20355APPLICANT TO FILL IN INFORMATION WITHIN RED LINED — USE BALL POINT PEN ONLY
Building Project Identification
Building Address:
PERMITNO.
2.0355
10100 Torre Ave. Unit 155 (D2.2) "
remn anre. nee:
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION I PERMIT
5/10/90
canlrador'. Name: LIc. No:
CATFLORY CONTROL N
BUILDINGELECTRICALPLUMBINC-MECHAMCAL
ArehltM/Engineer. Llc No:
'QTc' " ELECTRIC PERMIT-,`- FEE,'S
- ,,,,,",'BUILDING .P,ERMIT INFO.
PERMITISSUANCE 12
Addms
LICENSED CONTRACTOR'S DECLARATION
I heh by under of Chaprer9(cemnumc-
APPLIANCISRESIDENTIAL
JOB DES�C�RE/R-7 N
PANIC
Sxxtk 700Mof ivdon3licernarnil
Businesand
Ingwe 1. In fon force and affect. o(the BuslnmmdlarofeeslonsCode,mdmy
license Is in fail (orae and effect.
�
Liacnx Ctsn Lc4
UP TO 200AMPS
RCB
Date Contractor
ARCHITECf 5 DECLARATION
I understand my plant shall be used as, public records
—
201-1000 AMPS
OVER 1 W0 AMPS
SQ. FT. FLOOR AREA
S/SQ. FT.
SIGNS ELECTRICAL
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affimnthat I am exempt from the Contractor'.Lkense law forthe
730
74.92
SPECIALCIRCUIT/MISC
TEMP, MEITR ORPOLE INST.
followingresses,(Setion7e31S, Budnmand Professions Code: Any dty or
.etywhlch requlres a permit to mntMucl, titer, bnprove, demo W h, or repair
enyslrudure prlortu its Issuance, also requlrestheappilant forsuch permit to
I& a signed statement that he b homsed pursuant to the provbioru of the
POWER DEVICES
SWIMMING IDOL ELECTRIC
Contradoe. License law(Chapter 9(commencing with Sedan 7000) of Divi-
.ion 3 of the Business and Profmions Code) or that he is exempt therefromand
VALUATION
the basis for the alleged exemption. Any violation of Section 70715 by any
apphcant for a permit subjects the applicamtoa civil pemhy offset more than
OUILETSSWITCHpSFI%NRES
$54,692.00
rive hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their sole
compensation, will do the work and the structure is not intended or offered for
NEW RESIDENTIAL ELECTR SQ.FT.
STORIES
TIDE CONSTRUCTION
V—N
.Is (Sec 7064, Busiresa and Prefmlem Cade: The Conrado?. Lt.. IA.
does not apply to an owner of property who builds or Improves thereon, and'
whodmauchworkhlmselforthrough hlsownemployess, provided thatsuch
OCC.CROIII'
RFS. UNITS
Improvements are not intended oroffered forests. If, however, thebullding or
Improvement bsold within oneyearofcompledio,the owner-bullderwif have
tl)gl2urdenefpmv1ng the he did not build orimprove forpurpossofsale.).
u L as owner of the pmperty, am exchasmly contracting with licensed
cennadom to construct the project (Sec. 7044, Business and Profeaiom Code:
TOTAL:
QTY. PLUMBING PERMIT .. FEE
R-3 '
'
FLOODZONE
APN
PER MMT ISSUANCE
19
The Contractors License Law does not apply'to an owner of property who
s for such tejecb with •
Wilda or Improvca thereon, and who centradp
TTNdor(s) licensed pursuant to the Coretradora License Law.
I am exempt under Sec. B k P C for this reason
ALTER -DRAIN 6 VENT- WATER ffAE
FEE 'SUMM ARY:,
BACK FLOW PROTECT. DEVICE
DRAINS FLOOR ROOF, AREA, GOND.
SANITARY RECEQ'T g
Owner Dee
WOR KMAN COMPENSATION DECLARATION
that I have a rtiflute of coaxto self -Insure, or •
❑I hereby affirm ceRK
certificate of Worken'Corepersatlon Insurance or a cartified copy thereof(Sec.
3800, Lab C.)
Pocky M
pp(TTJgEq, PER TRAPer
SCHOOL TAX Y_ N»
E MPT
GAS IA. SYSTEM -1 PNCAOUTLErS
PARK FEE Y N
RECEIPT M
FA. SYSTEM-0VER 4 (EA)
am
CoS
BUILDING DIVISION FEES
rtlfled copy is hereby fu ed.
y, with the y Impaction division.
Certified copy fitsd theeft
GRFVASE/INDUSTRL WASTE INTERCEPTOR
PLANCHECIC FEE
GREASETRAP
CERTIFICATE OF EXEMPTION FROM WORKERS
PAID
SEWER -SANITARY -STORM EA. 20(hrr
COMPENSATION INSURANCE
(Thbsecrion need not be completed lithe permit b for one hundred doll..
Dale Recci t#
WATER HEATER W/VENT/ELECTR
ENERGY FEE Y_ N_
(Slo(I)orlm.)
I certify that he the performance of Nework forwhicle this permit le bsucd,
WATER SYS.1'EM/TREATING
I shall not employ any person In any manner so as to become aubjrd to the
Workeri Compenulbn Lawe of 611fomla. Data
PAID
NEW RESIDENTIAL IaI.MB. SQd.T.
Applicent
NOTICE TO APPLICANT: H, after making this Certificate of Exemption, you
should become subj. t to the Workeri Compematlon provisions of the Labor
Date Recei t#
TOTAL:
437.00F3.
Code, you moat forthwith comply with such provisiom orthb permit shall beFEE
deemed revoked.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
Therebycork for w tberebacomroctlm lendingag7,Cly. .) pedorrryTOTAL,
anceoflhe work for which this permit bbelied (Sec. 3097, Clv. CJ
Landers Name
lender'sAddre.
I certifythatl havereadthb eppllotionand eatethatthc above Inforrtutlan
Is corned. I agree to comply with all city and county ordinances and state laws
ELECTRIC FEE
PLUMBING FEE
-
QTY. MECHANICAL PERMIT ,fit }h -.FEE
MECHANICAL FEE
0 25
PERMIT ISSUANCE 12
FEES PAID:
relating to building cemtrudlon, and hereby authorize representatives of this
city to enter upon the abovo-menlbned property for Inspection purposes.
(We) agree to save, Indemnity an d keep harmlm the City of Cupertino
against liabilities, judgments, coNsand x.penxe which may inanymyscence
ALTERORADDTOMECH.
Date Receipt#
AIR HANDLING UNIT(TO 10000 CFM)
SUBTOTAL:
against uiqy�ty In con equenc• ft egr tingofrhbpernq.
/�/�
AIR HANDLING [MIT (OVER 10,(100 CFM)
CONSTRUCTION TAX
�E=pa_
Slgnatture.f Applicant/Cent.ctor I) If Date
EXHAUST HOOD(W/DUCD
CONSTRUCTION TAX PAID:
HAZARDOUS MA ALS DISCLOSURE
Will the applicant or future budding occupant store or handle haaardous
'
HEATING UNIT (to 100,000 BTU)
Date Rece1 t#
material as defined by the Cupertino Municipal Code, Chapter 9.12, and the
I Lealth and Safety Cade Sedlon 25532(a)7
❑ Yes No
WBlthe applluntarfuturebuRdingompantu.e equipment ardevicce
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
s
VENTILATION EAN(SINGLE RFSID)
ISSII{A�I ATE
which emit harardous air contaminants as defined by the Bay Area Air
Quality Management District?
Yes d No
91 averead a under of
)("'
I ) Z) 1990
BDILER-COMP DID OR 100,000 BTU)
BOILER-COMP(OVER 100,000BTU)
feus tyCode,Sercqulrcments
5533aChapter.1
the GBand t Health k Safety Code,nedlom 25505,25533 a tenant, and 25534. I
ealth
therrcn0yrourehichthatb
uade.taadrhat lithe WOdlnupant
'
NEW RESIDENTIAL MECH. SQ.FT
mot
r dor to i uaity to na laid k.ta fOt a pe rcquiremendswhich must be mot
of
pdortolssuance aaCertlfkate of Ocapancy.
}.� /,
�IcY Of 1s IIBPrHD(/
�
ISSUED B4_Axo�. �Tl V����
Owner or authorised agent Date
TOTAL:
OFFICE COPY