20403APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification
Building Address:
PERMITNO.
20403
10100 Torre Ave. Unit 203 F1.4
Owners sore: v,p one:
ro er`ties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
5/10/90
Co"'nm
"aName1 Lie. No:
738-4444
BUILDING-ELECTRICALPLUMSINGMECHAMCAL
CATEGORY
CONTROL
Architect/Engineer. Lk. No:
QTY ELECTRICPERMIT FEE
BUILDING PERMIT INFO
AddreuELELI
PERMITISSUANCE _2
LICENSED CONTRACTOR'S DECLARATION
AIfffANCESRESIDEMTAl
Ihthat I am licenseunder prova(Chapler9(commen
InthSedion7ODlNftheBusundPro(edoneCodeandmy
license Ie In fell force and effect.
License Clan LILY
Date Contractor
]OB DESCIUPTION
RCB
PANELS
UPT02DOAV
201-1030 AMPS
ARCHITECTS DECLARATION
I understand my plans shall be used a public records.
OVER1000AMPS
SQ. IT. FLOOR AREA
$/SQ. FT.
SIGNSELECTRICAL
Licensed Professional
OWNER -BUILDER DECLARATION
1 herebya(Ormtlall ern exempt from the Contractor's Lkxnse law for the
-
985
74.92
SPECIALCRCUIT/M15C
7FMp.MEfFR DAPDLE INST.
follewing reaaon.(SecHon 70315, Buihms.rd Profeakma Code: Any city or
countywhichrequires.apermittommt d,alter,Improve,demnlbh,orrepar
anystructun prierto its issuance, also requivnlheappllcant forsuch permit to
file a signed statement that he e, licensed pursuant to the provisions of the
Contnctorb License Law(Chapter 9(commencing with Section 7000) of Divi-
slon3o(the Buslnesamd Profmloru Code)orthathee,emmptthemfromand
the basis for the alleged exemption. Any violation of Section 70211.5 by any
applicant fora permit subjects the applicantto a civil penalty of not more than
POWER DEVICES
'
SWIMMING POOL ELECTRIC
OUTLETS-SWI7C-IFSFIXTURES
VALUATION
$73,796.00
five hundred dollars (5500).
F1 I, as owner of the property, or my employees with wages as their ..In
NEW RESIDENTIAL ELECTR SQ.IT.
STORIES
TYPE CONSTRUCTION
compensation, will do the work and the strocturc is net intended or offered for
sale (Sc. 7064, Business and Professions Code: The Contractorse s Licence Law
V-1�
does not a pply to an owner of property who Wilds or improves t hereon, and
who does such work himself or through his own employees, provided that such
Improvements are not Intended mattered forsale. If, however, thebuildingor
TOTAL:
OCC.CROUP
R-3
RES. ENDS
/
Improverrentissoid within oneyearofcompletioNthe owner-bulklerwRl have
l
tlitturden of proving that he did not build or improve for purpose of sale.).
Lj L as owner of the property, am exclusively contracting with licensed
contractors to mretrun the project (See. 7064, Bush . and Profeninns Code:
QTY, PLUMBING PERMIT FEE
FLOOD ZONE
APN
PQ(MI.I.ISSffANCE 12
Ile Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts (or such p(ojecia with a
cgpjpetoK.) Bmnwd punuanttothe Contnd&&Linnx Law.
LJ I am exempt under Sec. B k P C for this ressen
pLIFR-DRAIN & VEM-WATER (EA)
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
DRAINS FLOOR ROOF, AREA, COND.
SANITARY Y N
RECEIPT tl
Owner Date
WORKMAN COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self-Inre
Qsu, or
aditlateofWorkers'ComperuetlonlmuranumamAifWmpythemo(free.
lab CJ
policy Y
FD(T(JRES PER TRAP
SCHOOL TAX Y_ N_
RECENT Y
GAS F.A.YS'fEM-i INCA OUTLETS
PARK FEE Y N
RECEIT T M
Co
Co�any
GAS EA. SYSTEM -OVER 6 (EA)
BUILDING DIVISION FEES
Itled copy is hereby filed the city
LffCeriffird copy e, tiled with the city ins)xation division.
GREASE/INDUSTRL WASTE INTERCEPTOR
PLANCHECK FEE
,
CREASETRAP
CERTIFICATE OF EXEM PTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
(This section need not be completed B the permit e, forons hundred dollars
Date RCtt'1 1#
SEWER-SANITARY-BTORM EA. XIOFT.
WATER HEATER W/VENT/m crTR
ENERGY FEE Y' N
(5100)orlesaJ
I certify that In the pedomianceofthe work for which this permit is Issued,
WATER SYSTEM/TREATINGWorkers'Compemation
I shall not employ any person In any chanter m as to become subject to the
laws. of California. Date
PAID
Applicant
N017CE TO APPLICANT: If, after making this Certificate of Exemption, you
should become subject to the Workers' Compensation provisions of the Labor
NEW RESIDENTIAL PLMB. SQ.FT.
Date Recei t#
TOTAL:
U NG
Code, you =at forthwith comply with such provisbres orthe, permit hall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
5.18
1 herebyaffirm thethere is a reametot lendingagenry Imthe perform-
ance of the work for which this permit e, leseed (Sec. 3097, Civ. C.)
Lender's Name
Lenders Address
I ceditythstl have resdthe, application and statethattheabove infomatioo
Escorted. l agree to comply with all city and county ordinances and date lawn
TOTAL:
ELECTRIC FEE
36.63
PLUMBING FEE
16
QTY, MECHANICAL PERMIT FEE
MECHANICAL FEE
PERMUISSUANCE 19
FEES PAID:
relating to building mratrudich, and hereby authorize representatives of the,
city to enter Pon the above-mentioned property for inspection purposes.
(We) agree to save, Indemnify an d keep harmless the City of Cupertino
against liabilities, judgmembs, meta and expenenwhlch may In anywayacwe
ALTERORADDTOME-CH.
Date Receipt#
AIR HANDLING UNIT (TO 10,000 CFM)
SUBTOTAL:
against said nm f Ee ant or this permiitt
s%
AIR HA LADLING UNIT (OVER 10,000 CrivO
CONSTRUCTION TAX
-'-m '
Signature or Applicant/Contractor / t. to
IXFTAUSTHOOD(W/DIKT)
CONSTRUCTION TAX PAID:
HAZARDOUS MATERMSDISCLOSURE
HEATING UNIT (TO 100,W0 BTU)
Date Reeei t#
Will theappliesen car future building occupant store or handle hazardous
material.. defined by the Cupertino Municipal Code, Chapter 9.11, and the
Ffealt Yana Safety Code, Section 75531(.)7
HEATING UNIT (OVER 100,OW BTU)
TOTAL:
VEN'nLATION PAN C51NGLE RESID)
ISSUANCE DATE
Rh
Ill the applicant or future building occupant use equipment our devices
which emit hazardous air contaminants as defined by the Bay Area Air
Quality Management District?
Yes No
�If.d`9L
BOILER -CAMP pin' OR 100,000 BTU)
BORER -03\11' 100,000 BTU)
have read the hazar ous materials requirements under Chapter6.95 of
the California Health &Sa(ety Code, Sen ions 25505, 75533 and 25536. 1
undenla nd that if the building does not currently have a tenant, that it is my
?
I l4, 1 5 1990
NEW RESIDENTIAL MECH. SQ.FT.
responsibility to notify the occupant of the requirements which most be runt
prior to issuance o(a CeriOate o(Occupanry.
t
/tl{rt of /aBBPFIInf)
la`h�
ISSUED -]'DO1AJ C4_1
� /
Owner or authorized agent Data
TOTAL:
'�-mal
OFFICE COPY