20411APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification
Building Address: -
PER)ATNO.
O 11
10100 Torre Av . Unit 211 (A1.2).
41
wnera ams: one:
APPLECA iiON sU9MrrT_A=
Properties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION I PERMIT
BUILDINGELECTRICAL-PLUMBING.MECHANICAL
5/10/90
C.utraetor. N.me: LIm, No:
738-4444
CATEGORY
CONTROL#
Archbect/Engineer. Lie. No:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Address:
PERMITISSUANCE
❑X 1K
11� KI
LICENSED CONTRACTOR'S DECLARATION
Thereby Chapter9(commrnc
amst.0
APPEANCESRES[DENTIAL
JOB DESCRIPTION
PANTS
U.u70thatL
ofhAll.d ess.rdro
l.gudttime. force Afdeffect. ofthe Busineesand Pro(esslonsCode,and my
!1«fix is In full fore and effect.
Uanse CWss Lic.#
Date Contractor
}RCB
S r D W
201-10MAMPS
ARCHITECTS DECLARATION
I understand my pizw shall be used as public records
OVER 1000 AMPS
SQ. 17. FLOOR AREA
$/SQ. Fr.
SIGNS ELECTRICAL
Licensed Professional
SPECIAL CIRCUIT/MISC
OWNER -BUILDER DECLARATION
I hereb .(Kron that l am exemptfrom the Contractors License Law for the
y
1, 115
74.92
TEMP. METER OR POLE INSI.
following reason. (Section 70315, Business and Professions Code: Any city or
countywhichrequiresapermittoconstruct,altemimprove,de=lB h,orreper
-
anystmu mpriortolt.Issuance,abomquimatheappllantfwsuchperrrdtio
file a signed statement that he Is h«nsed pursuant to the provisions of the
POWER DEVICES
gWIv1MING POOL ELECTRICaloe
Contractor's License Law (Chapter 9 (mmmenWg with Section 7000) of Divi-
3 of the Buslnesa and Professions, Code) orthat he is exempt therefrom and
VALUATION
the basis for the alleged exemption. Any violation of Section 70115 by any ct
Applicant fora permit subjects the appBeantlo a civil penalty of net more than$83,536.00
O�ETS,%VITCHEec FIRES
Ove hundred dollars (5500).
❑ I, as owner of the property, or my employees with wages as their sole
NEWRESIDENTIALELECTR SQ.FT.
STORIES
TYPE CONSTRUCTION
compensation, willdothe work and thestructum is not Intended or offend for
sale (Sec. 7041, Business and Protessu iaCode: The Contractor's License Law
V_N
does not apply to an owner of property who Wild. or improves thereoq and
who does suchwork himself orthrough his own employees, provided that such
improvements am not intended oroffercd for sale. If, however, thebullding or
TOTAL:
OCC.GRCUP
R-3
RES. UNITS
improvement V sold withinoneyearolcompletlon, theowner-bullderwill have
the burden of proving that he did net build or Improve for purpose ofsale.).
M L as owner of the property, am exclusively contracting with licensed
contractor to mvwct the project (Sec. 7046, Business and Professions Cade:
'
QTY, PLUMBING PERMIT FEE
FLOOD ZONE
APN
PERMIT ISSUANCE
12
The Contractor's License Law dm net apply to an owner of property who
Wild. or Improves thereon, and who contracts for such projects with a
cWJE.dm(e)hanerd P.....t to the Contractor's License law.
Lf I am exempt under See. B A P C for this reason
ITER -DRAIN 4 VENT- WATER ffA)
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
I 5E -
DRAINS FLOOR A, ROOF, AREGOND.
Fp(TTTRgS M TR"
SANITARY RECEIPT
SCHOOL TAX Y_ N_
RECEIPT M
Owner Dee
WORKMANCOMPENSATION DECLARATION
L31 hereby affimn that I have a certificate of consent to self -Insure, ora
cedl(Icateof Workers'Compereation Imumem or a ratified copy thereof(Sec.GAS
3800,Lab CJ
Polis
Polity
EA.SYSTEM-1 llVC60UTLECS
—
PARK FEE Y N
RECEIPT
#
Co�any
GAS EA. SYSTEM -OVER 6 (EA)
BUILDING DIVISION FEES
led copy is hembytumecity
eniRed ropy V tiled with the city Inspection division.
CREASE/INDUSIRL WASTE INTERCEPTOR
PLANCHECK FEE
CREASE TRAP
CERTIFICATE OF IXLMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
(This section need not be completed if the permit te for one hundred dollars
SEWFR-SANUARY-STORM EA 200FT
Date Recei t#
WATER IMAT M W/VENT/ELECTR
ENERGY FEE Y_ N_
(5100)ortifythat
I aily that in the performance of the work forwM1lcM1 this pemdt la loved,
WATER SYSTEM/TREATING
I shall not employ any person In any runner eo as to become subject to the
Laws of California Date
PAID—
NEW RESID=AL PLMB. SQ.17.
Applicant
Applicant
Date Recei tit
NUTICETO APPLICANT: If, after making this Certificate of Exemption, you
should become subject to the Workers' Comperaatlon provisions of the Labor
Code, you must forthwith comply with such provisions orthis permit shall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
TOTAL:
I
BUILDING567.50
SEISMIC FEE
l herebyafOrmthat there is a mnstrucion lending agency for the perform
ance of the work for which this permit Is blued (Sec. 3097, CIv.C.)
Lender.Name
Lenders Add nrea
I.AifylhatIhavereadthbappLcatbnand statethatthe above In(ormatlon
EA correct.I agree to comply with all city and county ordinances and state laws
TOTAL:
ELECTRIC FEB 39 8
PLUMBING FEE -A
QTY. MECHANICAL PERMIT FEE
MECHANICAL FEE
.
FEES PAID:
PERMIT ISSUANCE 12
relating to building construction, and W reby autlemtlu representatives of this
city to enter upon the above-mentioned property, lou inspection purposes.
(We) agree to save, indemnify an d keep harmless the City of Cu pert too
against liabilities, ja dgments, mats and expenses which may in any way accrue
ALTERORADDTOMECH.
Date Receipts.
AIR HANDLING UNIT CEO 70,000 CIM) -
SUBTOTAL:
agawt>aid Cfty ri;u sense t ra leg.fthie perml,/
• lel
AIR HANDO NG UNIT (OVER 10,000CFM)
CONSTRUCTION TAX
_2b
Signshimof AppBeant/Contractor 4155— 4� to
EXHAUST HOOD(W/DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUS MA LS DISCLOSURE
Will the applicant or future WRding occupant store or handle hazardous
Date Recei tN
HEATING UNIT (TO 100,000 BTU)
material as defined by the Cupertino Municipal Conde, Chapter 9.12 and the
Health and Safety Code Section LS537(a)7
Yes No
WBl the xppllantw future Wliding occupant use equipment or devices
RD] the
which emit hazardous air contaminants as defined by the Bay Area Air
Quality Management District?
Y. No
have m.dtheh. sus materials requireemetsuader Chapler6.95of
HEATING UNIT(OVER 100,000 BTU)
TOTAL: -�
VENTILATION PAN (SINGLE RFSID)
AER.
/918P
BOILER -COMP OHI' OR 100,0(0 BTU)
BOILER -COMP (OVER 100,000 BTU)
the California HealthASa(etyCWe,Sedions25505,25533 and 75534. I
understand that ifthe Wllding dose not currently have tenant, that ltVmy
i J7Vy9/1
{ Ii1 1 I
NEW RESIDENTIAL MECH. SQ.FT
mpomibllity to ndify the..p.nt of the aequiremente which must be net
prior to Issuance of a Certificate of Occupancy.
Cl* of ruT erf�rrw_
ISSUED BY. �7L a
Ownmr or auth.rlud agent Date
1OTAL:
OFFICE COPY