20345�,r
IL�
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY'
Building Pro ad IdentlHotion
Building Address: -
PERMIT NO. -
20345
10100 Torre Ave. Unit 145 .(B1)
nenasst:
. one.
Properties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
BUFLDINGELECTRICA PLUMBING -MF KANICAL
5/10/90
con nda eNarre: Lk. No:
738-4444
CATEGORY
CONTROLe
Architect/Engineer. Lk. No:
QTY ELECTRICPERMIT FE
BUILDING PERMIT INFO
Address
PERMIT ISSUANCE 12
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed under provlalons of Chapter 9 (wmrne
Ingwith Section7000)afDlWNon3 ofthe Businessand PwfesslonsCode, and my
license is in MU (oras and effect.
APPLIANCESRESIDENTIAL
JOB DES'CARUM'ON
�r V
PANELS
LiwnasC6n Lk.s
Data Contractor
RCB
201-IWO AMPS
ARCHITECT'S DECLARATION
I understand my plane shall be used as public records.
_
OVER IOW AMPS -
SQ. FT. FLOOR AREA
$/SQ. FT.
SIGNS ELECTRICAL
Licensed Professional
OWNER -BUILDER DECLARATION
I herebya(0rm that I am exempt fromthe CoNractorslicense Law (a the
following exame.(Section 7031.5, Business and Professions Code: My city or
countywhich requleesa perauttomrutmct, alter, Improve, demoWh,armpalr
1,398
74.92
SPECIALCIRCUIT/MISC
TEMP. METER ORPOLE INSET.
anystmmsmpdm Wits WuancgaleorequlmtheappUmtfwr chperMtto
file a signed statement that he is licensed punumt to the provblom of the
Contractor's License Law (Chapter9(commencing with Section 7M) of Divi.
Nonaofthe BuN mmdProfmlom Cade)orthathe Isexempttherefromand
({OWER DEVICES .
SWIMMING POOL ELECTRIC
- VALUATION
tW bas's (or the alleged exemption. Any violation of Section 7MIS by any
eppBcant fora permit subjects the applkmttoa civil penalty of not =in than
OUTLETS-SWITCHES-FIXTURES$104,738.00
NEW RESIDENTIAL ELECTR SQFT,
five 1, as owner ofdollars
property, or employees with wages thele sole
❑ I, as owmr o(thWEI
STORIES
TYPECONSIRUCTION
do t he r
Intended ora((ereL(or
ask snot 7014,
.Is(Sacompensation,44Businessaavak+ndlhesCode: Tis he
an and Protrusions Code: The C es me Law
V—N
to ow
don not apply tom owner ofpropertyhisonemoymproovidedroryand
Improves he
theme,
who does such work hImseltathrough hlsawnemployas, provided that each
OCCGROUP
RES UNITS
Improvements are not Intended oroffered for sale. If, however, the building or
Improvement kne sold within ayearofcompletion, the avner-builderwBi have
TOTAL:
R -3l
It an of proving that he did not build or Improve for purpose of sale.).
I I, as owner of the property, am exclusively eonlracRng with licensed
contractors to construct the project(Sec. 7064, Business and Pro(mlons Code:
(JTy; '' PLUMBING PERMIT FEE
FLOOD ZONE
APN
PFRMITISSUANCE 12
The Contndoes License Law don not apply to as owner of property who
We
builds or improvthereon, and who contracts (a such pkajacls with a
c adoRO licensed pursuant to the Contrado's License Law.
LJ I am exempt under Sec. B k P C for this reason
--
ALTER -DRAIN AVENTWATER EEA)
FEE SUMMARY
gACK FLOW PROTECT. DEVICE
OUTS I DE FEES
DRAINS. FI.ODR ROOF, AREA, GOND.
SANITARY Y_ N_ '
RECEIPT
Owner Dale
WORI(MAN COMPENSATION DECLARATION
❑1 hereby affirm that I have a certificate of consent to self -insure, ora
ceetificam.fWorkeri Compensation Insurance are certi(lad copy thereof (Sec.
38licy 11 .)
Policy x
FIX'CURF_S PER TRAP
SCHOOLTAX Y N
RECEIPTNY
GAS EA. SYSTEM -1 IJC.60UTLE15
PABX FEE Y N -
RECEIPT M
Com an
GAS EA. WITS d -OVER 4 (EA)
BUILDING DIVISION FEES
10ed copy In tuh d.
herebythcity
e city e ty
N -
LyTcertllled copy is feed y finspection division.GREASE/INDUSTRL
WASTE INTERCEPTOR
PLANCHECK FEE
GREASE TRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
(TM1lasectlon need not M completed Ilhe permit Infocom hundred dollars
Date Recti t#
SEWER-SANITARY.SPORM EA 20OFT
WATER HEATER W/VENT/EI-ECTR
ENERGYFEE Y_ N_
PAID
($100)orim.)
1 artl(ythat in the performenceof the work forwhich this permit Is blued,
I shall not employ my person In any canner so as to became subject to the
Workers' Compensation Laws of California. Date
WATER SY5777rf/TREATING
APpllant
NOTICE TO APPLICANT: If, after making thisCertificate of Exemption, you
should beame+ubjed to the Workers' Compensation provisions of the Labor
NEW RESIDENTIAL PLMB. SQ.FT.
Date Recti t#
TOTAL:
BUILDING
657.00
Code, you =at forthwith amply with such provisions; orthis permitshall be
deeread revoked.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
7.35
I hereby af(irmthat there is a eomtrudlon lending agency forthe perform,
ane of the work for which this permit is blued (Sec. 309/, Civ. Q
I<nde'sName
Lenders Address
I artilythat I have mad thlsapphcationand NaMthat the above Information46.95
Is comet. 7 agree to complywlth all cityand county ordinances and Mate laws
TOTAL:
ELECTRIC FEE
6.95
PLUMBING FEE
QTY: ! ".AIECHANICALdPERMIT .:�E
MECHANICAL FEE
PERMIT ISSUANCE 12
FEES PAID:
relating to building comlmction, and hereby authorize representative o(thb
city to enter upon the above-nantlomdl property for inspection purposes.
(We) agreeto save, Indemnify an d keep harmless City of Gu peetino
against liabilities, lodgments, costa and expenses which may In anyway acewe
ALTERORADDTOMECH. -
Date Receipt#
AIR HANDLING UNIT CFO 10,000 CFM)
SUBTOTAL:
0
agaWtsald is Etre o n Ing of this petm
��- _ /`��
MR
R FiANDLINC UNCI (OVER IO,OWCFM)
CONSTRUCTION TAX
Slgratureof Applicant/Contractor r�/lt. f—'Tam
CONSTRUCTION TAX PAID:
HAZARDOUS M IALS DISCLOSURE
HEATING UNIT (TO 100,000 BTU)
Date Recti t#
Will theappllcant or future building occupant store or handle hazardous
matelot as defined by the Cupertino Municipal Code, Chapter 9.12, and the
Health and Safety Code Section 25532(a)7
❑ Ye No
WIIItha a ppllcan,Rom, building occupant use equipment or devices
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
VENTILATION FAN (SINGLE REBID)
ISSUANCE DATE
which emit ba.ed.o Ar wnlamWnts as defined by the Bay Area Air
Quality Management DlsMd7
Yes No
I have read the haaa—rMaeemterlals requimments under Chapler6.95 of
the California Health da Safety Code, Sections 25505,25533 and 25534. I
understand that lithe building don not currently have a tenant, that it is my
Pat g•�
PQ ,
q p
.• :A IiJQ
BOILER-COMPOI-0sOR 1W,OW BTU)
BOILERLGMP(OVER 100,000 BTU)
NEW RESDENTIAL MECH. SQ.FT
responsibility to rad ify the occupant of the requirements which most be met
prior to Was nce of a Certificate of Occupancy. .-
City .{
Cit Bf Cupertino
ISSUEDBY: h�«'
Owner or aulhorired agent Data
TOTAL:
OFFICE COPY