20369APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Pro ea Identification -
Building Address:
PERMITNO.
10100 Torre Ave. Unit 169 (D1.1)
20369
.m.Name: one:
A
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION/PERMIT
5/10/90
Cemlbxdor'e Nanse' Lk. No:
—
BURDINGUECTMCAIPEC
LUMBING-MHAMCAL
CATEGORY
CONTROL N
Archite </Fsgineer. Lk. No:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Addrma:
a �L
L�
PERMITISSUANCE
LICENSED CONTRACTOR'S DECLARATION
I hereby
ectionAffirm 'hat lam.1.3 d under Chapter 9
tog with Secuon7000)ofDlvision3oltheBusinessandPro(eesionsCade,and my
APPLIANCESRESIDEM'IAL
]OB DESCRIPTION
license is In full form and effect.
PANELS
-P
S
License Class Lie.4
\
RI.B
Date Contractor
UP TO 2DO ANTS
301-IODOAMPS
ARCHITECTS DECLARATION
I understand my plans shall be used As public records.
OVERIOOOAMPS
SQ. FT. FLOOR AREA
S/SQ. FT.
SIGNS ELECTRICAL
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 70713, Business and Professions Cade: Any city or
ceuntywhichrequiresapermittomn malter,impmve,demolkh,orrepair
SPFCIALCI6CUIT/MI5C
669
74.92
TEh{p.METER ORIOLE INST.
anystrudum pdartolts Wuame,also requireitheapplicantfor such permute,
file a signed statement that he is licensed pursuant to the provbioro of the
Contractor's License Law (Chapter 9(commencing with Section 7000) of Divi-
sian3 of the Business and Prefessb+roCode) or that he is exempt therefromand
POWER DEVICES
,
SWIMMING POOL ELECTRIC
VALUATION
the basis for the alleged exemption. Any violation of Section 70315 by any
applicant fora permit subjects the applicant to a civil penalty ofnm more than
five hundred dollars (ISM.
0 L as owner of the property, or my employees with wages as their sok
OUTLETSSWITCHES-FIX TURES
$50,121.00
NEW RESIDENTIAL ELECTR SQ FT.
STORIES
TYPE CONSTRUCTION
mmpensrtion, wlldothe work and thestrucNre is nm Intended or offered for
sale (Sen 7064, Business and Professions Code: The Contradoes License Iaw
V—N
does net apply to an owner of property who Wilde or Improves I hermry and
whodcessuchworkhimselforlhrough hisownemployees,provWed that such
OCC.GROOP
RES. UNITS
improvements arc noHmencied oroffered for sale. If, however, the Wilding or
Improvement issold within amyearolcompleWmtheowner-bulderwll have
t"Men of proving that he did nmbuldorimproveforpurpmeofsakd.
LJ L as owner of the property, am exclusively contracting with license
conlmctom to cenamed the prefect (Se. 7061, Busmen and Professns ioCode:
TOTAL:
QTY;,. PLUMBING. PERMIT' FEE
PERMIT' ISSUANCE 12
R-3
'
FLOOD ZONE
APN
The Contmdor's License Law don not apply to an owner a property who
Wilde or improves therein, and who centrads for such p(ojeds with a
mRfi+dogs) licensed pursuant to the Contractor's License Law.
LII am exempt under Sec. B & P C for this ..
--
ALTER -DRAIN &VENT WATER (FA)
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
DRAINS FLOOR ROOF, AREA, COND.
SANITARY Y N
RECEIPT N
OwnerDace
WORKMAN COMPENSATION DECLARATION
01 hereby affirm that I have a mMficste of coesnt to self -Insure, ora
certlflcateolWorkers'Comnsmce
peation lnsuece m A rtlfled copy the.((Sec.
3800, Lab CJ
pIXIL)RES PER TRAP
SCHOOLTAX Y_ N_RECEIPT N
GAS EA.SYSTFM-1 INC.10UTLEIS
PARK FEE Y N
policy M
RECEIPT N
GAS. ESYSTEM-0VER 4 (FA)
Com n
BUI LDING DTVI SION FEES
Ificd copy la hereby furnished.
eMML copy k fled With the city Inspection division.
CREASE/INDUSCRL WASTE INTERCEPTOR
PLANCHECK FEE
'
CREASETRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
(chis section need am be completed I the permit is for one hundred dollars
'Date Recel IN
BEN'ER-SANITARY-STORM EA 200Ff
WATER HEATER W/VENT/ELECTR
ENERGY FEE Y N
PAID
(S100)orless.) -
I certify that In the performance of the wmk for which this permit is Issued,
I -bel out employ Any person in any manner so As to become subjed to the
Workers' Compensation laws of Calfomla. Date
WATER SYSTEM/TREATING
Applicant
NOTICETO APPLICANT: suer making ec Certuk is Exemption, you
should become subject to thea Workers' CampensaRon provisions of the Labor
Date Recel til
NEW RESIDENTIAL PLMB. SOFT.
TOTAL:
you =at comply with such provisions orthk permit be
deemed revoked.
deemed
CONSTRUCTION
13UILDING FEE
41(3 00
SEISMIC FEE
3.57
emisaLENDINGAGENCY
Therebyarkformthereia.constructiontlending097,ry farthe perfomm
once ofthe workforwhkhthla permitlaksued (See.3097,CIv.CJ
Tornl:
ELECTRIC FEE
28.73
Lender's Name
Iandre.AddresA
I mrtlfythatl have reacithb application ami statethattheamwe Inforrt etlon
isconect lagreetocomply with all city and county ordlnancoand late laws
CITY. ;;MECHANICAL PERMIT FEE
PLUMBING FEE
28.73
MECHANICAL FEE
PERMUISSUANCE 12
FEES PAID:
relating to building construction, and hereby authorlu represntatives ofthis
city to enter upon the above-mentioned property for Inspection purposes.
(We) agree to save, Indemnity and keep harmless the City of Cupertino
against liabilities,ptigments, casts and expense which may in anywayamaue
agaWt sldC otcons� M�oa j�sr �,m of this permit.
permit
//Ci
ALTER OR ADDIO MECH.
Date Receipt#
AIR HANDLING UNIT (TO 10,000 CFM)
SUBTOTAL:
AIR HANDLING UNIT (OVER Ig000CFM)
CONSTRUCTION TAX
r �_
-GG
Slg.Mre of Applicant/Contractor to
O(HAUSTHOOD(W/DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUS MAT LS DISCLOSURE
HEATING UNIT (TO 100,0D) BTU)
Date Recei tp
Will the applicant or future building occupant store or handle haardous
material as defined by the Go pert.. Municipal Code, Chapter 9.12, and the
Health and Safety Cade Section 25532(a)2
Yea No
Will the applicant R ture building occupant use equlpment ordeviom
HEATING UNIT(OVER 100,000 BTU)
TOTAL:
VENTILATION FAN (SINGLE RESID)
— _
IS — DATE
which emir haardous Air conhunnanta as clefted by the Bay Area Air
Quality Management Distruct7
Yes ❑1�No?r
I have reed the hazar�e,a, matadala mgairementa under Chapter 6.95 of
-
�t. eIIJ�U
BOILER -COMP OHP OR 100,000 BTU)
BOILER -COMP (OVER 100,000 BTU)
the CAllfomla Health & Safety Code, Sections 25505, 25533 and 25536. 1
understand that lithe building does not currently have a tenant, that it is my
responsibility to notify the ouvp.rt of therequlremenm which mu At be met
p
. City of CUnpoir10
NEW RESIDENTIAL MECH. - SQI-7
pAorioksuanmo(a CeAificeteofOmNncy.
I r
ISSUEDBYA. � ycc_;Qh/
Owner or authorlad agent Date
TOTAL:
OFFICE COPY