20339APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification
Building Add rest:
PERMIT NO.
20339
10100 Torre Ave. Unit 139 (C1).
seri came: one,
A
CITY OF CUPERTINO-BUILDING DIVISION
'
Con ractme Name: .Le. Na
738-4444
APPLICATION I PERMIT
BUILDING-ELFGT[UCAT PLUMBINGMECHANICAL
5/10/90
CATEGORY
CONTROL0
Architect/Engimer. Lk. No:
'QTY . ELECTRIC PERMIT FEEBUILDWGPERMIT
QTY
INFO
KI
PERMITISSUANCE 12
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed under provision• ofChapterg (marrome,
ing Mth Section7000)of DiWig.3ofthe Busimssand ProfeoionaCode,and my
license Is in fug force and affect.
APPUANCESRESTDENTIAL
JOB DFSCON
F TE
PANELS
License Clan LION
LIP TO 2DOAMIPS
RC13
Date Conmador
201.1000 AMPS
ARCHITECPS DECLARATION
I understand my plana shall be used as public records.
OVER1000AMPS
SQ. Fr. FLOOR AREA
S/SQ.Fr.
SIGNSELFG'TRICAL
Licensed Professional
1,181
74.92
OWNER -BUILDER DECLARATION
I herebyafflrmthat I ammct
exempt frothe Contraor's License Law for the
following .... (Section7031.5, Busineoand Penfesons Code: Mycityor
tsar my wh IN requim a pemdt to mmtm d, alter, improve, demollsh, or repair
SPFGIALCE?CIRT/MLSC
TEMP. M= OR POLE INS,.
anyatrudure prbrto Its knaame, alsorequluestheappliant I ... och permit to
foe a signed statement that he In licensed pursuant to the provisions of the
Contractor's License Law (Chapter 9(commencing with Section 700) of Divi-
ivi-
Mon
Mon3 ofthe Business and Prole elora Code).,that he Is exempt theremfroand
POWER DEVICES
SWIMMING TOOL ELECTRIC
VALUATION
the basis for the alleged exemption. Any violation of Section 70315 by any
applicant fora permit subjects the applicant to a civil penalty of ndm mthan
dollars (SM.
five 1, as nerofthepm
❑ I, a. owner of the property, or my employes with wages their sok
OUTLETSSWITCH6SFIKTURES
$88,481.00
NEW RESIDENTIAL ELECIR SQFf
STORIES
TYPE CONSTRUCTION
compensation, 7 on, will doBlume thew rkandProfen the ionsC structure nm intended or offered for
r
sale (Ste 7011, Pro(mkm Code: The License Lw
{]_�1
to an owner or unpct.Ys
dos out apply torn imel ofporthropertywho build,
who dm•suelh khlmsen mpoilmproovidedreoRand
t,providedildithatng
OCC.GROUP
RIES. UNITS
ents am edor.ughldaowne. If,ho r
improvementsarenot Intended earatredforsale.I(however, flder ldNgve
improrden nt oflsso proving within he did r d bumpor im rhee, for p rpose of sl have
tlLj I A. wnersathat he dW, am excuildlusively
primp contra ting wieof ense
u 1, a• owner tr the properly, am.70K B si ms.,ol ng with Bcenxd
contractors to construct the projM(Sec.7f14y Businco and Profeolons Code:
TOTAL;
QTy, " - ;: PLUMBING PERMIT FEE
R—
—FLOOD ZONE
APN
PERMRISSUANCE 12
The Contractor's License Law don not apply to an owner of property who
builds or improve thereon, and who contracts for such pwiecra.wfth a
aptIactor(s)licensed pursuant to the Contractor's License Law.
I am exempt under Sec B & P C for this reason
ALTER-DRA'N & VENT - WATER (EA)
FEE SUMMARY
BACK FLOW PROTECT. DEVICELJ
OUTSI DF FEE S
DRAINS FLOOR ROOF, AREA, COND.
SANITARY Y_ N_
RECEIPT N
Owner Date
WORKMAN COMPENSATION DECLARATION
E31 hereby Hll. that I have • cerdflate of consent to self-mure, ora
cerbflateofWorkere'CompensatlonlnsuranceoracertRled mpythereof(get.
3500, Lab of
Policy N
FIX111RF_S PER TAM
SCHOOL TAX Y_ N_
RECEIPT N
GAA.SYSEM-11NCAOIIILETS
S E
PARK FEE Y N
RECEFI` N
�� y
GAS EA. SYSTEtd-0VER/IRA)
BUILDING DIVISION FEES
Bled copy V hereby famihed.
s
edified copy is filed with the city inspection dlvlelon.
GREASE/INDUSTRL WASTE INTERCEPTOR
PLANCHECK FEE
GRF-ASETRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
(This section need me be completed If the permot k far one hundred dollars
SEWER -SANITARY -STORM F.A.
Date Recei of
WATER HEATER W/VENT/FI-ECTTt
ENERGY FEE. Y N_
Matlock..)
I certifythat in the performance of the work forwhich this permit is Issued,
WATER SY51FM/TREAnNG
I shall not employ any person le any manner Is, an to become subject to the
Workers' Compensation laws of California. Date
PAID
Applicant
NOTICETO APPLICANT: IL after making this Certiflate of Exemption, you
should bemm nobO to the Workers Compensation provblorsafthe Labor
Date Recel HI
NEWRESLDENTIALPLMS. SQ.Fr.
TOTAL:
BUILDING FEE
SQn-nn
Code,you must forthwith comply withsuch provisiom.rthis permit shallbe
deemed revoked.
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
Iherebyaffirmthat there k acomBuctlon lendingagency forthe perform-
anre of Issued!he work for which this permit Is Issued! 3097, Civ. CJ
lender.Name-
Lender.Addre
IcertifythstLhavereulthlsappliati.oned statethattheaboveinforra i.n
l.cormit. l agree to complywlth all cityand countymelinanon and date laws
TOTAL:
ELECTRIC FEE
PLUMBING FEE
r
QTY. MECHANICAL PERMIT- FEE'":
MECHANICAL FEE
41.53
PERMIT ISSUANCE 12
FEES PAID:
41. jj
relating to building co.tmdi.., and hereby authodes representatives of this
cityto enterupon the abovcmenrkmdI property for inspection purposes.
(We) agree to save, Inm
derdty an d keep harmless the City of Cupertino
against llabilitka,judgments,contsand expenses which my N anywayacaue
ALTERORADDTOMECH.
Dale RCCeI t8
AIR HANDLING UNIT(TO 10,001 CFM)
SUBTOTAL'
Z0t
agsimt aid Ci come ceolgof thin permit.
wets �
AIR HANDLING UNIT (OVER 10,0XICFM)
CONSTRUCTION TAX
Signature �AppBanl/Contrador Date
EXHAUST D(HAUST HOOD (W/DUCT)
CONSTRUCTION TAX PAID:
,
HAZARDOUS MAT LS DISCLOSURE
HEATING UMT(TO 100,000 RTU)
Date Recei Iii
Will the applicant or future building occupant store or handle hazardous-
material as defined by the Cupertino Municipal Code, Chapter 9.1 Z and the
IicAthand SafetyCode Sectica.M2W?
❑ Yes No
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
//,s
ZAP
FAN (SINGLE RESID)
ISSUANCE DATE
Will the applicant or tura building occupant use equipment or devicesVENTILATION
which emit hazardous air contaminants as deftned by the Bay Area Air
Quality Management District?
Yes No
A.
PA
JO
BOILER -CAMP OHP OR 100,0013 BTU)
BOMER-COMP(OVER 100,000 BTU)
have read the Faze pus materials requirements u nder Chapter 6.95 of
the Ca llfomkFlealth&Safety Code, Sedion. 25505, 25533 and 25531.1
understand that lf the building does not currently have. tenant, that it is my
y '
�l�l% i 6 1JJUnA? -
NEW RESIDENTIAL MECH. SQ.FT.
resporaibility, to notify the occupant of the requirements which must be met
prior to issuance of a Certificate of Ouvpa ncy.
City Of Clmertino
BY: GL
Ownerorauthorized agent Data
TOTAL,ISSUED
OFFICE COPY