20405APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification
Building Address:
PERMIT NO.
10100 Torre Ave. Unit 205 (11.1)
204:05
caner.awy�;a 4•�y �.e one.
jJ 1 `
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION I PERMIT
A
5/10/90'
Contractors Name: Lic. No:
_
BUILDINGELECTRICALPLUMBING-MECHAMCAL
CATEGORY
CONTROL N
Architect/Enginrer. Lk. No:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Add.
7
PE6MITISSUANCE 12
LICENSED CONTRACTOR'S DECLARATION
I hereby af(bm that l am licensed under provisionsof Chapter9(commenc-
tngwith Sedion700W)of DiAsion3ofthe Businnsand ProfessionsCode,and my1
APPLIANCESRESMENTIAL
JOB DFSCRB'TION
-
license is In full force and effect.
PANELS
S a
Licence Claes Lk.#
R'
Date ContactorLWTO2D0
Mrs
,
207-I000 AMPS
ARCHITECPS DECLARATION
I understand my plans shah be used as public records.
OVER IOW AMPS
SQ. Fr. FLOOR AREA
$/SQ.FT.
SIGNSELECTRICAL
Limmed Professional
$Pp-CIALCIRCNT/M1SC
OWNER -BUILDER DECLARATION
I hereby affirm that l am exempt from the Contractor's License Law for the
1 0020
74.92
TEMP. METQt OR POLE INST.
following reason. (Section 7031.5, Business and Professions Cade: Any city or
county which requires permit to construct, alter, Improve, demolish, or repair
any structure prim to its issuance, also requires the applicant for such permit to
file a signed statement that he is licensed pursuant to the provisions of the
POWER DEVICES
SWD/MING IDOL ELECTRIC
Contractors License I.. (Chapter 9(commencing with Section 7000) of Divi-
s1on3 of the goals. and Professlam Code) mthat he b mempt therefrom and
VALUATION
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant fora permit mbjects the applicant too civil penalty of net m mathan
OUTLETS.SWITCiESFIXTURES76
a 418.00
NEW RESIDENTIAL ELECTRSQ.FT.
five hundred dollars (xSM.
❑ I, as owner of the pmperty, or my employees with wages as their sole
STORIES
TYPE CONSTRUCTION
compensation, will do the work and the structure b not Intended or offered for
sale (Sec 7064, Bushes and Professions Code: The Contractor's Lim. Law
V—N
does not apply to an owner of property who Wilds or improves thereon, and
who doessuch work himself orthrough hisown employees, provided that such
OCC.GROUP
RFS. UNITS
Improvements are not intended oroffered fonale. If, however, the Wilding or
Improvement hsold within omyearofcompleib theowner-builderwill have
TOTAL:
R-3
/
t ben of proving that he did not Wild or improve for purpose of sale.).
4 as owner of the property, am exclusively contracting with ..cense.
r.ot.mors to construct the project (Sec 7064, Boniness and I'mfesskm Code:
QTY. PLUMBING PERMIT FEE
FLOOD TONE
APN
PERMIT ISSUANCE
12
The Contractors License Law don not apply to an owner of property who
Wilds or improves thereon, sod who contracts for such pgojects with a
qqpp(R( ctw(s) licensed pursuant to the Contactors License Law.
cl__l I am exempt under Sec. B 4 P C for this reason
-
ALM -DRAIN &VENTWATER (EA)
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
DRAINS FLOOR ROOF, AREA,COND.
SANITARY Y N
RECENT N
Owner Date
WORKMAN COMPENSATION DECORATION
❑I hereby affirm that I have a nrlifinte of consent to self -insure, o a
certificate ofWorkea' Compensation Imuran or a certified copy thereof (Sac.
3800, Lab C.)
licy
FO('IVRES PER TRAP
SCHOOLTAX Y_ N_
REGENT #
GAS EA. SYSTEM -I INCA OUTLETS
PARK FEE Y N
RECEIPT IF
#
company
any
GAS EA. SYSTEM -OVER 6 (EA)
BUILDING DIVISION FEES
lOed copycihereby fumished.
entified copy h filed with the city W pection division.
GREASE/INDUSTRL WASTE INTERCEPTOR
PLANCHECK FEE
GREASETRAP
CERTIFICATE OF IXEMPTION FROM WORKERS'
PAID
SEWER -SANITARY -STORM EA 200£1'
COMPENSATION INSURANCE
(rhissectkn need not W completed If the permit is for one hundred dollars
Date Recei t#
WATER HEATMW/VENT/ELECTR
ENERGY FEE Y_ N_
(S100)mless.)
I certify that In the performance of the work forwhich this pentyl Is Issued,
WATR SYSTEM/TREATING
I shall not employ any person In any manner so as to become subject to the
Workers' Compensatlon Laws of California. Date
PAID
I NEW RESIDENTIAL PLMB. SQJT.
Applicant--- .
NOTICETO APPLICANT: R, after making thio Certlof Exemption, you
should become subject to the Workers'Compematlon provlslom of the Labor
Date Remi t#
TOTAL:
BU
536.00
Code, you most forthwith comply with such provblom orthis permit shall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
5.39
Ihercbys(firmthatthere lsacovtmcilon lendingagenry for the perfom�
ance of the work for which this permit is Issued (Sec. 3097, Civ. C.)
Lender's Name
Lender's Add
I cartilythatl have mad thbappliationand statethattheabove Information
bcorrect.I agree to comply with all cityand countyordleancosand statelaw.
TOTAL:
ELECTRIC FEE
37.50
PLUMBING FEE
QTY. MECHANICAL PERMIT FEE
MECHANICAL FEE
PERMIT ISSUANCE 12
FEES PAID.
37-.—.5
relating to building comtmetion, and hereby authorise representatives of this
city to enter upon the above-mentioned property for Inspection purposes.
(We) agme to save, Indemnify an d keep harmiess the City of Cupertino
against hablBties.pdgments, coetsand expenses which may In anywayamue,
ALTER OR ADD TO MFGH.
Date Receipt#
AIR HANDLING UNIT (TO I(LODO CFM)
SUBTOTAL:
ri
againstsaldC fypw / gr tingofthlopermit
en��-` S l �4D
'uRIiANDLINGUNIT (OVER IO,000CFM)
CONSTRUCTION TAX
Slgnatureof Appllant/Contractor �i to
FxHAUSTHOOD(W/DUCT
CONSTRUCTION TAX PAID:
HAZARDOUSMA ALSDISCLOSURE
HEATING UNIT (TO 100,WOBTIJ)
Date Recei t#
Will the applicant or future building occupant store or handle hazardous
material as defined by the Cupertino Municipal Code, Chapter 932, and the
I lealth and Safety Cade Stolon 25532(a)7
❑ Yn M No
Wllllhe applicant or future building occupant useequlpmenl ordevices
HEATING (IMT (OVER 1 W,OW BTU)
TOTAL:
VENTILATION FAN(SINGLE RESID)
ISSU�TE
which emit hazardous air contaminants as defined by the Bay Arca Air
Quality Management District?
P4Yes 9No
h mad Health Coedalsmont 25Sntsund aChapter 6.95 of
Sus afety
the Califomlahleaith b.ildiy Code, Se Mm755O5,255 t3aadt,thM.7
understand thatifthe building don not avrrently have atenani that ltkmy
y`1
s i 17 0
BORER -COMP OIIP OR 1 W,CM BTT
BOILER -COMP (OVQt1W,000 BTU)
NEW RESIDENTIAL MECii. SQ.Ff.
responsibility to notify the occupant of the requirements which must be met
priorm LsuanmofaCedifkateof Ocmpanry.
p .y
City of CUD00i"M
ISSIIGD BYj,• YAVL 'IAVCZj1
Owner or authorized agent Date
TOTAL:
OFFICE COPY