20407APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
9uildin Project Identification
Budding Address:
PERMITNO.
� A O
10100 Torre Ave. Unit 207 (F1.5)
0
20407
G 4
Owner. Narrrtla one:
� V Properties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
5/10/90
Contractors Name. Lie. N.
—
BUILDINC-ELECnUCAI.MUMBINGMECHANICAL
CATEGORY
CONTROL
A.Mtect/Engineer. Lk No:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Add.
EN EE EA D
PERMITISSUANCE
LICENSED CONTRACTOR'S DECLARATION
I hereby underprovisions
re Chapter
ssions9de,and a
]1-..1 Semon 7000)of d died. 3 o(lhe Budnessand Pro(esslonaCode, and my
license le In !u8 fomre and effect.
APPLIANCES-RESIDENTIALiAgw
JOB DESCRIPTION
RI.'$
PANES
Data Gla® Lk. N
Late " LJ.# or
•t— V
S, r ^ �
2II-1000 AMPS
ARCHITECT'S DECLARATION
I understand my plans shall be used As public records.
OVERIODOAMPS
SQ.FT.FLOORAREA
f/SQ. FT.
SIGNS ELnCT'RICAL
Licensed Professional
.
SPECIALCIRCUIT/MISC
OWNER -BUILDER DECLARATION
I hcmbyaf .th tlamexempt fromthe C.M.doe's License Law forth,
985
74.92
TEMP METER OR POLE INST.
following mate.(5ectlon 70115, Business and Professlons Code: Any city or
county which requlmsa permit to construct, alter, Improve, demolish, or repair
any structure price to its issuance, also refulexs the applicant for such permit to
file a signed statement that he Is licensed pursuant to the provisions of the
Contractor's License Law (Chapter 9 (commencing with Section 7000) of Divl-
slon3 ofthe Budneeand Prdemiona Code)orthatheisemmptthem(mmand
POWER DEVICES
SWIMMING POOL ELECTRIC
VALUATION
the basis for the alleged exemption. Any violation of Section 7031.5 by any
Applicant fora permit subjects the applicant to a civil penalty d not more then
OUTLETSSWn'CIiESE%'NRES
$73,796.00
five hundred dollars(f.500).
❑Las owner of the pmperty, or my employees with wages as their sole
compensation, will do the work and the structure Is not Intended or offered for
NEW RESIDENTIAL ELECIR—PO'FT'
STORIES
TYIIE CONSTRUCTION
V—N
rule (Sce. 7044, Busbnes and Profeeakma Code: The Cmd.cta. License Taw
does not apply to an owner of property who builds or Improve thereon,and
hlsovenemployees, provided that such
OCC.GROUP
RFS UNITS
Improvements are not Intended oroffeedforsale. If, however, thebulldbng or
Improvement issuld within oneyearofcompletion,theowner-Wilderw111 have
TOTAL:
R-3
'
llil,kurden of penning that he did not build or improve for purpose of sale.).
u [ as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business and Professions Code:
QTY. PLUMBING PERMIT FEE
FLOOD ZONE
APN
PFRMR ISSUANCE
12
The Commoner's License Law does not apply to an owner of property who
builds or Improve thereon, and who contra. for such projects with a
�qBE�+ec. dor(s) licensed pursuant to the Contractor's License Law.
LJ I am exempt under SB & P C for this reason
ALTER -DRAIN & VEM-WATER (EA)
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
DRAINS. FLOOR ROOF, AREA, COND.
SANITARY Y N
RECEPT N
Owner Data
WORKMAN COMPENSATION DECLARATION
01 hereby affirm that I have A cent@ate of consent to self -insure, ora
certificate of Workers' Compewtionlreumne, or a certified copy themed (Sec.
C.)
Policy
Policy
FIX.IVItES PER TRAP
9C11001. TAX Y_NN_
RECEIPT
GAS- EA. SYSTEM -1 INCA OUTLETS
PARK FEE Y N
RECEIPTM
N
N
COany
GAS- EA. SYSTEM -OVER 4 (EA)
BUILDING DIVISION FEES
fled copy ishereby furnished.
crtlfled copy is Bled with the city Iwpectlon division.
GREASE/INDUSIRL WASTE INTERCEPTOR
PLANCHECICFEE
'
GREASE TRAP
CERTIFICATE OF EKEMPT[ON FROM WORKERS'
PAID
COMPENSATION INSURANCE
(This section need net be completed if the permit Is for one hundred dollare
SEWER -SANITARY -STORM [A 100FT
Date RCCCI t#
WATER HEATER W/VENT/ELECTR
ENERGY FEE Y_ N_
PAID
($100)mless.)
I certify that In the perfamunca of thework forwhich Nb pemdt le Wued,
I shall not employ any penton in any manner Au As to become subject to the
Workers Compensation Lawsof California. Data
WATER SYSTEM/TREATING
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you
should become subject to the Workers'Compensation provisions of the Labor
NEIN RESIDENTIAL PLMB. SQ.FL
Date Rc' i t#
TOTAL:
BUILDING
522.501
Code, you must fonhwlth comply with such provisions or this permit shall be
denad revoked.
CONSTRUCTION LENDING AGENCY
-
SEISMIC FEE
5.18
IhmxbyafBem that there las constmetion lending agency for the perform-
Arco of the work for which this permit is issued (Sec 3097, CIv.C.)
LerdAe. Name
Lenaer.Aade,..
ImnifythatIhavereadthBappUmtlonanddatethattheabove Infort tion
is correct.I agree to comply with all city and county ordinances and date laws
TOTAL:
ELECTRIC FEE
36.63
PLUMBING FEB
36.63
QTY. MECHANICAL PERMIT TLE
MECHANICAL FEE
36-61
PERMIT ISSUANCE 12
FEES PAID:
relating to building construction, end hereby authmice representative of this
city to enter upon the above-mentioned property for Inspection purposes.
(We) agree to save, indemnify an d keep harmless the City of Gopertlno
dgments, cents and expenses which may In any way accrue
against liabilities, pd
ALTER OR ADDTO MECH.
Date Receipt#
AIR FIANDLING UNIT (TO I O
DODO CFM)
SUBTOTAL:
7 •
against said��44yy in onegr ting of this permit.
AIR F3ANDIJNG UNIT (OVER I0,000CFM)
CONSTRUCTION TAX
SignaCtureof Applicant/Cantsactor AM. Cl--
EXHAUST HOOD(W/DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUS MA ALS DISCLOSURE
HEATING UNIT (TO 100,000 BTU)
Date Reeei f#
Will the applicant cur foto. buildingocevp.ct store or handle hazardous
m
material A. defined by the Cupertino Municipal Code, Chapter 932 and the
I lealth and Safety Cade Section 75531(.)7
❑ Ye M No
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
37a
VENTILATION FAN (SINGLE RESM)
ISSUANCE DATE
Will the a pplicant or future building occupant use equipment or devices
which emit hazardous air contaminants as defined by the Bay Area Air
ality Management Dlstrict7
Yea❑ No
BOILER -CAMP OHPOR 100,000 BTU)
BOILER-COMP(Ova 1(0,000 BN)
have read the hazardous materials requirements under Chapter 6.95 of
the CaliforniaHeaith&Sofety Code,Sed1oro255W,25533and75534. I
ncurrently have a tenant, that it is my
understand that if the building daes
I f�Iii y �pp/T
ii .w�7JJV
� J-7
NEW RESIDENTIAL MECO. JFT
SQ
responsibility to notify the occupant of the requlrmnents which most be met
prior to Issuance of a Certificate of Occupancy.
p pP..rI.L
ylty Of GU TnO
ISSUED BY -.j_ 1" t{'fC. �^
Owner or authorized agent Date
TOTAL:
OFFICE COPY