20333APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
tlulldin Pro en Identification
Building Address:
- PERMIT NO.
20333_
10100 Torre Ave. Unit 133 W)
nsrsName; one:
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION/PERMIT
BUB,DINGMECnUCALPLUMBINGMECHAMCAl
APPLICATION SUBMI1 IAL
-
5/10/90
enntraetnr.Narre:LIe.No:
738-4444
CATEGORY
CONTROLM
Architect/Engineer. - Lk. No:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO.
PERMBTISSUANC•E 12
Add. _
LICENSED CONTRACTOR'S DECLARATION
Iherebyaffbmthat l am licensed under provisions ofChapter9 (councratere,
APPLIANCES tBIDENTIAL
JOB DE9CRIPDOS1I
PANES
Ingwlth Se ion7000)of Divlelon3ofthe BuslmmandProfe$MonsCode,and my
license Is In full fora and effect.
f
Llama Clam LION
'
"'
Date Canmxctor
ARCHITECPS DECLARATION
I understand my plans shall be used as public maids.
UP TO 2DO A�
201-1000 AMPS
OVE(IOWAMPS
SQ, Fr. FLOOR AREA
VSQ. FC.'
SIGNSELECTRICAL
Licensed professional
995
74.92
SPECIALCIRCUIT/MTSC
OWNER -BUILDER DECLARATION
Herebyaf orthat l amexempt fromthe Contractors License Law fathe
TEMP, METFROR POLE INST.'
following mason.(Section70315, Business and Prefemlons Code. Any cityor
countywhkh require a permit mcomHuct, alter, improve, demolish, ormpair
anystructure prlorto its bauame,Worequlreathe applicant for such perndtto
file a signed statement that he is licensed pursuant to the provblons of the
POWER DEVICES
SWIMMING POOL ELECTRIC
Contractors License LAW (Chapter 9(comerenctng with Section 7000) of Divi-
elon3ufthe Buslnessand Pro(ensloru Code)orthat he is exempt there(romand
VALUATION
the basis for the alleged exemption. Any violation of Section 70315 by any
applicaotfor a permit subjects the applicant too civil Penalty of not more than
OUILETSSWITCHFSFIX ORES
$74,545,00 ,
five hundred dollars (3500j.
❑ I, as ownar of the property, or my employees with wages as their sole
compenuHan,willdothe work endtheetructure is rot intended or offered for
as is (Sec. 7004, Business and Pretensions Code: The Contractors License Law
NEW RESIDENTIAL ELECTRSQFr.
STORIES
T1TE CONSTRUCTION
V—N
TOTAL:
does not apply to an owner of property who builds or improve lherean,and
whodoessuchworkhlrruelf orthreugh hisownemployees, provided that such
Improvements are not Intended oroffered forsale. 11,howevegthebuildingor
OCC.GROUP
R-3
RFS. UNITS
'
Improvement issold withinoneyearofcomplellomtheowner-builderwlll have
ft.ta den of proving that he did not build or Improve for purpose ofule.).
" L as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7014, Business and Profemims Code:
QTY. PLUMBING PERMIT' FEEFT.ODD7DNE
APN
PERMITISSUANCE
The Contractor's License Law dm not apply to an owner of property who
builds or Improves thereon, and who contracts fee such pi e)eM with a
�g0t[scumW licenced pursuant to the Contractors Licenns Law.
LJ 1 am exempt under Sec B A P C for this mason
ALTER -DRAIN AVENT- WATER (EN
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
'
DRAINS FLOOR ROOF, AREA, COND.
SANITARY Y_ N_
RECEIPT N
Owner Date
FLCNRES PER TRAP
SCHOOL TAX Y N—
RFLEPr N
WORKMAN COMPENSATION DECLARATION
MI hereby affirm that I have a certificate of consent to self -Insure, o a
GAS EA. SYSTEM -1 ING OUTLET'S
PARK FEE Y_ N_
RECEIPT N
mmficam of Workers Compensation Insurance ma certified copy themof(Sec.
3800, Lab C.)
Policy N
C. y
GAS EA. SYSTEM -OVER 4 (EA)
BUILDING DIVISION FEES
C�Hified copy b hereby furnished.
Certified copy Is filed with the city inspection division.
GRPASE/INDUSTRL WASTE INTERCEPTOR
PLANCHECK FEE
GREASE ]RAP
CERTIFlGTE OF IXEMPTION FROM WORKERS'
PAID
SEWER -SANITARY -STORM EA. 2DOFT.
COMPENSATION INSURANCE
Rhlssection need not be completed lithe permit bforom hundred dollars
Maine ne It..)
I certify that In the performance of the wok for which this permit Is Issued,
Date Recti tN
WATER ITEATFR W/VENC/ELECTR
ENERGYFEE Y_ N_
WATER SYSTE.4/TREATING
I shall not employ my person In any manner w e to become subject to the
Workeri Compensation Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you
should become subject to the Workers' Compensation provisions of the Labor
PAID
Date Recel til
NEW RESIDENTIAL PLMS, SQ.FC.
TOTAL:
Code, you resat forthwith comply with such prevblons or this permit ahall beBUILDING
SEISMIC FEE
deemed revoked.
CONSTRUCTION LENDING AGENCY
I herebyafIrmthat there laacerestruction lendingagency forthe perform-
ancoof the work forwhlch this permit b beard (&c 3097, Clv. C.)
LenderBNd
nderb Addd ress
TOTAL:
ELECTRIC FEE
36.88
PLUMBING FEE
1A RA
Q' ,,-.MECHANICAL PERI: .
QTY. MTFEE
MECHANICAL FEE
em statel laws
Iartt. Iagr learn ply with aBcety and county
bcoingtoagreeto comply with ailtltyandmuntyomrepraaanduti satelasva
relating to building mhe above- ren and hereby authorize repmenbtive of thio
city to d property purpose.
PERMR ISSUANCE 12
FEES PAID:
36.88
ALTER OR ADDTO MECH.
Date Reeei tp
W)enter
handeas the it
(We)agmem save,een,.9. andkeephumiem the ClayCupertino
agmpon ave, inve-m ify an
against liabilities, pdgrrcnle, cos{e and expenses which may In myway acerue
against said C mane ena f t gra Ing cf this permit'
AIR HANDLING UNIT IO,ODO CFM)
SUBTOTAL:
AIR HANDLING UNIT (OVER 10,000CFM)
CONSTRUCTION TAX
r��'
E(HAUSTHOOD(W/DUCT)
CONSTRUCTION TAX PAID:
Signatureof Applicant/Contractor Q e
HAZARDOUSMA ALSDISCLOSURE
Wllltheappllcentortuturebulldingoccupantstoreorhandlehazardous
HEATING UNIT (TO 100,000 BTI])
-
Date Reoei tri
Health and defety CedeSCupertino Munlctpal Code, Chapter 9.12, and the
HealthandSafety Coder—Stection 75532W)7
❑ Yes u No
Will the applicant or future building occupant use equipment Or devices
which emit hazardous ab contaminants as defined by the Bay Area Air
a Ilty Management District?
Yes El No
have read the haoranT .. materials requirement underChapter6.95 of
HEATING UNIT (OVER 100,000 BTU)
-
TOTAL:
Z
VENTILATION PAN (SINGLE RESID)
ISSILANrtEDATE
FAllYE��"
^�• 7 i�^JrIfT '
i 90
BOILER -COMP OHP OR 100,0(D BTU)
BOILER -COMP (OVER 100," BTU)
the California Health A Safety Code, Sections 75505,25533 and 2SS34. I
and costs rat that if the building does not currently have a tenant, that It is my
NEW RESIDENTIAL MIECH. SQ.FT
reaponsibllity to notify the occupant of the requirements which at be mer
prior to Issuance of a Certificate of Occopa racy.
t� /3
CR of Ia IIOiehi
Owner or authorized agent DateISSUED
TOTAL:
BY: VGC^
OFFICE COPY