20352APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building PmEad Identification I-
B.fldug Add
PERMIT NO,
^ 5 2
10ress:
10100 Torre Ave. Unit 152 (D1.4)
20352 O
- G VS G
mersName: one:
'
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION/PERMIT
5/10/90
CO,tractar'sName: Llc.No:
739-4444
BUILDINGELECTRICAI PLUMBINGMECHAMCAL
CATEGORY
CONTROL#
Architect/Engineer. Lie No:
.QTY; - ELECTRICPERMIT, - FEE
BUILDING PERMIT INFO
Add..
7:1 El
PERMIT ISSUANCE 12
LICENSED CONTRACTOR'S DECLARATION
I hereby ion7OOO).f Dt 0cenaeduM.st.o bald f.h.,C.dro, mmc
It ..1 In fullfarmandafeion3afthc Businemand Pro(e&tonsfpde, and my
1.lChiss !orae and affect.
APPLIANCES -RESIDENTIAL
JOB DESCRB'/70N
JJ �/
PANELS
Licam
Llrene Clam Lre.N
-�^Rl
Date Contractor
UP TO 2DO AMPS
101-1000 AMPS
ARCHITECTS DECLARATION
I understand my plans&hall be used as public records.
OVER1000AMPS
SQ, Fr. FLOOR AREA
$/SQ.FT.
SIGNS ELECTRICAL
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law tar the
669
74.92
SI'ECULCEICIRT/MISC
7EMP.MECE2OR POLE INSC.
(o0owingreason.(5--dim70315, B..imssand Profesalmu Code:Mycttyor
coon tywh ich requ irm a permit to mmtmd, alter, Impmve, demnlbh, or mpai r
any&tmdumprbr Mita suancgabamquimstheappllcantforauchperMtto
file a signed statement that he la hamsed pursuant to the provisions of the
Contractor's License Law (Chapter 9(conamencing with Section 7000) of Divi.
start ofthe Business and Professions Code) miller he Is exempt therefromand
POWER DEVICES
SWIMMING POOL ELECTRIC
VALUATION
the bash for the alleged exemption. My violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
fiv�uLas owner of ars
I, as owner the property, or my employees with wage as there sole
pro
OUTLETSSWIT'CHFSFI%TURFS
$50,121.00
NEW RESIDENTIAL ELECTR SQFI'.
STORIES
TYPE CONSTRUCTION'
a
will ed far
compensation, Business and k.and the stmdureicnot Intended. License
salLaw
7044, an ProlessiContraorimpoctor'aGmnu Law
Y_N
doe not to owar of
does not apply to rk owner of property who Wanda or improves thereon, and
who
who work himself Msmvne that such
oho ea, p
OCC. GROUP
RFS UMTS
improvements Intended othrough
Improvement issold ithindedoroReredfor platiothe owevepilder, illhading ve
sale. ll , theb
Improvement lamld within omyearolcompletWn, the owner-bu0derw111 have
TOTAL:
Q7y:'+^}; ;PLUMBING PERMIT. FEE
R-3
the burden of proving that he did not build or improve far purpose of sale.).
LI L as owner of the property, am exclusively contracting with Iteemcd
contracture,to construct the project (See. 7614, Badness and Professions Code:
The Contractors License Law doe. not apply to an owner of property who
WildaALM-DRAIN
or Improves thereon, and who contracts for such pEujec. with a
licensed pursuant to the Contractor's License Law.
"El A P C for this rean
LII am exempt under Sea 0 w
PERMIT ISSUANCE 12
& VENT -WATER (EA)
FLOOD ZONE
APN
FEE SUMMARY
BACK PLOW PROTECT. DEVICE - '
DRAINS FLOOR ROOF, AREA, GOND.
FIXTURES- PER TRAP
SANITARY Y N
BBC= p
Owner Dara
WOR"AN COMPENSATION DECELERATION
C31 hereby affirm that I have a certificate of cement to self -Insure, ora
3800, 380lflcab of Workers'Canpematlm Insurance aracertlfled ropythereof (See.
Policy x
SCHOOL TAX Y_ N_
RECEPT #
GAS PA. SYSTEM -1 INC.4 OUTLETS
PARKFEE Y N
RECEDING T N
GAS EA. 51'SfFM-OVER 4 (EA)
Ca,��myy''ny
BUILDING DIVISION FEES
K=, -d copy la hereby th the city
j�i�e:erlBlad copy b flied y fu the tlty impaction division.
GREASE/INDUSIRL WASTE INTERCEPTOR
PLANCHECIC FEE
GREASETRAIP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
(Thlsmetion need not be completed If the permit la foram hundred dollars
(SIM)orlees.)
I mmilythat in the performance of the wok (orwhich this permit Is Issued,
I shall not employ any person In any manner w as to became subject to the
Workers' Compensation Laws of Callfomla. Date
Date RCCCI IN
SEWER -SANITARY -STORM EA 1(0FT
WATER HEATER W/VENT•/.E1.ECER
ENERGY -FEE Y_ N_
PAID
WATER SYST[M/TREAn NG
Applicant
NOTICE TO APPLICANT: If, after naking this Certificate of Exemption, you
should become subject to the Workars' Compensation provisions of the Labor
Date Recet t#
NEWRESIDENTIALPLMB. SOFT.
TOTAL:
Code, you =at forthwith comply with such provisions orthla permit shall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
U I NG FEE
419 nr
SEISMIC FEE
-
3. 5
I herebyaffimm that there la a construction lending agency forthe perform-
once of the work (.,which this permit is Issued (Sec 3097, Cie. C.)
Le.dae. N.
Leader'&Addrea
TOTAL,
ELECTRIC FEB
PLUMBING FEE
MECHANICAL FEE
QTY. MECHANICAL PERMIT" .. FEE '•
I molly that I have read thio application and nate that the above Information
bcormct. I agree to comply withal) dtyand muntymilimmes and tate laws
PERMIT ISSUANCE 12
FEES PAID: -
'
relating to building construction, and hereby authariae repmeatatives of this
city to enter upon the above-mentioned property for Inspection purposes.
(We) agrm to save, indem ily an d keep barrel. City of Cu pen into
against liabilities, Pdgments, miss and expenses which may in any way accrue
ALTERORADDTOMRCH.
Date RCCCI to
AIR HANDLING UNIT Q010,000 CFM)
SUBTOTAL:
Q
of egr ting of this pemsit
agalmtsaid ity taro ZZ S O
Sigmturc of Applicant/Contractor , ate
AIR HANDLING UNIT (OVER 10,000CF'M)
CONSTRUCTION TAX
E%ItAt1ST HOOD (W/DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUS MA ALS DISCLOSURE
HEATING UNITED l 00,ODO BTU)
Date Recei t#
Will the applicant orfutere bu0ding occupant store or he ad ie havardous
material as defined by the Cu Fenton Municipal Code, Chapter 9.1 1, and the
He❑alt annd Safety Code SSectlaon75532(a)7
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
.Yea'
VENTILATION FAN (SINGLE RESID)
ISSUANCE DATE
Wllltheapplicant or luturn building occupant use equipment or devices
which emit ham rdou&air comaMmest. as defined by the Bay Area Air
&Illy Management District?
Yea ❑ No
#�
� �
BOILER -COMP OHP OR 100,000 RTU)
BOLLFR.COMP(OVER 100,000 BTU) -
have lead the hazard... materials requirement, under Chapter 6.95 of
the Californbllealth&Safety Code, Sed lam 15505,75533 and 25534. I
Irr
,/1r' 15 1990
NEW RESIDENTIAL MEIN. SQ.Fr.
understand that if the building does not currently have a tenant that it la my
responsibility, to notify the occupant of the requirements which moat be met
prior to lssuarec of a Certificate of Occupancy.
#s
City Of rUnArft11 n
ISSUED BY: V V C z
Ownerorauthodudagent Data
TOTAL:
OFFICE.COPY