20381APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building project Identification
Building Address:
PERMIT NO.
1")
10100 Torre Ave. Unit 181 (M2.2)
O 81
G 3
ries Name: one:
wlQwn
A
Center Properties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION/PERMIT
5/10/90
contractors Name: Lic. No:
738-4444
BUILDING -ELECTRICAL
CA7ECARY
CONTROL N
_
Archlten/Engleem Lt. No:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
-
Address:
® T
PfR4MITI55UANCE 12
LICENSED CONTRACTOR'S DECLARATION
Ihth bdi.7000that lamikrn3.fthdert.AssAdPmfx%9m.0 (mmmrnc
pr
Ingwith I.
to. Affeon3o(the Butlneuand Pm(ealonoCode, sod my
Ltcm CIms_force andmfect.
License Clam Lont
Data - CHITTCr
APPLIANCFSRE9DENTIAL
JOB DESCRIPTION
RCB
-F D `, l
`N
PANELS
UP TO 2MAhM
701-1000 AMPS
ARCHITECTS DECLARATION
I understand my plant shallbe used a public rcrorde.
OVERIMOAMPS
SQ. FT. FLOOR AREA
9/SQ. FT.
SIGNSELECTRICAL
Licenced Pmfesil al
OWNER -BUILDER DECLARATION
I hereby affirmthat I am exempt from the Contractor: Limase Law for the
SPECTALCIRCUIT/MLSC
995
74.92
TEMP METER OR POLE INST.
following ... (Section 7031S, Business and Professions Code: Any city or
county which requires permit in construct alter, improve, demolish, or repair
any structure prior to its tswa nce, also requires the applicant for such permit to
ilk a signed statement that he Is licensed pumuant to the provisions of the
Contractors License Law (Chapter 9(commencing with Section 7000) of Dist-
don 3 ofthe Business and Profen ansCode) orthat bets exempttherefeemand
the basis for the alleged exemption. Any violation of Section 7MI5 by any
applicant fora permit subjectathe applicant to a civil penalty of not more flan
POWER DEVICES
SWINIMING POOL ELECTRIC
OUTLETSSWITCHESFIXTURFS
VALUATION
$74,545.00
NEW RESIDENTIAL ELECTS SQ.FI'.
fivehundrcd d:,Ws(S500).
❑ I, as owner of the property, or my employees with wages as their sole
STORIES
TYPE CONSTRUCTION'
compensation,willdothe work andthestrumne Isom Intended or offered for
sale (Sec. 7044, Business and Profession. Code: The Contractor. Limine Law
V_N
does not apply to an owner of property who Wilda or improves thereon, and
who doessuch work himself or through his own employees, provided that such
Improvements are not intended orofferid forsale. If, however, lhebullding or
TOTAL:
OCC. GROUP
R-3
RES, UNITS
I
Improvement bsoldwithlnoneyearofcompletlon, theowner-W Ilderwlll have
ttiS,tiurdenof pmving that he did out Wim or Improve for Purpose of ale.).
LJ 1, as owner m the property, am exclusively contracting with Ilmoad
ms to the project (Sec. Business and Code:
QTY. PLUMBING PERMIT FEE
FLOOD TONE
APN
PERMIT ISSUANCE
12
TheconCo
The Contndor'o License Law does not apply m an owner of property who
r. License not apply of pmper
Wilds mr Improves tpursu And who mMrsda for such pt. with a
c _, dor exempted nt to the Contractor's License law.
1—J I am exempt under Sec B k P C for this mown
ALTER -DRAIN k VENT- WATER MAE
FEE SUMMARY
'BAIX FLOW PROTECT. DEVICE
DRAINS-FLOOK ROOF, AREA, CONED.
SANITARY Y_ N_
RECEIPT tl
Owner Date -
WORKMAN COMPENSATION DECLARATION
that I have a mrm o! cam to self -insure, ora
E31 hereby affirm dfkaor
certificate of Worker: Compen.ailon insurance or a certified ropy thereat (Sec.
3400, Isis CJ
p77(TIJREq PER TRAP
SCHOOL TAX Y_ N_
R1LEI7 x
GAS EA.SYSTEM-1 INCI OUTLETS
PARK FEE N
RECEIVE 9
Gollry tl
ChEaln
GAS EA. SYSCEM-OVER 4 MAI
BUILDING DI VISION FEES
Ll IBed copy b herebyfurnished,the cid.
mrtl(iad ropy Is filed with the city Inspection division.
GREASEANDUSTRL WASTE INTERCEPTOR
PLANCHECKFEE
GRFASETRAP
CERTIFICATE OF E%EMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
(This amnion need nm be completed I the permit b for om hundred dollars
SEWER -SANITARY -STORM PA. 200717.
Date Remi t#
WATER BEATER W/VENT/FT cr.I.R
ENERGY FEE Y N
PAID
(SIM)or lees.)
Icertifythat In the performance of thework lorwMch this permit is issued,
I shall net employ soy person In any manner An An to become subject to the
Worker: Compensation Law. of Callfor. a. Date
WATER SYSTEM/iRGTING
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you
should brrome subject to the Workea' Compensation provisions of the Labor
Date Rece'i t#
NEW RESIDENTIAL PLMB. SOFT.
TOTAL:
BUILDING ME
Code, you moat forthwith comply with such provisions or this perms shall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
5.25
Thereby affirm that there bammtmnlon lending agency for the peAornr
once of the work for which this permit ts betted (Sec. 3097, Cls. C.)
fender'. Name
Lender's Address
Immeity(hatl have readthbapplicztionand starethattheabovelnformation
b correct. I ageretocomplywith all cityand muntyordlnanmand state laws
TOTAL:
ELECTRIC FEE
.88
. 88
PLUMBING FEE
�a
QTY. MECHANICAL PERMIT FEE
PERMITISSUANCE
MECHANICAL FEE
E52.00
-�
FEES PAID:
relating to building remove lmx , end hereby property or inspection purposes.
citfWA).erupontheabovcmentlmed harmiss the City
(We) abuts to cove, Indemnify and keep harmless the City of Cupertino
against Ibb011ba judgments, mete and expenses which may In anyway .come
'
ALTER ORADD TO MI'f_H.
Date RCCCIPt#
AIRHANDI ING UNU CrOI0,000CFM)
SUBTOTAL:
ag.bsbaldtyinco once t granting of this permit.
AIR HANDLING UNIT (OVER IO,000CFM)
CONSTRUCTION TAX
Signature ofsAppIIcmt/Contractor ate
EXHAUST HOOD(W/DUCT) -
CONSTRUCTION TAX PAID:
HAZARDOUS MATS. ALS DISCLOSURE
Will the applicant or future Wilding occupant store or handle hazardous
material as defined by the Cupertl no Municipal Code, Chapter 9.1 7, and the
Iiealth and Safety Code+ --Section 75537(a)7
❑ Ya M No
HEATING UNIT (TO t M,000 BTU)
Date Recei t#
-
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
VENTILATION FAN(SINGLE RESIDE
15$"DATE
WBltheapplicant or future Wilding occupant use equipment ordevices
which emit hazardous air contaminants as derined by the Bay Area Air
alley Mmgernmt Dbirletl
BOILER -COMP ORP OR 100,000 BED)
Yes❑No
have read the hat Els materials requirements under Chapter 6.95 of
the Califemla Health k Safety Code, Sections 75505,75533 and 2':534. I
understand that lithe building does not currently have a tenant, that it is my
- -1 'l l�a�
I ''• l
-
BOILER -COMP (OVER 100.000 BTU)
NEW RESIDENTIAL MECH. SQ.FT.
raponsibilitytonotify the occupant of the requirements which must be met
prior to usuance of a Certificate of Otte parry.
/�
,Cnity of IrIinpr.i
ino
ISSUEDBYAy IAV Lz-
Owner or authorized agent Date
TOTAL:
j��0
OFFICE COPY