20367r
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification -
Build ing Address: ,•
PERMIT NO.
„_
10100 Torre Ave. Unit 167
20367
ears ams. - one:
- -enteiCITY
OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
APPLICATION SUBMIT i AL DATE
'-' 5/10/90
Contracmrs ame: Lic.No:
738-4444
BUILDING-ELECTRICALPLUMBING-MECHANICAL
CATEGORY
CONTROL N
Archfiect/Engineer. Lk. No:
Qry ", ELECTRIC PERMIT 3 I-},utFEE'
BUILDING:P.ERMIT,INFO .' ,. }
Address
-
PERMITISSUANCE 1`2„.,4
' LICENSEDCONTRACTOR'SDECb RATION
Thereby a(( free that l am licensed under provisions o(Chapter 9(commenc
ingwithSection7D00)ofDiAsien3ofthe BuslnemandPmfemionsCode,andmy
If.. Is In fu8 force and effect.
APPLIANCES -RESIDENTIAL
PANELS
JOB DFSCRII'TIOM(
c OB D
'License Clara Llcp
Data ConnectorUP
-
TO 2DOAMPS
.]
RCB -
201-1000 AMPS
ARCHITECTS DECLARATION
I underetand my plana shall be used as public records.
- -
OVERIOJOAMPS
SQ. Fr. FLOOR AREA
b/SQ. FT.
SIGNS ELECTRICAL
Licensed Professional i
OWNER -BUILDER DECLARATION
I herebyalfimthat lamexempt fromthe Contractor'sLicense lawforthe
following mum. (Section 7031.5, Business and Professions Code: Any city or
county which requires a permit to construct, alter, improve, demolish, or repair
any structure priortu its issuance, also requires the applicant for such permit to
Rb a signed 'statement that he is licensed pursuant to the provision of the
Contractor's License Law (Chapter 9 (commencing with Section 7000) of Divi-
sion3 ofthe Businessand Pr fesniope Code)erthathelsemmpttherefmmand
the basis for the alleged exemption. Any violation of Section 7(1)1.5 by any
t subjects the applicant to a civil penalty of net more than
applicant fora permit
fiven 1, hundred dollars %he pro
e as owner of the property, or my employees with wages r their sole
om(Sec.7 K Bu.meshe work and thestructure isnot Intended o coffered for
elle (sec. ainow and Code: The Law
669
'
-
74.92
SPECIALCItCUIT/MLSC
TEMP. METER OR POLE INSC
POWER DEVICES
SWIMMING POOL ELECTRIC
VALUATION
.5 (]
$50,121-00
NEW RESIDENTIAL ELECTR �'�''
STORIES
TYPE CONSTRUCTION
V—N
-
apply to f property builds or imfociols hemon
does not s es uch torn owner olf f his
o nempoyees, provided
d such
pr,thebthatsuch
Mfww
'
OCC.GROUIa
RES. UNIT'S
lmpand
erwntsmrkMmoededoroffe . 11,howa,
Improvement issold ithindneyearferectpletio>14howevegiheerwill haw
Improvement pros withinhe did nonfbuildo improve
tFB urden of proving ehaz he did non baud or lmpmve for purpose of sale.).
for purpose of sale.).
u 4 as owner of the property, am exclusively contracting wkh Ikeneed
contractors to construct the project (Sec 7044, Business and Profeseloru Code:
The Contractor's License law dean net apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a
cdor(s) licensed pursuant to the Commodore License Law.
r�l'?FEE.StJINMARY.
am exempt under gec B k P C (or thle reason
TOTAL
... „ _t
QTy,'. PLUM Bl` NC PERIYMIT;j,„,, ;FEEt'�,
PERMIT ISSUANCE 12
ALTER -DRAW kVENT-WATER (EA)
R-3
FLODZOZONE
»
APN
BACK PLOW PROTECT. DEVICE
ty,
Owner - Date -
DRAINS FLOOR ROOF, AREA, GOND.
FIXTURES. PER TRAP
SANTTARY Y N -
RECEIPT X
• WORKMAN COMPENSATION DECLARATION
pl hereby affirm that I have a certificate of consent to self -Insure, or
SCHOOL TAX Y N
certificate ofWorkenn' Compensation Insurance or certified copy thereof(Sec.
3800,Lab CJ
RECEI T N
GAS EA. SYSTEM -1 INCA OUTLETS
PARK FEE Y N -
RECEIPT F—
Colicy MpN
anY
GAS EA. SYSTEM -OVER 4 (EA)
BUILDING DIVISION FEES
I l._I ified copy b he d with t e city
ertllied copy b filed with the city. Wpectlon dlvIslon.
GREASEANDUSTRL WASTE INTERCEPTOR
PLANCHECK FEE
GREASE TRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissectlonered not becompletedlfthe permit bon
forehundred dollars
(81OD)or rtifyt.)
I if not employ an person in an tmannerhework forwMch this pesubjecmit to booed,
I shall not employ any person In any manner no u to become subject to the
W Applicant Lewy ofCalifomla. Date
NOTICnt
should ETO APPLICANT: a after making othis Certificate o(Excmpt a Labor
forth to the Workers' CompmsaHonpmvblopeomits Lab or
Code, you mart forthwith comply with such pmvlslope orthls permit shall be
deemed revoked.
PAID
Date Recei t#
SEWER-SANH'ARY STORM EA. XIOFT.
WATER HEATER W/VENT/ELECTR
ENERGYFEE Y N• —
PAID
Date Recei t#
WATER SYSTEM/TREATING
NEW RESIDENTIAL PLMB. .FT,
_SQFT.
TOTAL:
WILDING J FE
41 9.00
TOTAL:Lender's
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the perform
ance of the work for which this permit Is Issued (Sec. 3097, Civ. C.)
SEISMIC FEE
ELECTRIC FEE
2 .73
Name
Lender'. Address
I certitythat l have read this application and stabthat the above Information
,, - ..,
QTY:., g,,,
PLUMBING FEE
28.73
a;MECIiANICAL`;PERMIT ,;,{;tFEBiit
,28.71
MECHANICAL FEE
FEES PAID:
bcomed.I agreeto comply with all city and county ordinances and state laws
to building construction, and hereby authorize reprerenpurpoa o(thb
PERMIT ISSUANCE 12
city W enterpmpertyml ss the Cit purposes,
city agree to sae , indemnify an
(We) agree to save, indemnify and keep harmless the City y ayamme
against liabilities, pdgmenb,co&sand expenses which may In anywayaccrue
aga >Said
yt/ nra®oror/;��f this 'permit .
ALTER OR ADD 70 METH.
AIR HANDLING UNIT CFO 10,000 CFM) '
Date Recei t#
(r
SUBTOTAL:
TAL:
AIR HANDLING UNIT IO,000CFM)
CONSTRUCTON TAX
EXHAUSTHOOD(W/DUCT)
CONSTRUCTION TAX PAID:
'
Slgpeture of Appllnnt/ContractorI / Date
HAZARDOUS MATE SDISCLOSURE
HEATING UNIT CTO 100,W0 BTU)
' Will the applicant or future building occupant store or handle hazardoua
material as defined by the Cupertino Municipal Code, Chapter 9.12and the
Health and Safety Cede Section 75532(x)7'
Yes No
Date Recei t#
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
�.
VENTILATION FAN (SINGLE RESID)
ISSUANCE DATE
PAI!],
1:�11Y” 1990
r towns
Will the enuth emduar,cont building a.occupantefidby the BayequipmentAre. devices
whicheManagements I, contaminants nb as defined by the Bay Area Air
Quality Management Dls1 No
Fly. No
I haveroadthe th&SaftyCode, Se requirements25505,under Chapter .1 of
25534.1
theCaliforniaHealthkildin Code, Sections25505,have
BOILER -COMP DRI' DR 100,000 BTU)_„
BOILER -COMP (OVER 100,00) BTU)
NEW RESIDENTIAL M4ECH. SQ.FT.
tend
understand thatn t it
require
responsibility notihe fy the occupant of theoats which
requirements which rwst be rrvt
met
to Issuance of ccupa
prior to Lseuance of a Certl(icate of Occupancy.
ce of a Certificate
City Of Cunerlinn
ISSUED BY: -\m VLV
Owner or authorized agent Date
TOTAL:
OFFICE COPY