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20406APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY Building Prom Identification B°Itdln Ad 10100o Torre Ave. Unit 206 (Fl.l) PFJMIT NO. 20406 wners �one: roperties CITY OF CUPERTINO-BUILDING DIVISION APPLICATION / PERMIT BUILDINGELECTRICA4PLIJMBINGMECHANICAL 5/10/90 Contractor's Name: Lk. N. 738-4444 CATEGORY CONTAOLst Architect/Enginnr. Lie. No: QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Adtlresa © � 91 PERIATISSUANCE 12 LICENSED CONTRACTOR'S DECLARATION I hereby hau I a licensedundererinessa API'LIANCFSRESIDEMTAL JOB DFSCRITION PANESLicens certhemnthattaiv dPrefehapter9(commn It...I I. fon 70W)of d effecn Jo(the BuNmssand ProfenNona Code, and my Ilmnse Is in full form and effect. ClassLIc a Date_.Contractor RCB 201-IODOAMPS ARCHITECT'S DECLARATION I understand my plans shall be used as public records. OVERIMAMPS SQ. Fr. FLOOR AREA S/SQ, FT. SIGNS ELECTRICAL Licensed Professional SPECIALCIRCUIT/MISC OWNER -BUILDER DECLARATION I herebyaffiren that l am exempt fromthe Contractors LimnseLawfmthe following reason.(Section 70115, Business and Professions Code: Any city or countywhichrequimapermittommt d,alter Improve,demoWh,orrepair 985 74.92 TEMP. METER OR POLE INST. anyslmetim Inner to its Issuance, also requimtheappBmnt forsuch permit to file a signed statement that he in licensed pursuant to the provisions of the Ontnutor'e License Law (Chapter 9(commencing with Section 700D) of Divi. don3 ofthe Buslnnsand Pro(esslors Code)orthat he In exempt therefromand POWER DEVICES _ SWIMMING POOL ELECTRIC VALUATION the basis for the alleged exemption. Any violation of Section 7031.5 by any ore applicant fora permit subjects the applicant to a civil penalty of net mthan OUTLETSSWI7CF�SF3%TURFS $73796.00 s Ove hundred dollars ($500). ❑ I, as owner of the pmperty, or my employees with wages as their sole mmpersation, will do the work, and the stmctum V net Intended or offered for NEW RESIDENTIAL ELECTR SQFI. STORIES TYPE CONSTRUCTION V—N sale (Sec. 7044, Bushes and Preload.. Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon,and does such work himself orthrough his own employees, provided that such OCC.GROIIIa RES. UNITSwho improvementsere not intended oroffered for ale. IL however thebullding or improvementIss&dwithinoneyeacofcompleiaMit eowner-builderwglhave th*rdanofprovingthat W did nmbulid or Improve for purposeofule.). Lj L as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7014, Business and Professions Code TOTAL: QTY, PLUMBING PERMIT FEE R-3 f FLOOD ZONE APN pptMlT ISSUANCE 12 'the Contractor's License Law does net apply to an owner of property who builds or Improve thereon, and who contracts for such p(ojecie with a "q�ractorts) licensed pursuant to the Contractor's License Law. LJ I am exempt under Sec. B & P C for thin mason ALTER -DRAIN & VEM-WATER (EA) FEE SUMMARY BACK FLOW PROTECT. DEVICE FEES DRAINS FLOOR ROOF, AREA, COND. FIXTURES PER TRAP SANITARY Y N� RECEIPT s Owner Date WORKMAN COMPENSATION DECLARATION te of conto self -Insure, or [:]I hereby affirm that I have a mrtlfimsent 3900llmteo(Workers'Compematlonlnsuranm ora mrtlfkd copythereo((See. lab C) Policy SCHOOL TAX Y_ N_ RECEIPT GAS EA. SYSTEM -1 INCA OUTLETS ETS PARK FEE Y N RECEPT M Com�My GS EA. -04 (EA) BUILDING DIVISION FEES J` Ted copy Is hereby furnished. ertified copy Is flied with the city Inspection division. GREASE/INDUSIRL WASTE INTFRCEI'TOR PLANCHECK FEE GREASE TRAP CERTIFICATE OF EXEMPTION FROM WORKERS" PAID SEWER -SANITARY -STORM EA ]00hT COMPENSATION INSURANCE (Thlsseeian need not be completed lithe permit Isfor one hundred dollars (g100)or less) I certify that in the performance of the work for which this permit is issued, Date RCCCI t# WATER HEATER W/VFNf/FT.FOTR ENERGYFEE Y_ N_ WATER SYSTEM/TREATING I shall not employ any person In any manner n as to become subject to the Workers'Compensation laws of California. Date PAID RESIDENTIAL PLMB. SOFT'. ApplicantNEW NOTICETO APPLICANT: I, after making this Cedt icate, of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Date Reimi t# TOTAL: BUILDING FEE 522.5 Code, you =at forthwith campy with such provisions or this permit shallbe deemed revoked. CONSTRUCTION LENDING AGENCY SEISMIC FEE I 5.1E I herebya(fcentleat them isacenstructlon lendlegagency forthe perform- ance o(the work lorwhiclethis permit Is blued (Sec. 3097, Civ. C.) Lenders Name Lendcre Address I certify that have read this application and Nate that the above information iscerrect.lagree to comply with all city, and county ordinances and Nate laws TOTAL: ELECTRIC FEE 16-6 PLUMBING FEE Ic QTY. MECHANICAL PERMIT FEE MECHANICAL FEE PERMIT LSUANCE 12 - FEES PAID: relating robuilding construction, and hereby authortae representatives of this city to enter upon the idov&emntloned property for Inspection purposes. (We) agree to now, IMemNy an d keep harmless the City of Cupertino against Bab111tics,pdgments, cots and expenses which may in any way accrue ALTER OR ADD TO MECH. Dere ROceip[# AIR HANDLING UNIT (TO 10,000 CFM) SUBTOTAL: 63 agalnstimmnZgran ng o(thIs permit. AIR HANDLING UNIT (OVER to,000cFM) CONSTRUCTION TAX EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: Signature of Applicant/Contractor Dl. HA7ARDOUS MATQ LS DISCLOSURE Will the applicant or future building occupant store or handle haardoua HEATING UNIT (TO 100,ODO BTU) - Date Recei t# material as defined by the Cupertino Municipal Code, Chapter 9.1$ and the I Tealth and Safety Cade Section 25532(a)2 ❑ Y. MN. Will the applicant orfuhm, building occupant use equipment ordevices HEATING UNIT (OVER 100,000 BTU) TOTAL: VENTILATION FAN (SINGLE RFSTD) ISSZe(F ATE which emit haardous air contaminants as defined by the Bay Area Air Quality Management District? vc read the ballousomaterials requ lrements under Chapter 6.95 of IMa i•?nY 1 7990 BOILER -COMP Of N OR 100,000 BTU) MER-COMP(OVER10D,000 BTU) the California Health & Satiny Code, Sections 25505, 75533 and 25534. I underetandthatif the building does not currently have a tenant, that it Is my responsibility to really the occupant of the requirements which must be mM City of Cunarfino NEW RESI DENTIAL MECH. SQ.FT. prior to issuance of a Certificate of Occupancy. //tt ��,,aa, air, ISSUED BY:�' A*_V V—W4L—/ Zt� Owner or authorized ed agent Data TOTAL: OFFICE COPY