# HEATING UNIT (OVER IBLOW BTU) - TOTAL: VENTILATION FAN (SINGLE RESIDE I$ R�(�II DATE which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management D❑b Yes N No I have mad the hon ou. materials requirements under Chapter 6.95 of 1 ;) 1,190 BOILER -COMP DIP OR 100,0BTU) 100,D100,000 RM BOILER-COMP(OVER 100,000 BTU) the CalBomia Health 4 Safdy Code, SMlum 8.505, 25533 and 25534. I understand that lithe building don not currently have a tenant, that It is my rosponslbBity to notify the occupant of the requirements which moat be met Clty of.Gun?rfinn NEW RESIDENTIAL MECH. SQ.FT prior to iwuance of a Certificate of Octupanry. Sa. ISSUE.A • Q YL �--f Owner or authorized agent - Date - - TOTAL: OFFICE COPY