20340^� APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
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Buildinit Pra act Identification
Building Address:
PERMITNO.
10100 Torre Ave. Unit 140. (N1.3)
' 20340
OwnersName-.- one:
—ICeat er Properties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
BUILDING-ELFCTRICAL-PLUMBINGMECIIANICAL
5/10/90
Contra o . ,sem: 738-4444 LIc.N.
CATEGORY
CONTROL N
Architect/Engln.r. Lk. No:
QTY ELECTRIC PERMIT FEE
-BUILDING PERMIT INFO
Address:
PERMETISSUANCE 12
LICENSED CONTRACTOR'S DECLARATION
I herecedon md).(Di 11c.sedheunder Oug rovWdPmfChapter
Division Jo(the BuNmuandPm(euione Code, and my
msCocoand my
AI'PLIANCESRESIDENMLlegmt
JOB DESCRIPTION
limuseh 1. Illormaf
Ikense i, In full !ores and dfect.
PANELS '
V J(T $�
License ClAr LI[.N
Date CoMndvr "
101-1000 AMPS
ARCHITECPS DECLARATION
I understand my plarushallbe, used as pubtlereaomis.
OVER 1000AMP5
SQ. FT. FLOOR AREA
$/SQ. Fr.
ISIGNSELECTRICAL.
LI ... d Professional
909
74.92
SPECIALCIRCUIT/MISC
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
TEMP. METER OR POLE INST.
foaawing rerun.(Section 7011.5, Business and Professions Code: Any city or
countywhlch requlresa permltlo construct, alter, improve, demoBah,orrepalr
anystructure Inorto ltsbauance,also requirestheapplirantfor such permit to
file a signed statement that he Is licensed pursuant to the provblons of the
Contractors License Law (Chaphr9(commencing with Section 7000) of Divi-
abn3 of the Business and Professions Code) or that he E exempt there(romand
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjeesthe applicant to a civil penalty of not more than
pOWERDEVICES
SWIMMING POOL ELECTRIC
OUTLETSSWITCFTFSH%TURFS
VALUATION
$6.8,1021.00
NEW RESIDENTIAL ELECTR SQ.FT,
five hundred dollars ($500.
1, as owner of thep roperry, or my employee, with wages as their sole
STORIES
TYPECONSIRUCTION
it Old wdthe structure b got Intended ass oflemd for
ale( Sec apply an Code:The Contractor. Ll.me Law
V—N
to
does whodot apply torn owner otthroug hiswho
owand pruporty
whodoes such nampeyeas,pvrthereoMand
providedthat
OCC.GROIIP
RES. UNITS
mentsa nhimmRorthroughhisowale,ILum ildingh
Improvements intended or rofco p: ale. the o nvep deer l lln ve
Improvementbwldwithlnomyearo(completloMtheawnsr-builderwill M1ave
t}itIfurden of proving that he did nm build or Improve for purpose of sole.).
Lf 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec 7074, Business and Professions Code:
TOTAL:
,.
;'PLUMBING PERMIT" FEE
R-3
/
QTY;
PERMIT ISSUANCE
FLOOD ZONE
APN
The Contnaor's License law doe, not apply to an owner of property who
Wild. or Improv. thereon, rodwho contracts for such ptnjects with a
cq➢tt d.r(a) licensed pursuant to the Contmctnr's Lt... Law.
Lf I am exempt under See. B & P C for this pawn
ALTER -DRAW & VENT- WATER MA)
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
DRAINS. FLOOR ROOF, AREA, CONE).
SANITARY Y N
RECERrT N
Owner Date
WOR KMAN COMPENSATION DECLARATION
Ell hereby affirm that I have a .rdlirate of consent to .elf -Lore, w a
wrtlfi.te of Workers'Comperuatlan Insurance ma certified copy themo((Sec.
3800, Lab C.)
Pocky
FDC1URFS PER TRAP
SCHOOLTAX Y N
- RECEIVE N
GAS EA.SYS171N-I INC.40[IILETS
PARK FEE Y N
RECEE`T N
p
Co�eny -
GAS EA. SYSTEM -OVER 4 (EA)
BUI LDING DIV] SION FEES
C-ified.pyb hereby with tlehM.
aQC' tidied copy I. /lied fu the dry bupes[lan division.
GREASE/INOUSIRL WASTE INTERCEPTOR
PLANCHECK FEE
GREASE TRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
(Thi. section need not be completed It the permit Is for one hundred dollar
Date Recef t#
SEWER.SANITARY-STORM EA IOOFr.
WATER BEATER W/VENT/dECT'R
ENERGY FEE Y N
PAID
%lMorler.)
I certify that In the performance o/thework for which this permit is Issued,
I shall not employ any person In any runner an as to become subject to the
Workers' Compensation Lam of California. Date
WATER SYSIFl t/TREAnNC
Applicant
NOTICETO APPLICANT: If, after making this Certificate of Exemption, you
sM1ouid became subject to the Worken'Comperwllun provbbm of the Labor
Date Re i t#
NEW RESIDENTIAL ELMS. SQ.FT.
TOTAL:
BUILDING FEE
qnn nn
Code, you must forthwith comply with such provisions orthis permit shall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
4.83
I hereby affirm that there is a construction lending agency !cribs perform-
ance of the work forwhlch this permit Is Ensued (Sec. 309x, Civ. C.)
Lander. Name-
Lend.e.Address
I.rtlfy,that I have mad thisapplication and state that the Above Information
iscor.ct.Idgmeto eomplywith all cityand eountyordlnanees and gate laws
TOTAL:
ELECTRIC FEE
�k»-%-3
PLUMBING FEE
34.73
QTYc:'-;;"MECHANICAL.PERMIT,;,". -FEE
MECHANICAL FEB
PFRMTTISSUANCE 12
FEES PAID:
34.73
relining to building construction, and hereby authorize representatives of thio
city to enter upon the above-mentioned property for Wpectiun purposes.
(We) agree to save, Indemnify an d keep harmless the City of Cu pedino
against liabllRbs,Judgments, costs and expenses which my In any way accrue
ALTER OR ADD TO MECH.Date
Recei t#
AIR HANDLING UNIT 17010,000 CFM)
SUBTOTAL:
D
a go lint oldCity�R�anee r .of a a I[ gofthlspemdt.
/ytl
AIR HANDLING UNIT (OVER lO,aIOCFkf)
CONSTRUCTIONTAX
Signature of Applicant/Contractor Dat
EXHAUSTHOOD(W/DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUSMATE SDISCLOSURE -
HEATING UNIT GO 100,000 BTU)
Date Reeei t#
Will the applicant urfuture building occupant store or handle hazardous
material ae defimd by the Cupertino MuNdpal Code, Chapter 9.11• and the
Iieahh and Sat" Cade Section 75531(a)7
❑ Yes No
Wlllthe applicant m tore building oavpart use, equipment or devices
HEATING UNIT (OVER 100,000 RTU)
TOTAL:
i6C - O
VENTILATION FAN (SINGLE BESIDE
ISSUANCE DATE
which emit hazanlous air contamlmnts as cieflned by the Bay Area Air
Quality Management District?
Ye. No
have read the haza aur materials requirement, under Chapter 6.95 of
the California Health & Safety Cade, Sections 75505, 75533 and 75534. I
understand that if the build Ing does not currently have a tenant• that it is my
Lt! PAIDr1`
f 1��0
j ,, /. 5 J
BOILER -COMP O11POR 100,000 BTII)
BOILER.COMP(OVER 100,070 BTU)
NEW RESI DENTIAL MECH. SQ.FT.
respomibBity to notify the occupant of the requirements which most be met
prior to issuance of a Certificate of Occupa racy.
/s a�
CRY Qp I CunprllFD ,
ISSUEDBY: V. Din
Owner or authorised agent Data
TOTAL:
OFFICE COPY