20377APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification
Build Ing Address:
PERMIT NO.
n O
377
10100 Torre Ave. Unit 177 (L1.2).
G
Owners ante: one:
TolMm Cent Prnpprtips
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION I PERMIT
APPLICATION SUHMI1 IM, U=
5/10/90
C.mrador's Name: Lie. No:
7119-4444
BUfLDINGELFCTRICAI PLUMBINGMECHAMCAL
CATEGORY
CONTROL If
A rchite t/Fagir�eer. Lie No:
QTY ELECTRICPERMIT FEE
BUILDING PERMIT INFO
Address:
PERMIT ISSUANCE 12
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I thficem7000).ffX d..3licensedunser uateslaions of nd Profewdoer9de,and c-
ofd affect. olthe Budneuand ProfneloneC-ods, and my
ingwitime.h in
urease Is li NB fere. and k. N
LicenseClan LICX
Date Contractor
API'LIANCESRE9DENTIAL
JOB DCSCRR'IION
RCB
c f 1
PANES
201-1000 AMPS
ARCHITECTS DECLARATION
I understand my plans shall W used as public records
OVER 10110 AMPS
SQ. FT. FLOOR AREA
$/SQ. FT.
SIGNS ELECTRICAL
Licensed Professional
SPECIAL CIRCUIT/MISC
OWNER -BUILDER DECLARATION
I hereby afRreenthal I am exempt from the Contractor's License Law for the
following reason(SecMon 70315, Busueas and Prefenbne Code: Any city or�fp
county which acquires, a permit tocontneL alter, Improve, dennlbh,orrepair
1,040
74.92
MElIIt OR POLE INST.
any structure prior to its beuarnee, also requires the applicant for such permit to
file a signed statement that he d licensed pursuant to the provisions of the
Contractor's License Law (Chapter 9(ccmmencing with Section 7000) of Divi.
don3 of the Budmnand PodenbruCode) orthat he to erempttherefromand
the heed for the alleged exemption. Any violation of Section 7031.5 by any
applicant fare permit subjc v the applkant to a dull pevltyof seat more then
POWER DEVICES ,
SWIM NG POOL ELECTRIC
OU LETSSWITCHFSFIXTURES
VALUATION
7 7 917 . OQ
s
NEW RESIDENTIAL ELECTR SQJiT.
dollanheSWI.
five 1, as owner the property, or my employees with wages there dole
STORIES
TYPECONSIRUCTION
compensation, will r
.1. CIe70M B..i. the work and the iours, acture d not Intended or offered for
ale (Sec. 7034, Budinna and I'rMenlon Code: The Contrsctoh Llcene Law
�]—pj
does not apply to an owner of property who builds or Improvn thereon and
who does such work himself orthrough Msownemployms, provided thalsuch
OCC.CROUP
RFS UNITS
Improvements are not Intended reoffered for sale. If, however, thebuilding or
TOTAL:
R-3
'
Improvement dsold within onyearofcompltlon, the owner-buBderwill have
d)-tiurcien of proving that he did not build or Improve for purpose ofsed.).
LJ contracting with licensed
Las owner tr the property, am exclusively Business
to construct thew (Sem Budnen and Code:
QTY. PLUMBING PERMIT FEE
FLOOD ZONE
APN
PERMIT ISSUANCE 12
TheconCo tr
That C.ntrsctar's License Lw does not appty ct; f rune, of property who
doe apply of property
bullda t Impmvse thereon, and who matt.. !a each plojets with a
ory1([ator(eexem licensed
under ant tithe Caatranor's License Lew.
1—j I am exempt under gee B & p C for the reason
ALTER -DRAIN VENT- WATER(EM
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
OUTSI DE FEE S
DRAINS FLOOR ROOF, AREA, COND.
SANITARY Y_ N_
RECEIPT 9
Owner Date
WOR KMAN COM P DVSATION DECLARATION
❑I hereby afflrm that I have • arti0cate of consent to self -Inure, or a
carfifieve CJ o(Workers'Compemtlonlnunnce oracertl(kd copy thereof (Sec.
3800 Lab
Poliry '
FIX'NRF_S PER TRAP
SCHOOL TAX Y_ N_
RECEIVE N
GAS EA. SYSTEM-] INCAOULETS
PARK FEE Y N —
RFGEII'1' N
N
Com an
GAS. F.A.SYSTEM-OVER 4 (EA)
BUILDING DIVISION FEES
IBed copy d hereby famished.
W itt dd copy d filed with the city Inpe tlon division.
CREASE/INDUSTRL WASTE INTERCEPTOR
PLANCHECK FEE
GREASE TRAP
CERTIFICATE OF IX EMPTION FROM WOR KERS'
PAID
EA 2WFT
COMPENSATION INSURANCESEWER-SANITARY-STORM
(fhlesce ion need not becompleted if the permit la forone hundred dollar
Date RCCCI I#
WATER HEATER W/VENT/ELFGTR
ENERGY FEE Y N
($100)orlend
I cer ifythat in the performance of the week forwhich this permit ie dud,
WATER SY5TFM/,TREATING,
I shall not employ any peruse In any manner u as to become subject to the
WorkersCarol, cnsathm Lawsof Callfomla. Date
PAID
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you
should become subject to the Worker,' Compemation provision of the Labor
NEWRESIDENTIALPLMB. SQ.FT.
Date Revel t#
TOTAL:
BU NG
e, you must forthwith comply with such provisions .,this pemat shall be
CodFEE
deemed revoked.
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
Iberebyaflimrthatthered a controdden dndmgagenry, for the pedrrrry
arca of the .,it for which this permit is dud (Sec. 3097, Civ. C.)
Lender'. Name
Lender's Address
I mrtifythat I havereacithd applicationand anothat theabove Information
urorret. I agree to comply with all city and county ordinances and date laws
TOTAL
ELECTRICFBE
38.00
PLUMBING FEE
QTY. MECHANICAL PERMIT FEE
MECHANICAL FEE
PERMIT ISSUANCE 19
FEES PAID:
38
relating to building conbution, and hereby authorize representatives of this
city to enter upon the abovcmentbnd property for inspection purposes.
(We) agree to save, IndemN/y an d keep barreled, the City of Cupertino
against liabllitks,)udgmend, cmusand expenses which may In anyway accrue
ALTER OR ADD 717 MECH.
Date Revel t#
AIR HANDLING UNIT (TO 10,000 CFM)
SUBTOTAL:
against dv In myacucncepIt gryirgol the pel���D
J
AIR HANDLING UNIT (OVER IO,000CFM)
CONSTRUCTION TAX
EXHAUSTHOOD(W/DUCT)
CONSTRUCTION TAX PAID:
Signtureof Applicant/Contractor y Ede
HAZARDOUSMATITRIALSDISCLOSURE
Will the applicant or future building occupant store or handle haeadous
material as defined by the Cupertino Municipal Code, Chapter 9.12, and the
Health and Safety Code Section 25532(a)7
MYesM No
HEATING UNIT (TO IBO," BTU)
Date Recoi t#
HEATING UNIT 100,000 BTU)
TOTAL:
41�19- 26
VENTILATION FAN (SINGLE RESID)
ISS(-YNCE.'Fj DA'Z'E
Will the applicant or future building occupant use equipment or devices
which emit haaadom At contaminants as defined by the Bay Area Air
Qua lity Me,agement District?
4Yee❑�1 No
have read the hazarr7.us materials requirements under Chapter 6.95 of
I"ill
�a
I if, •�r 1 a IJyo
BOILER -COMP OFR' OR 100,000 BTU)
BOILER -COMP (OVER 100,DDO BTU)
the California Health&Safety Code, Section 25505,25533 and 25534. 1
understand that lfthebulldlog does not currently have a tenant, that it is my
NEW RESIDENTIAL MECH, SQTf
responsibility to edify the occupant of the requiremeate which must be met
/s .y
(]f
prior to Issuance or a Certificate of Occupancy..
4I{tr
si b�UBO'a100
IIP ce-
Owner or authorized agent Data
70TAL:
OFFICE COPY