20353APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification
Budding Addmm: . •
PERMIT NO.
10100 Torre Ave. Unit 153 (D1.2)
20353
tier.Name: me:
-
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
5/10/90
Contractor's Name: LIc. No:
378-4444
BUIL'DING.ELECTRICALPLUMBING-MECHANICAL
CATEGORY
CONTROL#
Architect/Engineer: LIc No:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
-
Address
PERMITISSUANCE 12
EN EN , EN DI
LICENSED CONTRACTOR'S DECLARATION
IherebyaoA700hat DiAsion3ofthe urp a dpro ChawsCocom do
It.. I. I. full 7000)of d effecn3ofthe BuMreuandlsrofeWonsCode, and
license le In lull tors and drM.
Lisnsc Clan Lie#
APE]ANCESRESIDENIIALing�t
JOBD CR ON
� � CB
PANELS
Date Contractor
ARCHITECTS DECLARATION201-10DOAMPS
I understand my plans shall be used as public records.
OVER I O00 AMPS
SQ. Fr. FLOOR AREA
S/SQ. Fr.
SIGNS ELECTRICAL
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby a(@m that I am exempt from the Contractor's License Law for the
following reason.(Section 7031.5, Business and Professions Code: Any city or
county which mqurees a permit to construct, alter, improve, demolish, or repair
any structure prior to its hwaree, also requires the applicant for such permit to
file a signed statement that he le licensed pursuant to the provisions of the
Contractors License Law (Chapter 9(commencing with Section 7000) of Divi-
Mona o(the Business and Professlmu Code)arthat he b exempt therefrom and
the bash for the alleged exemption. Any violation of Section 70315 by any
for a permit subjects the applicant to a civil penalty of one more than
five 1, as neroftheprdollars .
I, ate owner the property, or my employees with wages there wh
669
74.92
SPPLIALCIRCUIT/MISC
TEMP.MEfIZi OR POLE INST.
POWER DEVICES
SWIMMING POOL ELECTRIC
OUTLETS -SWITCHES -FIXTURES
VALUATION
$50 s 1,11 . 00applicant
NEW RESIDENTIAL ELECTR SQ.Fr,
ffUl S TYPECONSTRUCTION
will and the r ed for
compensation,0K
or..Law
-
Business and mfmio.Codk e:rehn C"ur"ried
thieve law
arta Professions Code: The or improve.
sale (Sec. apply to an
whodcxdoes tapply tork owmr ofprough hiso. employees, thatsuch and
whoavementswork intededoroughed fare, If,ho aerate uildingor
Improvement an,amithindi.ye.r fcomsuk. If, however, elder Wlhave
improvement is sold withinoneysarofcompletlorylheowner-W Bderwillluve
tlig.kurden of proving that he did not build or improve for purpose of sate.).
LJ L as owner of the property, am exclusively contracting with licensed
contractors to construct the project (See. 7614 Business and Professions Code:
The Contractors Limme Law does net apply to an owner of property who
Wilds or Improves thereory and who contracts far such p(o)ecas with a
�gRtr�&..(a) licensed pursuant to the Conrad e. Limes Law.
LJ I am exempt under Sec B k P C for this reasonOUTSI
�/_N
TOTAL:
QTY. �', PLUMBING PERMIT FEE
pp((,(n.ISSUANCE 12
ALTER -DRAIN 4 VENT - WATER (E,3)
OCC.GROUP RES. UNITS
R-3- /
FLOOD ZONE APN
BACK FLOW PROTECT. DEVICE
FEE SUMMARY
DF FEES
DRAINS FLOOR ROOF, AREA, GOND.
FlDi URFS PER TRAP
SANITARY Y_ N—
RECEIPT #
Owner Dale
WORKMAN COMPENSATION DECLARATION
01 hereby affirm that I have • cerfiftexte consent to self-twre, ora
SCIi00LTAX Y N
srtificab or Worken'Compensatlonlnsurans ora srti(td copythereo(6ec.
o
3300, ab GJ
1'o1lry #
REC=0
GAS EA. SYSTEM -1 INCA OLMErS
PARK FEE Y N
RECEE'I' N
Cpa^Y
GAS
GAS EA. SYSTEM -OVER 41 MA)
BUILDING DIVISION FEES
L� OM copy is hereby furnished.
Lgff�xftiflexi copy is rued with the city impedmn division.
WASTE INTERCEPTOR
PLANCHECK FEE
GRE'ASETRAP
CERTIFICATE OF EXEMPTION FROM WORKERS"
COMPENSATION INSURANCE
(rhtsectio" aced not be completed lithe permit lsforomhundred dollars
(9100)liless.)
isnot emplohat In y
say person in an thework so as to b comehis meth toted,
I shall "m employ any person In any manner at u to become eub)ect to the
Workcmws 'Compeneatlon laof Glllornt. Data.
Applicant
NOTICE co APPLICANT:ttthe ager making this Certificate Of Exemption, you
Code,shoulberme subject to the Worksit suchComprvialo provhionsofthe Labor
Code, you novel forthwith comply with such provlelons or this permit shall be
deemed ..ked.
PAID
Date Recei tp'
SEWER -SANITARY -STORM EA. 200Pr.
WATER HEATER W/VENT/ELFCTR
ENERGY FEE Y N
PAID
Date Recei tic
'
WATER SYSTEM/TREATING
NEW RESIDENTIAL PLMB._SQ.FI'.
TOTAL:
BUILDING EEE-
419.0
rornL:
SEISMIC FEE
ELECTRIC FEE
3.57
P8,
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lendingagency for the perform-
ance of the work for which thh'perrh dt bund (Sec. 3097, Civ. C.)
Lenders Name
Le^ace.Aaareaa
I certilythztl have madthb applicationand Matethattheabove information
bcorred'I agree to comply with all city and county ordinances and Mate laws
'Q Y. '^ - MECHANICAL PERMIT FEE
PLUMBING FEE
28.7
MECHANICAL FEE
28.7
PERMITISSUANCE 12
FEES PAID:
relating to Wilding construction, and hereby.whorlu representatives of this
city to enter upon the abovcmentioned property for Inspection purposes.
(We) agree to savc, indemnify as d keep harmless the City of Cupertino
against llablWles,judgment, omtand expenses which may In anywayaccrue
agalnstuld tyinconvquenc of he neng olthl.,an t
��
ALTER OR ADD TO MECH.
AIR FIANDLING UNIT(to 10,000 CFM)
Date Receiptlf
SUBTOTAL:
AIR HANDLING UNIT (OVER 10,000CFM)
Et
CONSTRUCTION TAX
Signature of Applicant/Contractor /e. Little
EXFIAUSI HOOD(W/DI,CT)
CONSTRUCTION TAX PAID:
HAZARDOUS MA t1ALS DISCLOSURE
HEATING UNIT CM t 00,000 BTU)
WRl the applicaest or future building occupant store or handle hazardous
material as defined by the Cu pertloo Municipal Code, Chapter 9.1 7, and the
Flealth and Safety Code Section 25537(a)?
�] No
Rill
Date Recei 111
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
Q
VENTILATION FAN(SINGLE RESID)
ISSUANCE DATE
p� -
jp_pj '
Ill the applicant or tum building occupant use equipment or devices
which emit hazardous air contaminants as defired by the Bay Area Air
Quality Management District?
Yea
4 Yea No
read the hazar cu.rmterials requirement under Chapter 6.95 of
BOILER -COMP MIP OR 100,000 BTU)
-COMP (OVER 100,000 BTU)'
the Califernla Health k Safely Code, Sections 25505, 75533 and 75534.[
understand that if the Wilding does not currently have a tenant, that it t my
responsibility to notify the occupant of the requirement which mart be met
r!!tV 5 1990
.
NEW RESIDENTIAL MECIi. SQ.Fr.
prior to issuance of a Certificate of Occupancy.
City QI /1t,ruRP111Rn
ISSUED BY: .N 7 Q 1A jZ C
Owner or authorized agent .Date
7DTAI-:
OFFICE COPY