20348•
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification
Building Addmsa:
10100 Torre Ave. Unit 148 (N1.1)
PERMIT NO.
20348
nen ante: one:
Untpr Properties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
BUILDINGELECTRICAI PLUMBINGMECHANICAL
5/10/90
e°ntnctor,Name: Lie. No:
718-4444
CATEGORY
CONTROL If
—
ArchltM/Engineer. Lk. Na
6TY ELECTRIC PERMIT
•"
• FEE
BUILDING PERMIT INFO
Address:
71 In 1!1 21
T'ER)ATISSUANGE
12
LICENSED CONTRACTOR'S DECLARATION
I heh Secti@mtbat I amafDiv Beml ofthesed erpessandsdChdorisC(e,and,
Budnemand ProfeaslonaCydesand my
It...iSection force and
Licemp b iiissin orce and . if
License Clam Llc p
Dale Contactor
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I herebyaffirmthat I amexempt fromthe Contractor's License Law for the
followlogmas.,.(Section70315, Btudameand Professions Code: Any cttyor
countywhich mquba a permit to mmtmcL altep Improve, demolish, car repalr
anystructum pdarto its Issuance, also mquImetheappRaerMt
ntforsuchpto
file a signed statement that he b Rttnaed pursuant to the provisions of the
Contractor's License Law (Chapter 9(mmneming with Section 7000) of Divi.
sior3 ofthe Buslnemand Pe femimo Ceds).,that he is exempt therefromand
the basis for the alleged exemption. Any violation of Section 70315 by any
applicant fora persalt subjects the applicant to a civil penalty of rot ..than
flue hundredddbrs.
❑ u as owner of theheproperty, or my employees with wage as their soleNEW
mmpensatlan,Mlldothe work andthestmmm b nd Intended or offered for
sale (Sec 70K Businessand Pr f.W. Code: The Contractor, License Law
does nest apply to an owner of property who builds or Improves thereon.and
who doessuch work himaelforthrough Ms own employees, provided that such
Improvements arc not intended oroffered forsale. If, however, thebullding or
Improvement issold withinoneyeara(compldlon, thommer-builderwlll have
tfe�urden of proving that he did not build or Improve for purpose ofak.).
LJ L as owner of the property, am exclusively contracting with Ilttn,ed
contractors to construct the project (Sm 7014, Business and Professions Code:
The Contractor's License Law does nest apply to an owner of property who
builds or Improves thereon, and who contract, for such p(ojects with a
cgaqadw(s) licensed pursuant to the Contractor, Liman Law.
LJ I am exempt under Sec B k P C for this recon
CESRESIDENTIAL
JOB Duizuti T N
,a..._ ^RI �•-
4= C) RCB
-
PANELSAPPLIA
PANELS
UP TO 2DOAMPS
101-I000 AMPS
JOVERIMAMPS
SQ. Fr. FLOOR AREA
909
$/SQ.FT.
74.92
SIGNS ELECTRICAL
SPECTALCMCUIT/MISC
TEMP METER OR POLE INST.
POWER DEVICES
SWIMMING POOL ELECTRIC
OUTLETSSWITCHESHXfURES
VALUATION
$68,102.00
RESIDENTIAL ELF -CTR SQ.FT.
STORIES
TYPE CONSTRUCTION
V—N
TOTAL:
QTY; PLUMBING PERMIT
FEE
OCC.GROUP
R-3
RES. UNITS
I
FLOOD ZONE
APN
'
PERMIT ISSUANCE
12
ALTER -DRAIN kVENT-WATER (W
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
FEES
DRAINS FLOOR ROOF, AREA, COND.
SANITARY Y N
RECEIFF M
Owner Date
WORKMAN COMPENSATION DECLARATION
P hereby dorthat I have • rtiBm of ,.,sent to self -insure,
❑ m mare, ora
certificate of Workers' Comparsatlonlruurance or a certifled copythereof (Sec.
Policy ab CJ
Ib
pIX'NRF.S. PER TRAP
SCHOOL TAX Y N
AECEI NB
GAS EA.SYSrFM-1 WC.60I/iLETS
PARK FEE Y N
RECEIPT I
N
in
Com n
CASEA.SYSEMOVER4(EA) T
BUILDING DIVISION FEES
trifled ropy is hereby furnished.
Certified copy Is filed with the city inspection division.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed lithe permit is forces hundred dollars
(5100).,tem.)
cer
I taythat In the performance of the wait fe,which this permit Is hued,
I shall not employ any person In any manner w as to become subject to the
Compenatlon Lawsof Califumb. Date
Applicant
NOTICE TO APPLICANT: If, after nuking this CertRlate of Exemption, you
should bemore subject to the Workers' Compensation provisions of the Labor
Code, you most forthwith comply with such provblom or this permit shall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency forthe perform-
ante of the work forwhlch this permit b Issued (Sec. 3097, Clv. C.)
Leader's Name
Landers Address
Irndlfythatl have read thisappliationand statethatthe above Info mution
bmrrect. l agmatu morplywlth W city and countyordinances and elate laws
relating to building construction, and hereby authorise representatives of this
city to enter upon the above-mentioned property for lnspodlon purposes.
(We) agree to save, Indemnify an d keepar
harmless the City of Cu pride.
against liabilities]adgments, cons and expense, which may in any way accrue
ages W/tul�, Gw, 1�l�y�''a o he nting of this permmiit.
"�'"--""� — "�/6
Signatumd Applicant/Contractor /r Dom—
HAZARDOUS M IALSDISCLOSURE
Will the applicentorfuturc building occupant store orhandle hazardousHEATING
material as defined by the Cupertino Municipal Code, Chapter 9.12, and the
Health and SafetyCode� —Srection 25532(a)7
n YonL�1 No
Will the npplicnnt., future building occupant sae equipment or device
which emit hevrdous air contaminants as defined by the Bay Area Air
ality Mar'agemenl Dbtrkt9
Yea ❑ No
have read the hazardous materials requirements undei Chapter 6.95 of
the California Health & Safety Code, Sections 25.505, 25533 and 15534. 1'�
understand that if the building does rad currently have a tenant, that It is my
resposlbRlty to rally the occupant of the requirements which moat be mrd
prior to Issuance o! a Certl(kate of Ouvpanry.
CREASE/WDUSIRL WASTE INTERCEPTOR
PLANCHECKFEE
PAID
Date Revel tM
GREASE TRAP
SEWFR.SANITARY-STORM EA 20017,
WATER HEATER W/VENT/Ef.ECTR
ENERGY FEE Y N
PAID
Date Recei tic
WATFdI SYSTEM/TREATINGWorkew
NEW RESIDENTTALPLML SQ3•T.
TOTAL:
BUILDING FEE
500.0(
SEISMIC FEE
' 4. S
TOTAL:
-
ELECTRIC FEE
PLUMBING FEE
14 70
(TTY. `i ::'MECHANICAL. PERMIT "
"
PERMITISSUANCE
FEE
12
MECHANICAL FEE
FEES PAID:
'
ALTER OR ADD TO MECH.
Date Recei tM
AIR DANDLING UNIT (TO 10,000 CFM)
_
SUBTOTAL:
61.0
MRHAND12NG UNIT (OVER IO,WOCFM)
CONSTRUCTION TAX
EXHAUST HOOD
CONSTRUCTION TAX PAID:
UNIT CFO 100,MO TIT"
Date Recei tM
HEATING UNIT (OVER 100,000 BTU
TOTAL:
VENTILATION PAN (SINGLE RESPD)
ISSUANCE DATE
PA J6Sll;;
4'
frit,
l 1,01 f4Cnpertlno
ISSUED BY. t) 1n rr
BOILER -COMP DHP OR 100,000 BTU)
BOILER-COMP(OVER100,000BIU)
NEW RESIDENTIAL MECH. SQ.FT.
Owner or authorlud agent Data
TOTAL:
OFFICE COPY