203820
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification
Rudd log Add res.:
PERMIT NO.
10100 Torre Ave. Unit 182 (E1)
.20382
nerd acre. one:
AL DAIE
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
5/10/90
Contractor's Name: Lk. No:
7,18-4444
BUfLDINGGELF TRICAILPLUMBINC-MFGHAMCAL
CATEGORY
CONTROL(.
Architect/Engineer. Lk. No:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Add..
111 X1LICENSED
PERMITISSUANCE
CONTRACTOR'S DECLARATION
I hereby affirm that ection700Tol provisions apter9(rommrnc
InenseISection force s Divfect. theBuslneeaandProtesalonnCodaand my
license In WLLforte and effect.
APPUANCESRESIDENTTAL
JOB DFSCRII'TI N
i•' }—I'lC
J T L1RC
PANELS
Chss
Date ContractorUP
Date Cont
TO 200AMM
201-1000 AMPS
ARCHITECTS DECLARATION
lunderstand myplansehallbeused aspublicremrdL
OVERIODOAMPS
SQ. Fr. FLOOR AREA
$/SQ.FT.
SIGNSELECTRICAL
Licensed Professional
SPECLILCIRCU[T/MLSC
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License law fm the
]91
74.92
TEMP. MER$ CREOLE INST.
following reason.(EMlon 7031.5, Business and Profeastons Code: Any city or
countywhlch rcqufresa permit to construct, alter, improve, demolish,or repair
anystmcture priortoltsissuance,also requires theapplfcant fmmch Permit to
file a signed statement that he Is licensed pursuant to the provisions of the
POWER DEVICES
SWIMMEING POOL ELECTRIC
-
Contractor's License Law (Chapter 9(commencing with Section 7000).f Divi-
sion 3 of the Business and Prefesslmu Cod0cothat he b exemp"herefromand
VALUATION
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant fora perms subjeRathe applicant to a civil penalty of net more than
OUILETSSWITCHESHXTURFS
$59 262.00
s
NEWRESIDENIIALELECTR SQFTTRICTION
—SQ.Fr.
five hundred delta. (SM.
❑ I, as owner of the property, or my employees with wages as their sale
STORIES
TYPE CONSTRUCTION
compensation, will do the work and them. m . b am Intended or off oad for
sale (Sec. 7004, Bualneaa and Prafessiow Code: The Contractors License law
does net apply to an owner of property who Wilds or Improves thereon,and
who doessuch work himself or through hisown employees, provided that such
OCC.GROUP
RFS UNITS
Improvements arc not Intended or offered for sale. If, however, thebuilding or
TOTAL:
R-3
improvement bsold within omyearofcompledomtheowner-budderwill have
tli,tiurden of proving that he did not build or improve for purpose of sale.).
LJ I, as owner of the property, am exclusively mnUacting with licensed
contractors to construct the project (Sec 7674, Business and Profeats loCode:
QTY, PLUMBING PERMIT FEE
FLOOD TONE
APN
PERMITISSUANCE 1'z
The Contractors License Law does not apply to an owner of property who
Wilde or Improves thereon, and who contracts for such p1o)etts with a
�gN(actor(s) licensed pursuant to the Contractor's License Law.
L� I am exempt under Sec. B & P C for this mason
ALTER -DRAIN & VENT - WATER (FA)
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
DRAINS FLOOR ROOF, ARRA, COND.
SANITARY Y N_r
RECEIVE 0
Owner Date
WORKMAN COMPENSATION DECLARATION
rtite of consent to salt -Insure, ora
E31 hereby affirm that I have a relica
rerti(Icate of Works.'Comperuadon Insurer. or a certified ropy the.((See.
3500,lab C.)
FIXTURES. PER TRAP
SCHOOL TAX Y_ N
RECER'T Y
GAS EA.SY51'EM-1 INC.40UTLETS
PARK FEE Y N
RECEB'TI
-
Company
omy
LI goeflfind copy is herebyfurnished.the the city
artNed copy V Ned with Inspetbn division.
GASYSTEM-OVER 4 (FA)
S F.A.omp
BUILDING DIVISION FEES
WASTE INTERCEPTOR
CRFASG/INDUSTRL ERC
PLANCi-IECK PEE
GREASE TRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
Qhfssectlon need not be, completed It the permit is forces, hundred dollars
Date Receii2t#
SEWEJESANTARY-STORM E.A.20OFf.
WATER I{FATFR w/vENT/ELECTR
ENERGYFEE Y N
(a100)or ma..)
I certdythat In the performance of the work forwhfch tide permft is Issued,
WATER SYSTEM/TREATING
I shall not employ any person in any manner n as to became subject to the
ers'
WorkCompensation Lawsof California. Date
PAID
NEW RESIDENTIAL PLMB. SOFf.
Applicant
NOTICE TO APPLICANT: If, after nwking this Certificate of Exemption, you
should become subject to the Workes' Compensation provisions of the Labor
Dale Reuel t#
TOTAL:
B NG
459.50
Code, you most fort hwith comply with such provislons or this perndt shall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
4.20
I hereby affirrothat there Is, a construction lending agency for the performTOTAL
ance of the work for which this permit is issued (Sec. 3097, Civ. C.)
Lenders Name
Lenders Address
I certifythatl have readthisappLLcetfon and statethattheaboveinformatlon
Lacormt.] a8reet0c0mply with all city and county ordinances and nate laws
ELECTRIC FEE
31•78
PLUMBING FEE
QTY. MECHANICAL PERMIT FEE
MECHANICAL FEE
PERMITISSUANCE 19
FEES PAID:
relating to building constsuctlon, and hereby authotlze representatives a( this
city to enter upon the above-mentioned property for Inspection purposes.
(We) agree to save, indemnify an d keep harmless the City of Cupert Inca
against llabfllties,Pdgments, casts and expenses which my In any way accrue
ALTERORADDIOMECH.
Date Reeeipt#
AIR HANDLING UNIT UO 10,000 CFM)
SUBTOTAL:
against said C'ty in con ence o444he rant ag of this pevnh.
�� �—
AIR HANDLING uNII'rovm to,000crd)
CONSTRUCTION TAX
Signature Of Applicam/Contractor to
EXHAUST HOOD(W/DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUSMATERIMI.SDISCLOSURE
HEATINGUMT(TO100,00011TU)
Date Recel t#
Will the applicant or foam, Wddingaccupantstoreorhandle ha,tardous
material as dented by the Cupertino Municipal Code, Chapter 9.1$ and the
I lea lth arad Safety Code Scum 25532(.)7
❑ YesNo
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
VENTILATION FAN (SINGLE RESID)
IS$IIAN.DATE
WIIl the applies rat or cars buildingomapantux equipment or devires
which emit haaardous air contaminants as defined by the Bay Area Air
Qua llty, Management District?
4Yes ❑❑No
have read the hazirclaas materials requlremenh ands Ghaple 5.95 of
;
r1(J
11AY-15 i9
BOILER -COMP DIE' OR 100,000 BTU)
BORER-COMP(OVER 100,000 BTU)
the California Health & Safety Code, Sections 25505, 25533 and 25534. 1
understand that if the lou llding does net currently have a tenant, that it is my
NEW RESIDENTIAL MECI{. SQ.FT.
responsibility to not ify the occupant of the requirements which must be mm
/� /E ,y
�liy of
prior to issuance of a Certificate of Occupancy.
' 1,rBBP,r,lfllj
ISSUED
Owner or authorised agent Data
TOTAL:
OFFICE COPY