20379APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification
B°Ildleg Address:
PERMIT NO.
10100 Torre Ave. Unit 179 (K1.2).
20379
nen ame: one:
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION I PERMIT
5/10/90
Contractor's Name: Lie. No:
71S-4
BUILDING-ELECTRICALPLUMBING-MECHANICAL
CATEGORY
CONTROL If
Architect/Englrimr. Lie. Na:
QIY ELECTRICPERMIT FEE
BUILDING PERMIT INFO
.
Address:
PER)ATISSUANCE 12
LTCENSEOCONTRACTOR'SunderDECLARATION
Ihereby
Ingwith Sef.11foresea Dlvffeel. the Buslneuand ProlesdoneCode, and my
aon7O that O).(amecen3.fth.erprteandso(Cssions9de,and
limes le force end .
APPLIANCESRESIDENf1AL
]OB pESCRI'DON
RCB
PANES
License Che Lie«
li s Licit
Contractor
UP TO 2DO ANTS
Y F D VVDate 1-2
2011000 AMPS
ARCHITECTS DECLARATION
I understand my plans shall be used ax public records.
OVER1000AMPS
SQ. FT. FLOOR AREA
$/SQ. FT.
SIGNS ELECTRICAL
Licensed Professional
,
SPECIAL CIRCUIT/MLSC
OWNER -BUILDER DECLARATION
I hereby afOrmthat l am exempt from the Contractor's License Law fee the
713
74.92
TEMP. METER OR POLE INST.
following reason.(Sect1.70115, Businessand Professions Code. Any city or
county which requires a permit rocanstsuct, alter, Improve, demolish, oreepair
anystmmmpdortokslsauame,aLwrcquircatheappgmnlforsuchpem tto
file a signed statement that he I. licensed pursuant to the provisions of the
Contractor's License Law (Chapter9(commencing with Section 7100) of Divt-
sion3ofthe Busine.sand Professia.0 de)orihet he b esempttherefromand
POWER DEVICES
SWIMMING POOL ELECTRIC
VALUATION
the basis for the alleged exemption. Any violation of Section 70315 by any
Applicant fora permit subje ts no the applicant to a civil penalty of nmore than
OUTLETSSWIICHFSFIXTURES53
a 418.00
five hundred dollars (5500).
❑ I, as owner of the property, or my employees with wages as their sole
NEW RESIDENTIAL ELECTR SQRT.
STORIES
TYPECONSTRUCTION
compensation, will do the work, and the structure Is not intended or offend for
sale ('Sec. 7064 Business and Professions Code: The Contractor's License Law
V -N
does not apply to an owner of property who Wilds or improves thereon,and
does each work himself orthrough Iris own employees, provided that such
OCC.GROUP
RES. UNITS
improvements are not intended oroffered for ease. If, however, thebuliding or
improvement Ls sold within one yearofcomplNlon, the owner-builderwill have
TOTAL:
R-3
t1jiLtlorden of proving that he did not build orlmprove for purpose ofsale.).
LI 4 as owner of the property, am exclusively Business
to construct project (Sec. ess and contracting with ns, Codd
Code:
sand Pr'
QTY. PLUMBINGPERMIT FEE
FLOOD ZONE.
APN
PERMIT ISSUANCE
� ], 2
TWconContractor's Liventhe
TM Coor in one License .., rices not apply sc an owner of property what
Am apply to an property
Wild. or Improve thereon, and who .nencts for such pV.jetts with a
c9nitacter(a) licensed pursuant to the Contractor's License Law.
LJ I am exempt under See B & P C for this reason
'
ALTER -DRAIN& VENT -WATER (RA)
FEE SUMMARY
BACK FLOW PROTECTDEVICE
.
DRAINS FLOOR ROOF, AREA, COND.
SANITARY Y_ 14
RECEPT «
Owner Date
WORKMAN COMPENSATION DECLARATION
❑I hereby affirm that I have a certffimlom
te of ..sent to self-wer, e
mdifimteo(Workero Compem timlw mncemacertifledcopyther.f(Sec.
3800. Lab C.I
policy
pIXT1RRES PER TRAP
SCHOOL TAX Y_ N_
RECEIPT «
GA INCd OUTLETS
GAS EA
PARK FEE Y N
RECEIPT «
«
Cam any
GAS EA. SYSTEM -OVER 6 (EA)
BUILDING DIVISION FEES
filed copy l9 hereby furnished.
Ccoil ed copy b filed with the City Inspection division.
CREASE/MDUSTRL WASTE INTERCEPTOR
PLANCHECKFEE
GREASETRAP
CERTIFICATE OF EXEMPTION FROM WORK ERS'
PAID
SEWER -SANITARY -STORM EA. 20t1Ff.
COMPENSATION INSURANCE
(Thlsnection need seabe.mpleted lithe permit b foroce hundred dollars
Date Recel t#
WATER HEATERW/VFNT/ELECTR
ENERGYFEE Y_ N
PAID
($100) or less0
I certRythat In the performance often work forwhlch this permit is issued,
I shall not employ any person in any manner. as to become abject to the
Workeri Campen.a(ion Lawsof Ca)Ifomb. Date
WATER SYSTEM/TREATING
ApplicaNOTICE
OTICE
NOTTCEco APPLICANT. 11, orlerrsWng this Certlfimtei-It—pilon, you
should subtest to the Workers' n provbioM of the Labor
Date Recei ton
NEW RESIDENTIAL PLMB. SQ. .
TOTAL:
BUILDING FEE
you =a such prowisi
Code, you ower forthwith comply with such provisloM or this permit shall be32.50
deemed revoked.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
I herebya(firm that there b a construction lending agency for the perform
ance of the work for which this permit is issued (Sec. 3097, Civ. C.)
Ie.der's N.
Iender'.Address
I certifythatl haveread this apphemam and statethattheabovelnformation
Is correct.I agree to comply with all city and county ordinances and nate law.
ELECTRIC FEE
29.83
29.83
PLUMBING FEE
QTY. MECHANICAL PERMIT FEE
MECHANICAL FEE
PERMIT ISSUANCE 12
FEES PAID:
relating to Wilding .estruc ion, and hereby authodae representatives of this
city to enter upon the abovcmentiondi property for Inspection purposes.
(We) agree to save, Indemnify an d keep haredeas the City of Cupertino
Against liabilities, Odgerent.,.9... cl a.peroses which may in any way accrue
ALTER OR ADDTO MECH.
Dale ReceipNl
AIR HANDLING UNIT( TO 10,000 CFM)
SUBTOTAL:
.gelmteai Ity 1�ohe crating ofthi. permit.
5�� L,Q
AIR HANDLING UNIT (OVER 10,"CFM)
CONSTRUCTION TAX
Sigeutureof Appfimm/Contractor te
EXHAUST HOOD(W/DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUS :RIALSDISCIASURE
HEATING UNIT (TO 1 LOW BTU)
Will the applicant or future building occupant store or handle haeardous
material a. defined by the Cupertino Municipal Code, Chapter 9.1 7, and the
I Iealth and Safety Code Seetian 25532(a)7
❑ Yes No
Wlllthe applicant Prune hulidingoccupant use equipment ordevices
Date ReceI til
-
HEATING UNIT (OVER 100,OW BTU)
TOTAL:
VENTILATION FAN (SINGLE RESID)
ISSUt;NCF�ATE
which cont haeardou.at, .ntandeantsas defined by the Bay Area Air
Quality Management District?
I Ym No
Q
I exteeyes read the haza sue rtulerlab requirements andel Chapter G95 of
&-;iii A
1 a) IrJV
BOIFR-COMP OH POR 100,000 BTU
BOILGR-COMP(OVER 100,000 BTU)
the California Health & SafetyCode, Sectiors 75505, 25533 and 25536.1
understand that if the building does not currently have A(coast, that itis my
responsibility to notify the occupant of the requirements which moat be met
CRY of 811ar1i"A
NEW RESIDENTIAL MECH. SQ.FT
prior to Issuance of a Certificate of Occupancy.
ISSUED B
Owner m authorised agent Date
TOTAL:
OFFICE COPY