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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —.USE BALLPOINT PEN ONLY
Building Project Identification
Building AddreMe20346
PERMIT NO.
.
100, Torre .Ave. Unit 146
mN1.2
rear.
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
5/10490
cent a Ga No
738-4444
BUMDINr—ELECnUCAL-PLUMBING.MECHAMCAL
CATEGORY
CONTROL If
Architect/Engineer. Lk. No:
QTY - ELECTRIC PERMITg
BUILDING PERMIT INFO
_
Address: '
IN M
OLICENSED
PERMITISTJANCE 12M
CONTRACTOR'S DECLARATION
Ihereby
di.irmihatlemlka 3ofthederproviand Pr fCssions 9(mmmeno-
Ingwi Is 1. fullforce and effect. ftheBuNrieesand ProfeulonaCade, and my
binful fora and effect. -
AP[sLIANCFSRESIDENTIAL
JOB DESCRIPHDN
1
DRC-��
PANELS
Liter
License Chss LbY
Dale Conlncior
UP TO 2DO AMI'S
B
201-IODOAMPS
ARCHITECT'S DECLARATION
I understand my planehafi be used as public records
OVERIODOAMPS
SQ. FT. FLOOR AREA
$/SQ. FT.
SIGNS ELECTRICAL
Limned Professional' -
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's Li... Law far the
909
-
74.92
SPEICULCIiCNT/MISC
TEMP. METER ORPOLE INST.
followingreason.(Eeafon 71131.5, Business and Professions Code: Any city or
emntywhkh requires a permit to mrstmc4 alter, impmve, demol&h,ormpatr
anyNmclumprimtoitsbmance,alsorequr iheappnontforsuchpermltto
file a signed statement that he is licensed pursuant to the previsions of the
POWER DEVICES
SWIMMING POOL ELECTRIC
Communes License Law(Chapter 9(commencing with Section 7000) of Divi-
Men 3 of the Buslneseand Profeaumu, Code) or that he 0 exempt therefrom and
VALUATION
the bash for the alleged exemption. Any violation of Section 7W 15 by any
appBcent for a permit eubjectetheappncant to a civil penalty of not more than
five hundred da)lan(f.5001.
❑ I, a owner of the property, or my employees with wages as their sole
OUTLETS -SWITCHES -FIXTURES
$68.102.00
NEW RpgppN'pAL E[,pGTRSQFC
STORIES'
TYPE CONSTRUCTION
compensation, will do the work, and the structure bout intended or offered for
.In (Sr . 7014, Business and Profenian Code: The Contnctots Lim. law
—
V—N
does not apply to an owner of property who builds or Improves thereon,and
who doessuch work himself orthrough his own employees, provided that such
OCC.GROIIP
RFS. IIIVFIS
Improvements are not Intended or offered for sale. If, however, the building or
Improvement is sold within onyearocompletion, the owner -builder will have
the burden of proving that he did not bund or improve for purpose ofule.).
LJ L as owner of the property, am exclusively mntracting with IlmneM
mntnctes to comtmct the project(See 7044, Bushes and Profession Code:
TOTAL:
.
QTY'.( '"''�PLlMBINGPERMIT FEE
R-3
FLOOD TONE
APN
PERMIT ISSUANCE 12
The Conte cter's License Law does not apply to an owner of property who
Wild. or Improves thereon, and who contra for such p(ojects with a
ctthe Contractor'sLicee Law.
cgNFae - can pungent m n
L� I am exempt under Sec 8 & P C for this recon
ALTER -DRAIN & VENT- WATER MA)
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
DRAINS FLOOR ROOF, AREA, CONTI.
SANITARY Y N
RECEU T 0
Owner Date
WORKMAN COMPENSATION DECLARATION
❑01TRAP
I hereby affirm that I have • mttificke of consent to calf-insurew a
certificate ofWorken' Compereatfon lnurance or a certified copy thereof (See.
Tab C.)
Policy
Policy
FIXTURERFGFI
SCHOOL TAX Y N
NN
CAS F.A.SYSTEM-1 INC.40ITILECS
PARKFEE Y N
RECEIPT #
#
Com any
GAS FA. SYSTEM -OVER 4 (EA)
BUILDING DIVISION FEES
Bled copy is harehy famished.
�crtrtBied copy b filed with the city inspection division.
GREASE/INDUSIRL WASTE INTERCEPTOR
PLANCHECKFEE
GREASE TRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
COMPENSATIONINSURANCE
(TMesectionnsednulbecompletad8thepermitbformahundreddollan
Date Recei t#
SEWER 'SANC[NtY"'"CORM EA'2(IOF7'
WATER HEATER W/VENT/ELECTR
ENERGY FEE Y N
(5700).elcm)
I cedBythat in the perfoSena.ce of that work furwhich this permit le issue ,,
WATER SYSCEM/TRFAnNG
I shall not employ any person In any manner se u to become subject to the
Wmkcra Compensation Laws of Califomh. Date
-
PAID
NEW RESIDENTIAL PLMB. SQ.FT.
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you
should Weeme subject to the Workers'Compenation provision ofthe Labor
Date Recei t#
TOTAL:
U G
500.00
Code, you must forthwith comply with such provision orthls permit shall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
I hereby affirmthat there k a mntructlon iendingagency for the perform-
ance of the work for which this permit Is issued (Sec. 3097, Civ. Q
Lender's Name
Lender'.Address
I certilythat I have read this application and state that the above information34.73
Is correct. I`dgne to comply with all city and county ordinances and Nate laws
TOTAL:
ELECTRIC FEE
34.73
PLUMBING FEE
-
QTY. �: ,MECHANICAL PERMIT „ 'FEE
MECHANICAL FEE
PERMIT ISSUANCE 12
FEES PAID:
relating to building construction, and hereby authorize representatives .f this
city to enter upon the above-mentioned property for impection purposes.
(We) agree to save, Indemnify an d keep harmless the City of Cu pertlno
aga last BabiWics, judgments, " a and expensnwhichmaylnanywayacwe
ALTERORADDTOMFGH.
Date Receipt#
AIR HANDLING UNIT CFO 10,000 CFM)
SUBTOTAL:
1911.S
.galcalci Ience ft
nt2�rating of this permit.
Signtere of Applicant/Contractor Data
AIR HANDLING UNIT (OVER 10,ODOCFM)
CONSTRUCTION TAX
D(FIAUST HOOD(W/DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUS MA W IALS DISCLOSURE
HF.ITING UNIT (TO 100,ODDBTU)
Date Recei t#
Will the applicant orfutun budding occupant store or handle hazardous
material as defined by the Cupertino Municipal Code, Chapter 9.12 and the
Health and Saf&y Cock Sect .. 25532(.)?
❑ Yes No
-
HEATING UNIT (OVER 100,000 BM
TOTAL:
VENTILATION FAN (SINGLE RESID)
ISSUANCE DATE
Will theappliant or Nn, building occupant use equipment or devices
which reek hazardous air contaminants as denned by the Bay Area Air
Quality Management District?
YesNo
have read the haze nus materials requirements u ncier Chapter G95 of
*
P� P�
BOILER -COMP OHP OR 10,000
BOILER -COMP (OVER I OO,ODO BT"
the California Health &Safety Cod, Sect tore 25505,25533 and 25534. I
understand that if the building does not mmerely have a tenant, that It is my
D t�pO
NEW RESIDENTIAL MECH. SQ.FT.
responsibility to notify the occupant of the requirements which must be rest
prior to issuance ofaCertiicateof Occupancy.
#s at
laity 0 CB pertino
ISSUED BY: A IL row VC:G
Owner or authorized agent Data
'
TOTAL:
OFFICE COPY