20341APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification
Building Address:
PERMITNO.
20341
10100 Torre Ave. Unit 141 (N1.4
nee ane:, one:
A
"
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
5/10/90
Contractoe.N.me: Lic.No:
718-4444
BUILDING-MMTMCAT PLUMBINGMECHANICAL
CATEGORY -
CONTROL x
Architect/Engineer. Lk. No:
Q" , ELECTRIC PERMIT " FEE
BUILDING PERMIT INFO
Address: -
191 IN 9
FIRMITISSUANCE
LICENSED CONTRACTOR'S DECLARATION
I hereby d(bm that lam lkmeed underprovtlone of Chapter9 (commmo-
(the Bustnessand Pro(ewlonsCode, end my
inenseiSection force and
Ileense le in half tonx and dfttt.
APPIdANCESRESIDENITAL
JOB DESCRIPTION
�I
�- }—
PANELS
LicenseCie. Lk.x
Date Contractor
UP TO 200 AMPS
RCB
201-IODO AMTS
ARCHaTECTSDECLARATION
]understand rcy plan shag be used as, public records.
i
OVER 7000 AMPS
SQ. Fr. FLOOR AREA
S/SQ. FT.
SIGNS ELECTRICAL
Licensed Professional -
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 7631.5, Business and Pm(swbns Code: Any city or
=ntywhlch requiresa permit to comtnM alter, Impmve, demolbh,ormpair
909
74.92
- S1? CIALCIRCUIT/MISC
TEMP. METER OR POLE INST.
anystructureprlortolis issuance,also ret{uimlheapplIcanlforsuch permltto
file a signed statement that he is licensed pursuant to the provision of the
Contractors LlcemeLaw(Chapter9(commencing with Section 7000) of Divi-
don 3 of the Business and Fro(emiom Code) or Nat he fs exempt therefmmand
POWER DEVICES
SWIMMING POOL ELECTRIC
VALUATION
the bash for the alleged'exemptbn. Anyviolationof Sectlon7091Sbyany
appBmnl fora permit subjectetheapphcant to a dvll penity d not more than
flv61, as undred
hepr($500,
I, as ower of the property, or employees with wages their sole
OVILETSSWITCHESFIXTURES
$(8 102.0
a
NEW RESIDENTIAL ELECTR SQ.Fr,
.STORIES
TYPE CONSTRUCTION
the he
andthnsCde:TheCure is not lmmdedorof(
r
com(Soc.7KBuldess
sale Sec. Business and
ando Pr Code: The C Llano law
Law
V—N
TOTAL:
QTY. • " PLUMBING PERMIT. .FEE
f property
applydoes net rope ty improves
whodoesuch torn ower offprough his one mparimprovnthereoMand
whodoementswork rIntended
Improvements wandwe intendneyear(erect pleor lo.]l,howeerr Oderwiling or
nthimse dedorough Msowne. If,hoes,p ,thebovided ilding r
Improvemembamd withlnoneyearofcompidlogtheowner-buBderwlll)ave
tfiLlIurden of proving that M did not build or Improve for purpose of saleJ.
u 1, as owner of the property, am exclusively contracting with licensed
centractms to construct the project (See. 7014, Business and Profession Code:
OCC.GROUP.
R_3
RES. UNITS
FOOD 70NE
"
APN
PERMIT ISSUANCE 12
The Comewim's License Law does no apply to an owner of property who
bu Bds or Improves thereon, and who contracts for for such pko)ewith a
cgfl)pec ct,(.)Benard pursuant to the Contractor. Lirenw Law,
tri am exempt under SB k P C for this reason
-
ALTER -DRAIN 4 VENT WATER tEN
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
DRAINS FLOOR ROOF, AREA, CONED.
SANITARY Y _ N _
RECET T x
(Tuner Date
WORKMAN COMPENSATION DECLARATION
QI hereby affirm that I have a certificate of consent to self -Weare, or a
a00,1.eo(Worken'Compematlonlnunnceora certl(hd copythercot(Se<.
I CJ
Dalry x
Policy -
FIXTURES PER TRAP
SCHOOL TAX Y _ N
RECEIPT x
GAS EA. SYSTEM.1 INCA OUTLETS
FARRIER Y N
RECEB'T M
GAS EA. SYSTEh1AVERd(EA)
Com y
Ified copy b hereby Furnished.
eels ied copy b filed with the city Inspection division.
BUILDING DIVISION FEES
CREASE/MDUSfAL WASTE MIFIZCFPTOR
PLANCHECK FEE
GREASETRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
ShWF.R-SAM.I.A[tY-bTDRM EA XpFI•
COMPENSATION INSURANCE
(rhissMlon need not be completed Bthe permit b fa oro hundred dollars
Date Recel ted
WATER HEATER W/VENT/ELECTR
ENERGY FEE Y N
PAID
(S100)oth
I certifyless.)t In the performance olthewmk lorwNch this pends is saved,
I shag not employ any person in any manner an as to become subject to the
Worken'Compensati nLaws of GBFornb. Date
WATER SYSTEM/?BEATING
Applicant
NOTICE TO APPLICANT: If, after making thb Certificate of Exemption, you
should become subject to the Worken' Compensation provision of the Labor
Date Remi{ tic
NEWRESIDENIALPLMB. SQJrT.
TOTAL:
Code,ymmustfWhwithcvmplywlthsuchprovblomorthbpenNtsha)Ibe
deemed revoked.
B G
S0(].Q
SEISMIC FEE
4-9
CONSTRUCTION LENDING AGENCY
Iherebya(firm that there is a construction lending agency for the perform
ante of the work for which this permit is Issued (Sec 3097, Civ. CJ
Landers Name
Lender'. Add...
I atifythat I have read thbapplicationand statethat theabove Infomertlon
bcorrect. I agree to comply with all eltyand countyurdinancuand A.telaws
- TOTAL:
ELECTRIC FEE
•34.7
7 -,PLUMBING
QTY: ,. 'MECHANICAL PERMIT ': FEE
FEE
34.7
MECHANICAL FEE
PERMITTSUANCE 12
FEES PAID:
a(thb
comtnMon, and hereby property
nthe
city to enter to u uponinspection
property (orlmpe Cit purpose.
dtyW)aee to saw, Indemnify an
(We) agree to Jude, indemnify an d keep harmless the City y ayam res
agalntliabilities, judgment, mstund expenses which may In anywayacaue
ALTEROA ADD 7O MSH.
Date Reset t#
P
AIR HANDLING UNIT (7010,000 CFM)
SUBTOTAL:
.O
sgawtufid �'In ue (1 ega ting of this permit.
S�d�96
Slgmtureo(Applicam/Contractor �D to
AIR HANDLING UNIT (OVER IB000CFM)
CONSTRUCTION TAX
EXHAUST HOOD (WEW/DUCT)CONSTRUCTION
TAX PAID:
HAZARDOUS MA ALS DISCLOSURE
HEATING UNHHO 100,000 BTW
Date Reeel t#
Will the appRmnt or future building Occupant store or handle hazardous
material as defined by the Cupertino Municipal Code, Chapter 9.13, and the
Ilealth and Safety Code Section25532(a)7
Yes No
Will the applicant Jr. No building occupant meequipment or devices
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
Q .p
VENTILATION FAN (SINGLE RF_SID)
ISSLW4 DATE
which emit harardous air contaminants as defined by the Bay Area Air
Quality Management District?
YetNo
have read the haza Rus materials requlrementsunderChapter6.95 of
AA
Qn
A a'Of�p
BOILER -COMP DEEP OR 100,DOO BTU)
BOILER -COMP (OVER 100,OOD BTU)
the California Heslth k SafetyCode, Srdlon 75505, 75533 and 75534. 1
understand that if the building does not currently have a tenant, that It b my
'
-
NEW RESIDENTIAL MECH. SQs7
respamibilitytonotify the Occupant of therequirement which must be mel
prior to issuance of a Certificate of Oc upancy.
City I f Gpreino
c�
BY:
Owner Or authorized agent Date
TOTAL:ISSUED
OFFICE COPY