20325APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification
Building Address:
PERMIT NO.
20325 O32C
100:Torre Ave. Unit 125 141.1
,,,LO mone:
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION I PERMIT
APPLICATION SUBMITTAL EA FE
5/09/90
Contrador.Nime: Lm. No:
—
BUILDINGELECnUCALPLUMBINGMECHANICAL
CATEGORY
CONTROL M
ArchitM/Engineer. Lk. Na
QTY .. ELECTRICPERMIT '- :FEE
BUILDING P,ERMIT.INFO
Address:
PFRMITISSUANCE
LICENSED CONTR DECLARATION
I herebyaffirmir70 that I am 0)oDivlkenmd underpessand sof ChionsCocommmo
under pn�islcru.(Ck.pterg
Ingwe 1. 1. full foWI of Dlvfect. ttheBusinessand Pro(e.sloneCade, and my
lslna (arm and effect.
APPLIANCES -RESIDENTIAL
OB QESCRII'f10p1
PANES
Litems
Llmnec Chea Lies
Date Contactor
UP TO 2DO AMPS
RCB
101 -IOW AMPS
ARCHITECTS DECLARATION
I understand my plans stall ne used as public remrda
OVER 1000 AMPS
SQ. FT. HOOR AREA
S/SQ. FF.
SIGNS ELECTRICAL
Licensed Profe admal
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or
cess my which requ bas a permit m mubuct, alter, impmve, dem W h, or repal r
805
74.92
SPECIALCIRCUIT/MISC
TEMP. MEM OR POLE INST.
anystmcture pdortolb bsuance,aisorequlrestheappaontfor such permit to
file a signed statement that he is licensed pursuant to the provisions of the
Contradocs License Law (Chapter 9(commendng with Section 7000) of Divi-
sion3 of the Business and Profl.WnsCode) orthat hela emmptthemfmmand
POWER DEVICES
'
SWIMMING POOL ELECTRIC
VALUATION
the bask forthe alleged exemption. Any vldatbn of Stolon 70TIS by any
appRmnl for a permit xbjectsthcapp[kant to a dull penalty d tad mere than
flv�undrecid.lars( ,M.
I, as owner of the property, or my employees with wages as their sole
OUTLETSSWHCHES-FIXTURES
-
$60,311.00
NEW RESIDENTIAL ELECTR SQ.FI.
STORIES
TYPE CONSIRLKTION
'
cimpenwtlon,will do thewor"rd the structure b one Intended or offered for
sale (Ber.70K Business end Pmfesslora Code: The Contractors License Law
does not apply to an owner of property who builds or Improves thereon,and
who does suchwork himself orthrough his own employees, provided that such
V_N
OCC.GROUP
RFS UNITS
Improvements are not intended oroffered forsale. If, however, thebullding or
Improvement brolold withinoneyearofmmpldtheowner-bu0derwlll have
TOTAL:
R-3
t rden of proving that he did not build or Improve for purpose of nla.),
LI, as owner of the property, am exclusively, contracting with licensed
contractor to mrutrud the project(See. 70K Business and Procealom Code:
The Contadora License Law does not apply to an owner of property, who
bs Oves ds or Improthereon, and who contacts for such pkojeds with a
cq➢t(ector(s)Bmneedpursanrtothe Contmdw'sLlmnwLaw.
LJ I am exempt under Sec B k P C for this reason
QTY; PLUMBING PERMIT FEE
FLOOD ZONE
APN.
PFRMHISSUANCE lz
ALTER -DRAIN & VEM-WATER (EA)
FEE SUMMARY
GIXFLOW PROTECT. DEVICE
DRAINS FLOOR ROOF, AREA, GOND.
SANITARY Y N
RECEIPT
Owner Data
WORKMAN COMPENSATION DECLARATION
01 hereby affirm that I have a comfimte of consent to self-Inma, or a
ordinate of workers Compensation Insurance ora certified copy thereof Dec.
3800, lab C.)
Paltry s
--
FO(711RE5-PER TRAP
SO IDOL TAX Y _ N
ucrERrT a
GAS EA.SYSTEM-1 INCdOUILEfS
PARK FFR Y_ N_
RECEIPT M
C. ny
CjortNed copy b hereby furnished.
ertUed copy b flied with the city Inspection division.
GAS EA. SYSTEM -OVER d (EA)
'BUILDING DIVISION FEES
GREASE/INDUSIRL WASTE INTERCEPTOR
PLANCHECK FEE
GRBASELRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID -
SEWER-SANITARY2WFT
COMPENSATION INSURANCE
(Thbsection need net becompleted If the permit b for ore hundred dollars
(S1 W)erte®a
1 ordifythat N the pedoraranm of thework forwhlch this Permit Is taxed,
Date Revel t#
WATER HEATER W/VENT/ELFCTR
ENERGY FEE Y_ N_
WATER SYSTEM/TREATING
I shall not employ any person In any manner an, u to become xbJect to the
Workers Compensation Laws of California. Dare
PAID
ApplicaNOTICE
NOuldb co APPLICANT:Certificate o(Exemple Lyou
sode,yocomeeforth ceche Worker' of Lab
Date Recei t#
NEW RESIDENTIAL PLMB. SQ.FT.
NEWaftermakingthio
TOTAL:
BUILDING
such provisions uthiomrmit
tlorthwith comply with such proWlons orthb permit shall be
s be
deemed
deemed revoked.
. CONSTRUCTION LENDING AGENCY
I SEISMIC FEE
hereby&farm that thea b a construction lending agency for the perform-
ante of the work for which thio permit la bred (Sec, 3W7, Civ. CJ
I<nder's Nam
Candace Addrece
I certifythai t have read thbappliatlonand statethattheabove Information
bcornv. lagreetocomplywlthWcityandmuntyordlnanceeandsiatelaws
TOTAL:
ELECTRIC FEE
PLUMBING FEE
P4.1
QTY. "MECHANICAL-PERMIt" `"•`,FEE "
MECHANICAL FEE
PERMIT ISSUANCE
FEES PAID.
relating rebuilding construction, and hereby authorize representatives of thio
cityto enterupon the above-mentioned propertyfor inspection purposes.
(We) agree to save, Indemnify an d keep harmless the City of Cupertino
agaimt11abWths,Wdgmnts,costsande.pen.o hlchmeyinanyw.yacerue
ALTERORADDTOMEOH.
Date RCCCipt#
AIR HANDUNG UNIT(TO 10,000 CFM)
SUBTOTAL:
ago Wt aid Ciy�n mens. Senn sj the Stant�ng of this permit.
/ e J // /�— rm-It.
'Signature of Applium/Contractor a
AIR HANDLING UNIT (OVER IO,ODOCFM)
CONSTRUCTION TAX
EXHAUS'THOODM/DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUS MATE SDISCLOSURE
Will the applium or future building occupant store or handle hazardous
material as ciefired by the Cupertino Municipal Code, Chapter 933 and the
I ealth and Safety Cade Section 25532(a)7
qYee Lj No
HEATING UNIT OO IW,ODO BM
Date Recei t#
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
VEN7LATIONFAN(SINGLE RESID)
ISSI}Q[Zi(,�,_ATE
illtheappliunt orfuturcbulldingompantuseequip.m ordeviccs
which emit hazardous air mntamtrants act defined by the Bay Area Air
Quality Management District?
4Yes. ❑❑No
haveread the hazardous materials requirements under Cha pier 6.95of
the California Health 4 Safety Code, Sections 25505,25S33 and 2SSM. 1
understand that if the building does not co cantly have a tenant, that it b my
l'�4468
` I
BOILER -COMP OHP OR 100,0110 BTU)
BOILER -COMP (OVER 100,000 BTU)
NEW RES[ DENTIAL MECH. SQYI
responsibility to notify the occupant of the requirements which must he met
prior to Issuance of a Certificate of Occo parry.
/� rs
City of ruin t.y
IB`Qa
BY:A�-ASOL
Owneror authorized agent Date
TOTAL:
,ISSUED
OFFICE COPY v