20409APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Pr° ectldemHkari..
PERMITNO.
11.11ding
10100 Torre Ave. Unit 209 (F1.4)
20409
sereName: 0 one.
APPLKLA LION SUKA41 I I p
r Pro erties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION I PERMIT
5/10/90
Commerce. Name: Lie. No:
738-4444
BUILDINGIIIECTRICAL-PLUMBING-ME HANICAL
CATEGORY
CONTROL#
Archlteci/Englnrer. Lk. Na
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Add.
PERMITISSUANCE 12
[E M O
LIC ENS EDCONTR
under rDECns of Chapter 9de,and c
Code, and my
It...I I.f°n force and died.
limns Isle full force and effect.
APPLIANCFSRESIDENf1AL
JOB DESCRE''f10N
�JJ
�FT VT
PANELS
License Chse Lkp
Date Cantnctor
' -RCB t
211-1000 AMPS
ARCHITECPS DECLARATION
I understand my pleas.hall be used as public record.
OVER 1000 AMPS
SQ. Ft. FLOOR AREA
- S/SQ. Ft.
SIGNS ELECTRICAL
Licensed Professional
SPECIAL CIRCUIT/MISC
OWNER -BUILDER DECLARATION
Ihereby affirm that l am exempt from the Contractor'. License law for the
985
74.92
TEMPMEnRORPOLEINST.
following reason.(Section 7031.5, Business a nd Profession, Code: Any city or
county which requiresa permit to construct, alter, improve, demolish, or repair
any structure price to Its bamoce, also requiresthe applicant for such permit to
file a signed statement that he is licensed pursuant to the provisions of the
POWER DEVICES
SWINMNG POOL ELECTRIC
OITILETSSWITCH6EXIVIRFS
Contractor'sLicense Law (Chzpter9(commencing with Section 7IX10)of Divi-
sion 3 ofthe Business and Profeasiors Cede)orthe he leexempt therefromand
the basis for the alleged exemption. Any violation of Section 7031.5 by any
to a civil penalty of nore than
applicant fora permit subjects(heapplicam ot m
VALUATION
$7.3,796.00
NEW RESIDENTIALELECTR SQFt
Ove hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole
STORIES
TYPE CONSTRUCTION
compensation, will do the work, and the structure isnot Intended or offered for
sale (See 70K Business and Pr feasimas Code: The Contractors License Law
V—N
does not apply to an owner of property who Wilds or Improves therms, and
who doessuch work himself or through his ownemployers, provided that such
OCC.GROUP
RES. UNITS
improvements are not Intended or offered for sale. If, however, the building or
Improvement ivsold within oneyearof completion, the owner-bullderwfll have
TOTAL:
R-3
tfLIirNeo of proving that he did not build or Improve for purpose of sale.).
u L as owner of the property, am exclusively =trading with licensed
contractors to construct the project (Sec 7046, Bunions and Professions Code:
QTY, PLUMBING PERMIT FEE
FOOD ZONE -
APN
pFgMRISSUANCE 1'z
The Contractor's License Law does not apply to an owner a property who
Wad. or improves thereon, and who contracts for such p(o)ect. with a
cgp(Factm(.) Ikensed pursuant to the Contractors License Law.
Lf I am exempt under Sec B & P C for thin mason
ALTER -DRAIN & VENT- WATER (EA)
FEE SUMMARY
BACKFLOW PROTECT. DEVICE
DRAINS FLOOR ROOF, AREA, COND.
SANITARY Y N
RECEIPT I
Owner Dale
WORKMAN COMPENSATION DECLARATION
❑I hereby affirm that I have a cectifiate of consent to self -Insure, or a
3800, ab of Workers'CompetsaHon Buurance cera certlflM copy thereof ($m.
Poli, Lab C.)
Polis,
FIX.n1RFS PER TRAP
SCI IDOL TAX Y_ N_
RECEIPT Y
GAS EA. SYSTEM -1 INCA OUTLETS
PARK FEF. Y N
RFCEVF R
#
Company
CAS G. SYSTEM-0VER 6 (EA)
BUILDING DIV] SION FEES
❑Certlfled copy is herebyfurnished.GREASE/INDUSIRL
crt fled copy is tike with the city inspection division.
WASTE INTERCEPTOR
PLANCHECK FEE
GRFASETRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCESEWER-spMipRY-STORM
(Thlssection need not becompleted lithe permlt leforom hundred dollars
ep 1ooF1•
Date Recei t#
WATER HEATER W/VENT/ELECT?
ENERGYFEE Y_ N_
(f100)or lese.)
I ceorlm.) t N the pedormunce of thework (orwhich this pnmdt I, issued,
WATER SYSTEM/TREATING
I shall not employ any person in any runner so as to become aubJect to the
Workers Compensation laws of California. Date
PAID
ApplicaNOTICE
OTICE
NOTICEco esubje Atotheaftermakingfhbtation profscate of Exemption, you
should become subject to the Workers' Comperoatlon provbiom of the Lebon
NEW RESIDENTIAL PLMS. SQFT.
Date Recel t#
� TOTAL:
BUILDING
Code, you must forthwith comply with such provisions or this permit shall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
5,18
IhembyafOrm thatthere leamrotmcdon lendingagency forthe perform
ance of the work for which thio permit is Issued (Sec. P09TCIv. C.)
Lender's Name
Lc.dc,b Aadrees
I cadBythall have read thkappliatlonand siatethattlee above information
Is correct. l agree to comply with all city and county ordinances and date laws
TOTAL
ELECTRIC FEE
PLUMBING FEE
MECHANICAL FEE36'6-3-
QTY. I MECHANICAL PERMIT FEE
PERMIT ISSUANCE 12
FEES PAID:
relating to build Ing construction, and hereby authorize representatives of thin
city to enter upon the ebovcmentloned property for inspection purposes.
(We) agree to save, Indemnify an of keep harmless the City of Cu pertlo,
against liabilltks, judgments, metsan ezpenm which may In any way amme
ALTERORADDTOMECH.
Date Recei t#
AIR HANDENG UNIT (to 10,00) CFM)
SUBTOTAL:
against said In�u nre of a nt of this permit
AI R HANDLING UNIT (OVER 10,000CIM)
CONSTRUCTION TAX
Sigmture of Appllant/Contractor D a
EXHAUST HOOD(W/DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUS MAT SDISCLO.URE
Will the applicant or future building occupant store or handle hazardous
material as deflned by the Cupertino Municipal Code, Chapter 9.11, and the
Health and Safety CodeSeemsSection 25532(.)?
❑ Yes `] No
HEATING UNIT (TO 100,000 ITV)
Date Recel t#
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
9-9;7
VENTILATION FAN (SINGLE RESID)
ISS1JUATE
Will the applicant or future building occupant use equipment or devices
which emit harardous air con/amdmnl. a. defined by the Bay Area Air
Quality Management District?
Yca No
have read lM1e haza ous materials requirements under Chaplet 6.95 of
bP
ay
.I (J9O
BOILER -COMP DHP OR 100,000 BTU)
BOILER -COMP 100,000 BTU)
the Calimmi. Health & Safety Code, Settlors, 25505, 25533 and 25534. 1
understand that if the building does not currently have. meant, that it 1. my
responsibility to notify the occupant of the requirements which must be met
City of CuPpOinn
NEW RESIDENTIAL MEIN. SQ.Fr
prim to Issuance of a CeHiflate of Ocmpanry.
ISSUEDBY:\L� VlTd kl,Ld-1 �I
Owne,m..th.rizcd a gent Date
TOTAL:
OFFICE COPY