20402APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification
Building Address:
PERMIT NO.
20402
10100 Torre Ave. Unit 202 (A1.2)
�tyro '�y�}- }y� ena
re r ties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
5/10/90
ContracimsName: Lic.No:
378-4444
BULDINC-ELECTRICAL-PLUMBING-MMC MCAL
CATEGORY
CONTROL#
Architect/Engineer. Llc. No:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Address
RD
® ® KI
PFRMITISSUANCE 12
LICENSED CONTRACTOR'S DECLARATION
I hthSyM .7000at Divisi 3o(tsed nder eBusi mond otChapterg miansCodc amen
ielon3oftheBuelnessand ProfeulanaCode,and my
Incense Is in fon force and
license le in full force and dfect.
APPLIANCFSRESIDEMIAL
JOB DESCRRDD''{{''[[ON
D Vag -
S T lj g
PANELS
License Class Ls.M
Data G r
UP TO 200AMPS
201 1000 AMPS
HEEEC
ARCNITECTSDECWRATION
I understand my platy slurs be used u public records.
OVERIOMAMPS
SQ. PT. FLOOR AREA
$/SQ.FT.
SIGNS ELECTRICAL
Licensed Professional
OWNER -BUILDER DECLARATIONSI'FOIALCRCNT/MISC
I hereby af0rmthat I am exempt from theComLicense Law fm the
11115
74.92
TEMP MEEK OR POLE INST.
following reason.(Section 7031 S, Bualnma and Professions Code: My city or
county, which requires. permit to cowtwct, alter, Improve, demolsh, or repair
any structure prior to its neuance, also requires the a ppBeant for such permit to
Ole a signed statement that he s licensed pursuant to the provisions of the
POWERDEVICES
SWIMMING POOL ELECTRIC
OUTLETSSWffCH6SFIXTURFS
Contractor's License Law (Chapter 9(emnandng with Section 700D) of DIA-
Mona of the Businen.rd Pratesslow Code) arthat he s exempt therefrom and
the bass for the alleged exemption. Any violation of Section 7031.5 by any
appBmnt fora permit subjects the applicant to a civil penalty of not more than
VALUATION
$83,536.00
five hundred dollars ($50).
n 1, as owner of the property, or my employees with wages as their sole
NEW RESIDENTIAL ELECTR SQ.F7.
STORIES
TYPE CONSTRICTION
compensation, will do the work and the structure is not Intended or offered for
sale (Sec. 7044, Business and Professions Code: The Contractor's License law
V—N
docs not apply to an owner of property who builds or Improves thereon and
does such work hlmselfor through his own employes, provided that such
Improvements are not Intended proffered forsale. If, however, thebulWing or
OCC.GROIRa
R-3
RFS. UNITS
TOTAL:
Improvement ssoW within ma yearofcomplenion,the owner-bulMerwill have
thiLilurden of proving that he did net bund or improve for purpose of sale.).
I, as owner of the property, am exclusively contracting with licensed
contractors to construct the ponied (Sec. 7044, Bualnen and Professions Code:
QTY, PLUMBING PERMIT FEE
FLOOD ZONE
APN
PERMIT ISSUANCE 12
The Cuntrador's License Law does not apply to an owner of property who
Wilda or Improves thereon, and who contracts fee such projects with a
contractor(.)Ilmnxd punuant to the C.Fador's Lt... Law.
I am exempt under Sec. B & P C for this reason
ALTER -DRAM & VFNF-WATER (EA)
FEE SUMMARY
BACK PLOW PROTECT. DEVICEI—1
OUTSIDE FEES
DRAINS FLOOR ROOF, AREA, COND.
SANITARY Y N
RECEIPT #
Owner Date
WORKMAN COMPENSATION DECLARATION
01 hereby affirm that I have a neraf este of consent to self -Insure, or a
ceAifiote of Worken'Compewatlan lmuranm mamalfW wpythemot(Sec.
MOO,LbC.)
Pdiry M
FIGURES PER TRAP
SCHOOL TAX Y_ N_
RFLEB7 a
GAS EA. SYSTEM-11NC4 OUTLETS
PARK PER Y N
RECEIPT #
Cam any
GAS EA. SYSTEM-0VER 4 (FA)
BUILDING DIVISION FEES
Ned copy s heed with the cityed.
Cedlfled ropy s filed with the city inspection division.
GREASE/INDUSIRLWASTEINTFRCEPTOR
PLANCHECK FEE
GREASE TRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
(This suction need not W complded lithe perirdt s furom hundred dollars
SEWER.SAMTARYSPORM EA M7
Date Recef 1p
WATER HEATER W/VENT/F1.ECTR
ENERGYFEE Y N
($100)orlea.)
I certify that N the performance of thewmk for which this permit Is Broad,
WATER SYSRM/TRGTING
I shall not employ any person In any manner deas to become subject to the
Workers'Compensation Laws of California. Date
PAID
NEW RESIDENTIAL PLMB. SQ.FT.
Applicant
NOTICE TO APPLICANT: R, after making thin Certificate of Exemption, you
should become subject to the Workeri Compensation provislaw of the Labor
Date Remi tic
TOTAL:
1 N
Cade, you must forthwith comply with such profailons or this permit shall be
deemed revoked.
CONSTRUCHON LENDINGACENCY
SEISMIC FEE
5.88
I hereby affirmthat there s s mwtrudion lending agency for the perform-
arse of the work for which this permit s sued (Bac. 3097, Civ. Q
Lender's Name
Lender's Addred'
I certifythatl have read thsapplicatlonand slatethatthe above Information
Is correct.I agree locomplywith all etyand county ordinances and state lawn
TOTAL:
ELECTRIC FEE
PLUMBING FEE
-Ag RA
QTY. MECHANICAL PERMIT FEE
MECHANICAL FEE
PERMITISSUANCE 12
FEES PAID:
,
relating to Wilding construction, and hereby authorize representatives of this
city to enter upon the above-mentioned property fee inspection purposes.
(We) agree to save, Indemnify an d kharmless the harmlethe City a( Cupertino
ag.Wt liabilities, pdgmenta, codsand e.penres which may in anyway...
ALTERORADDIOMECH.
Bate R0Ce1 tN
Date
AIR HANDLING UNIT (TO 10,000 CFM)
SUBTOTAL•
-t1
ag.inst mid Ci In cont ns of he ant gof this permit
s
AIR HANDLING UNIT (OVER 10,000CFM)
CONSTRUCTION TAX
Signature of Applicant/Contractor Data
IX7-I Al1S'T HOOD (W /DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUS MATER1bfLSDISCLOSURE
HEATING UMT(TO 100,000 BTU)
Date ReceT tp
Will thea Bort or future buildin ooca antstore or handle hazardous
PP B P
Heals .ace definedodthe Cupertino Municipal Code, Chapter 93Z andthe
Health and Safety Codrer�Sedlon 25531(.)7
❑ Ye u No
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
p
(S•0
VENTILATION PAN (SINGLE RESID)
I$^F1/$IGCyDATE
Will the appfietm or mrebullding occupantusa equipment or devices
which emit haze rdous air contaminants as defined by the Bay Arca Air
Qua llty Management District?
Yes n No
have read the haza our materials requirements under Chapter 6.95 of
A�I`91LP�
I ,a 1Y 1 y 1990
BOILER -COMP OTE' OR 100,0011) BTU)
BOILER-COMP(OVER I WOOD BTU)
the California Health & Safety Code, Sections 25505, 75533 and 75534. 1
understand that if the building does not currently have a tenant, that it is my
NEW RESIDENTIAL MECH. SQ.FT.
responsibility to ndlfy the occupant of the requirements which must be met
City Cunertinli
prior to Issuance of a Cedlfiote of Occupancy.
of
BY ��LL
Ownerorauthodud agent DateISSUED
TOTAL:
OFFICE COPY