20404APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification
Building Addreu:
pERMITNO.
10100 Torre Ave. Unit 204 (F1.2)
20404
mer. a \fes V'� ane.
`
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION I PERMIT
AppucATR57917111arrrArM PE
5/10/90
comoscuses Name: Lie. No:
739-4446
BUILDINGELDCTRICALPLUMBING-MECHANICAL
CATEGORY
CONTROL If
Architect/Engineer. Lic, Na
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
PLUMB MELH
mares
BLDG hL�i
O � � � ,
PERMIT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION
I a
I MhSyon7Oaffiren that Divisl 3oftheBuAnsed under andPrsions leadonsCodeanen
Ingweh 1. Fullforce andivfect. oflhe Busineuand Pro(eWoneCode,and my
license (sla. (arm and effect.
APPWANCESRESIDENML
JOB DESCRR'l10N
PANELS
Li Dat Clan Lich
Date Comnctor
UP To 2DO AMPS
'1'''RCB
s T DW
201-1000AMPS
ARCHITECT'S DECLARATION
I understand my plam.hall be used as public records
OVER 1030 AMPS
SQ. FT. FLOOR AREA
$/SQ.FT.
SIGNS ELECTRICAL
Licensed Pmleadonal
SPECGLCIRCUIT/MLSC
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contradorb License law for the
9HS
,
74.92
TEMP. METER OR POLE INST.
following ... (SecHon 70115, Bush. and Professions Code: Any city or
county which requires permit to construct, alter, Improve, demolish, or repair
anystrodure prior to Its Wua ace, also requires the applicant for such permit to
file a signed statement that he is licensed pursuant to the provisions of the
Contractors License Law (Chapter 9(commencing with Section 7000) of Divi-
Mon 3 of the Business and ProfeasiomCode) or that heb exempt therefromand
POWER DEVICES
-
SWIMMINGFOOLELECIRIC
VALUATION
the basis for the alleged exemption. Any violation of Stolon 70115 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
OUTLETS -SWITCHES FIXTURES
] 3 , 7 96.00
five hundred dollars ($500),
❑ I, as owner of the property, or my employees with wages as their sole
NEWRESIDENTIALELECTR SQ.IT.
STOWCS
TYPE CONSTRUCTION
compensation, will do the work and the structure he not intended or offered for
fit le (Sec. 7064, Business and Pre fe cions Cade: The Contractors License LVW
V4
does not apply to an owner of property who Wilde or Improves therms, and
whodoessuchwork hlmselforthrough hisown employees, provided that such
OCC. GROUP
RES, UNITS
impmvernous are not intended arreffered tarsals. If, however, thebuilding or
Improvement hadd within omyearofcompletlon,theowner-bu0derwlll have
TOTAL:
R-3
1
l
fip.4unden of proving that M did not Wild or 4nprove for purpose of sale.),
Lj L as owner of the property, am exclusively contracting with licensed--7-pFRMIT
rontrtctom to construct [M period (Sec. 70K Business and Professions Cade:
QTY, PLUMBING PERMIT FEE
FLOOD ZONE
APN
ISSUANCE
12
Ile Cmdradme. License Law does not apply to an owner of property who
Wilde or Improves thereon, and who contracts for such pVpocta with a
licensed pursuant to the Contractors License Law.
I am exempt under Sec. B k P C for thin reason
Ty,
ALTER -DRAIN -WATER (EAI
FEE SUMM ARY
YJ
BACK FLOW PROTECT. DEVICE
_.
OUTSIDE
DRAINS FLOOR, ROOF, AREA, GOND.
SANITARY RECEIPT
Owner Data
WORKMAN COMPENSATION DECLARATION
E31 hereby affirm that I have a certificate of consent to actlAnure, or a
certificate of Worlues'Compemuation Insurance oramrti(hd mpythemcf(Sce.
3800, lab C.)
Policy N
FIXTURES. PER TR AP SCHOOL
TAX Y_ N_
RECED'T N
GAS EA. SYSTEM -1 INCA OUTLETS
PARKIEE Y N
RECEIPTN
Co.AS-EA.
om
SYSTEM -OVER 4 (EA)
BUILDING DIVES ION FEES
Iny fledcopyhherebyfumished.
edified copy h filed with the city Inspection division.
GREASE/WDUSTRL WASTE WTQtCFPTOR
PLANCHECKFEE
GREASE TRAP
CERTIFICATE OF FROM WORKERS'
PAID
SEWER -SANITARY -STORM EA. 200FT.
COMPENSATION INSURANCE
(Thlssedlon need mol be completed tithe permit h forom hundred dollars
(4100)orlassJ
I artily that lathe pedomana o(the work (arwNch thio permit is hued,
Date Remi t#
WATER HFATERW/VENT/ELECTR
ENERGYFEE Y_ N_
SYSTEM/.TREATING
I shall not employ any person in any manner so as to become sub)ect to theWATER
WmMra'Comperadl.. awsof Callfned.. Data
PAID
Applicant
NOTICE TO APPLICANT: D, after mmeWng this CertDicate of Exemption, you
should become sub)ect to the Worsen' Compensation provbirim of the Labor
NEW RESIDENTIAL PLMB. �.FT.
Date Recei t#
TOTAL:
INFEE
'z 50
Code, you must forthwith comply with such provhlons or this permit shall be
doemed revoked.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
5,18
I herebyalflrm Nat there is a construction lending agency for the perform
anco of the work for which this permit is Issued (Sec. 3097, Civ. C.)
Lender's Nam6.-,..61
].seders Addrens
TOTAL,
ELECTRIC FEE -
36.63
PLUMBING FEE
QTY. MECHANICAL PERMIT FEE
MECHANICAL FEE
I certify that l have read this application a ad state that the above Information
Is mored. I agree to comply with all city and county oninancee and state laws
PERMIT ISSUANCE 12
FEES PAID:
relating tobullding construction, and hereby authorize reproardelves of this
city to enter upon the above-mentioned property for Wpedion purposes,
(We) agree to save, Indemnify an d keep harmless the City of Capedlno
agal"tliabilities, )udgerents, cods a rd expenses which may In any way accrue
ALTER OR ADD TO MECH.
Date ReCe)JJ[#
AIR HANDLING UNIT no veo00 CFM)
SUBTOTAL: -
agaodsaidCiU�ieM ce th n ng of this Pertntt.
�— `// D
J
AIR HANDLING] UNIT (OVER IO,"CrM)
CONSTRUCTION TAX
Signature of Applicant/Contractor t -fie —
EXHAUST HOOD(W/DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUS MATQ SDI SCLOSURE
Will the a pplleant or future building occupant store or handle Mzardous
HEATING UNIT (TO 100,000 BTU)
Date Recei t#
material as defined by the Cupertino Municipal Code, Chapter 9.13, and the
Health and Safety Code Section 25532(a)7
YeaNo
Will the applicant or Lure buildingcempant use equipment ordevim
which emit hazardous air contaminantsas defined by the Bay Area Air
Quality Management District?
hYves read the hazar❑ uNsom bminhunder 6.9 5 of
the eh Health Safety Code,Sections 25505,and 25534. 1
understand that lithe building does nocurrently have .tenant,that It is my
-
HEATING UNIT (OVER 100,000 BTU
TOTAL:
��7v
VENILATEON FAN (SINGLE RESID)
ISS�4NCEDATE
tl
1990
'
BOILER -COMP DFD' OR 100,000 BTU)
ILER-COAP (OVER 100,000 BTU)
NEW RESIDENTIAL MECH. SQ.IT.
responsibility to mollfy the occupant of the requirements which must be mart
prior to Issuance of a Certificate of Occupanry.
/� /a
NIty of 1ru'1BPrtlnn
ISSUEDB x 4'k KV��
Owner or authorized agent Dae
TOTAL:
OFFICE COPY