20328APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification
Building Address:
PERMIT NO.
f� O
10100 Torre Ave. Unit 128 (D1.1)
G
nee come:328
one.
A
CITY OF CUPERTINO-BUILDING DIVISIONPro
APPLICATION / PERMIT
-
5/09/90
can a erties Le. Nm
738-4444BIfILDINGELECTRICAL-PLUMBING-MECHAMCAL
CATEGORY CONTROL#
Archkect/Engineer. Le. No:
QTY ELECTRIC PERMIT. FEE
BUILDING PERMIT INFO
Address: •
PERhOTISSUANCE
LICENSED CONTR
I hereby under rDECLARATION'
eH 7OOD)olam licensedundererprovlalonso(Chapkr9(wmmrn
In ease i Section force ofd dslon3otthe BuelnessandlarofeselonaCode, and my
license la In (uLL force and effect.
APPLIANCESAE90ENML
JOB DESCRumo
T''�
�T �C
PANELS
Liana Clan Lk#
Date Contractor
201.1" AMPS
ARCHITECI'S DECLARATION
I understand my plans shall be used as public records.
OVER IOW AMPS
SQ. Fr. FLOOR AREA
$M. FT.
SIGNSELECTRICAL
Licensed Professional
669
74.92
SPECIAL C]RCNT/MISC
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt frornlhe Contractor'sLicense Law forthe
TEMP. METER OR POLE INST.
following re ..(Section 7031S, Business and Professions Code: Any city or
eau my which requ ire. a permit to construct, alter, Improve, demolbh, or repair
anystmeture prior to its bsuance, also requirmthe applicant (w such permit to
file a signed statement that he in; licensed pursuant to the provisions of the
Contractor's License Law (Chapter9(commencing with Section 7000) of Divi-
sion3 ofthe Business and Profanation Code) orthat he is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 70315 by any
applicant fora parent subjectithe applicant to a civil penalty of net more than
POWER DEVICES
SWIMMING POOL ELECTRIC
OUTLET&SWITCHES- XTURES
VALUATION
$50,121-.00
NEWRESIDENTIALELECTR SQFr.
five hundred dollars($500).
❑ I, as owner of the property, or my employees with wages ss their sole
STORIES
TYPE CONSIRIKT]ON
compensation, will do the work and the strocrom Is not intended or offered for
ale (Sec. 7074, Boston.. ad Professions Code: The Contractors [Access Law
V_N
dean not apply to an owner of property who builds or Improves tbeenar, and
who dossuch work himself or through hisownemployeas, provided that such
OCC.GROUP
RES. UNITS
Improvements are not Intended or offered for sale. If, humaeq the building or
Improvement bcm
eold within one yearofepletion, the owner-bullderwill have
ttb¢uden of proving that he did rat build or improve fee purpose of ale.).
LJ L as owner of the property, am excharmly contracting wkh 1—sed
contractors to construct the preject(Sm 7044, Business and Professions Code:
The Contractor's License Law does net apply to an owner of property who
ro
builds or Improves thereon, and who contracts for such pSolects with a
root e&or($) licensed pursuant to the Contractor's License Law.
LJ I am exempt under Sec. B A resumeP C for thin resume
TOTAL:
,. ...
"QTY.. • • .. PCUMBIN'CPERMIT FEE
R-3
FLOOD ZONE
MN
PERMIT ISSUANCE 12
�, (•�-DRAIN &VENT- WATER (EA)
FEE SUMMARY
BACK FLAW PROTECT. DEVICE
FEES
DRAINS FLOOR ROOF, AREA, COND.
SANITARY Y N_
RECEIPT N
Owner Date
WORKMAN COMPENSATION DECLARATION
01 hereby aBkm that 1 have a certificate of consent to self -insure, or a
.certificate ufWorkers' Compensation lnsumses a a certified copy thereof 03a.
3800, Lab CJ
Paley
FIXTURES PER TRAP
SCHOOLTAX Y_ N_
RECEIPT #
GAS F.A. SYSTEM -1 INCA Dun=
PARK FEE Y_ N
RECEfPTN
I
Cofm an
GAS EA. SYSTEM -OVER 4 (EAI
BUI LDING DIVISION FEES
L� ified copy b hereby fumishad.
Rifled copy in filed :vllh the city Inspection division.
GREASE/INDUSTRL WASTE INTERCEPTOR
PLANCHECK FEE
GREASETRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
(This refinanced act Is, completed lithe permit is forone hundred dollars
SEWER -SANITARY -STORM B.A. 20017r.
Date Recei t#
HEATER W/VENT/ELFC'1'R
ENERGY FEE Y_ N_
(13m) or lea)WATER
I certify that N the performance of thewmk forwhleh this penrdt is issued,
WATER SYSTEM/TREATING
I shall not employ any person In any manner so as to become subject to the
Workera•Compensation Laws of California. Date
PAID
NEWRESIDENTIALPLMB. SOFT.
Applicant
NOTICETO APPLICANT: IL after making thin CertBlote of Exemption, you
should became subject to the Workers' Compewllon provisionsof the Labor
Date Recei t#
TOTAL:
U
419. 00
Code, you most forthwith comply with ouch provisions orthis permit shall be
deemed revok d. -
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
3.57
l hercbyaffirenthst thea is a construction lendingagency forthe perform-
ance of the work for which this permit is Issued (Sec. 3097, Civ. C.)
Lander. NamePLUMBING
Iender'.Address
I certify thatl have and thbapplicationand statethattheabove Information
barred. Idgree to comply with all etyand cartyordinarms and state lawn
TOTAL:
ELECTRIC FEE
FEE
2R 73-
QTY. "' MECHANICAL PERMIT-, -'FEE
MECHANICAL FEE
PERMIT ISSUANCE 12
FEES PAID:
28.73
relating to building construction, and hereby authoms, representatives of thio
city to enterupon the abawreentioned property for Inspection purposes.
(We)agree to ave, Indemnify and keep bareness the City of Cupertiro
against liabilities, judgments, wren and expenses which may In any way accrue
ALTER OR ADD TO MECH.
Date Receipt#
NR HANDLING UNIT (T010,Om CFM)
SUBTOTAL:
�fJ'�f}�/�j1�
against aidc in en gra ng of this permit. �p
AIR HANDLING UNIT (OVER 10,000 CFM)
CONSTRUCTION TAX
EXHAUST HOOD
CONSTRUCTION TAX PAID:
Signature of Appliant/Contractor � Dte
HAZARDOUSMA LSDISCLOSURE
HEATING UNIT HO 100,ODO BTU)
Date Reoei t#
Will the applicant orfutum building occupant store or handle hazardous
material as defined by the Cupertino Municipal Code, Chapter 9.12, and the
Health and Safety Code Section 25532(.)7
❑ Yee I! No
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
VENTILATION FAN(SINGLE REBID)
-
ISSUANCE DATE
PAI
1'9
.0f.,i
Wllltheappllcantorfutum building occupant use equipment or devices
which emit hazardous air contaminants as dented by the Bay Area Air
ality ManagDistrict?ent District?
Yes Na
BOILER -COMP OHP OR 100,000 BTU)
BOILER-COMP(OVIR 100,000 BTU)
❑
have rad the hazardauamaterlab requirements under Cha pter6.95 of
the California Health k Safety Code, Sections 25505,25533 and 25534.1
understand that if the building does not currently have a tenant, that It is my
fH-�
b 7 1ggV
NEW RESIDENTIAL MECH. SQ.FT.
responsibility to notify the occupant of the requirementswhich moat be met
priorto(auanceof aCertlfiateof Occupancy.
/3 .I
City
City of �IlpertinD
ISSUED O . 1A UGLI
Owner or authorized agent Date
TOTAL:
OFFICE COPY