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204130 0 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES USE BALL POINT PEN ONLY Building Project Identification Budding Address: PFRMITNO. /"I O A 10100 Torre Ave. Unit 213 (P G1) 4 VS mire am . PP one: W913p2rties CITY OF CUPERTINO6BUILDING DIVISION APPLICATION / PERMIT BUILDINr—ELECnUCALPLUMBINGMECHAMCAL 5/10/90 ContranorsName: Lie. No: 738-4444 CATEGORY CONTROL# Atchimes/Engineer. Lk. No: QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Add. EN PLRFITISSUANCE12 LICENSED CONTRACTOR'S DECLARATION I hereby affirm that l am licensed under provisions of Chapter 9 (comment, Ingwlth Section 7000)of Divlelon3ofthe Businessand Profession.Code,andmy Ilcenselsln full force and erred. n Llc # _ Date Date ClaContactor APPLIANCFSRE-%DEMTAL JOB DESCRIPTION RC'B_ L /` S -� D V \, PANELS 201-1000 AMPS ARCHITECPS DECLARATION I understand my plans shall be used m public remmis OVER IODO AMPS SQ, FE, FLOOR AREA $/SQ. FE. SIGNSELECTRICAL Licensed Penfesimul OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law roe the following reason.(Section 7011.5, Business and Professions Code: Any city or munywhlchrequlreaaper ttocmutmd,alter,impmw,dennlbh,orrepair SPECIAL CIRCUIT/MLSC 1,258 74.92 TEMP. MEITR OR POLE INST. any structure price to lot Issuance, also requlreathe applicant foreuch permit to file a signed statement that he is horned pursuant to the provlsloro of the POWER DEVICES SWIMMING POOL ELECTRIC Contractors License Law (Chapter9 (commencing with Section 70000 of Divi- slon3 ofthe Business and Professimu Code) orthat hels exempt therefromand VALUATION the basis for the alleged exemption. Any violation of Section 70315 by any m applicant for a permit subjects theappllcant to a civil penalty of not ore than OUTLETSSWITCHFSFIATURES , $94249.00 s five hundred dollars ($500). []I, as owner of the property, or my employees with wages as their sole wmpensallon,wllldothe work andtheatructure is not Intended or offered for NEWRESIDENTIALELECTRFC. SQ STORIES TYPE CONSTRUCTION V—N sale (Sec 7046, Business and Professions Code: The Contactors License law does not apply to em owner of property who Wilds or Improves therem, and whodoessuchwork himself orthmugh hisownemployees, provided that ach OCC. GROUP RES. UNITS Improvements am not Intended oroffered for.ale. If, howevegthe building or TOTAL: R-3 Improvement bwldwlthln oneyearofcompletion,the owner-builderwill have the burden of proving that he did not build or improve for purpose ofeale.), 0 L as owner of the property, am exclusively contracting with licensed contracture to commod the project (Sec. 7040, Business and Professions Cade: QTY. PLUMBING PERMIT FEE FLOOD TONE APN PERMIT ISSUANCE 12 The Contractors License Law dm not apply to en owner of property who Wilds or Improves thereon, and who contracts far such '#(picas with a c JJ Ltt1actor(s) licensed pursuant to the Contractors License Law. LJI am exempt under Sec B A P C for this reason ALTER -DRAIN & VENT - WATER BBA) FEE SUMMARY BACK FLAW PROTECT. DEVICE DRAINS FLOOR, ROOF, AREA, COND. SANITARY V N_ RECEIVE # Owner Date WORKMAN COMPENSATION DECLARATION ❑I hereby affirm that 1 have a cerRRote of consent to ee8-Insure, ore mtiflcate ofWcrken' Compereatlonlwuranm or a certified copy thereof(See. 3800, Lab C.) FIXTURES PER TRAP SCHOOL TAX Y_ N_ RECEIVE # GAS EA. SYSEFM-1 INCA OUTLETS PARK FEE Y N RECEIT Polley Com # any GAS EA. SYSTEM -OVER 6 (EA) BUILDING DIVISION FEES Red copybhereby furnished. addled copy b filed with the city wpection divblon. GREASE/INDUSERL WASTE INTERCEPICS PLANCHECICFEE GREASEIRAP CERTIFICATE OF EXEMPTION FROM WORKERS' PAID COMPENSATION INSURANCE (Thlesedion need nil becomplded If the permit bfor one hundred deltare SEWER -SANITARY -STORM EA 200FC Date Rett'i L# WATER FIEATER W/VCNT/ELECTR L•NERGY FEE Y_ N_ (S10o)mless.) I amiifyth.t In the performancecef thework forwhlch this penult is Issued, WATER SYSTEM/TREAIIN'G I shall net employ any person In any manner w u to become subject to the Workera Cmnpensation Lawn of C#Bfomis. Date PAID NEW RESIDENTIAL PLMB. SQFT. Applicant making NOTICE TO APPLICANT: U, after ang this Certlf ee, of Exemption, you should become subject to the Worlues' Compematlon provisions of the Labor Date Revel t # TOTAL: N .617.00 Code, you must forthwith comply with such provblore, or this perrrdbhall be deemed revoked. CONSTRUCTION LENDING AGENCY SEISMIC FEE 6.65 I hereby affirm that there Is a construction lending agency forthe perform -TOTAL: arm or the work for which this permit 1s Issued (Sec. 3097, Civ, C.) Lender's N. Lender. Address I certly that l have read thisapplication and Mention the exwe Information e, correct.I agree to comply with all cityand aunty ordinances and state laws - ELECTRIC FEE PLUMBING FEE 43.45 QTY. MECHANICAL PERMIT FEE MECHANICALFEE 43.45 PERMIT ISSUANCE 12 FEES PAID: relating to building rowtmetion, and hereby autlont a representatives c f this city to enter upon the abovcmentioneci property for inspection purposes. (We) agree to save, indemnify an d keep harmless the City of Cupertino .game liabilities, judgerrnls, weased expenses which may In any wayaceme ALTIMORADDTOMECH. Date Receipt# AIR HANDLING UNIT (TO 10,000 CFM) SUBTOTAL: 7 -9 against said Cnceof lyegr�tiog/f this permit. L /_ / JDoA AIR HANDLING UNIT (OVER I0,000 CFM) CONSTRUCTION TAX Slgnabrre of Appllant/Contactor/�`/� E(HAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERI LS 31SCLOSURE Wilitheapplleant or future budding occupant source handle hazardous HEATING UNIT (TO 100,000 BTU) Date Receit# material as defined by the Cupertino MuelcipaI Code, Chapter 9.1Z and the Healthand SafetyCode�+ SSection25532(z)7 ❑ Yee n No Willtheapplicent or futumbuildingompantuse quipment ordevias which emit havardous air contaminants as defined by the Bay Area Aur Quality Management District? 4Yes ElNo hsvereadiheban msmaterialsrequimmntsunderChapter6.95of the California Health A Safety Code, Sections 25505,25533.ed 25534. 1 understand that if the building does not mreenlly have a tenant, that it is my HEATING UNIT (OVER 300,000 BTU) TOTAL: DD VENTILATION FAN (SINGLE RESID) ISSUANCE DATE Pik rt®' M_I"\l fill 1 BOILER -COMP OFD' OR 100,010 BTU) BOILER -COMP (OVER 100,000 BTU) , NEW RESIDENTIAL MECH. SQ.FT. neporeoflily to nilly the occupant of the requirements which most be, met prior to issuance of a Certificate of Occu panty. /��s� #^� Clay of 1'IJOPr6nO ISSUED BY: �� Owner or authorined agent Date TOTAL: OFFICE COPY