20414APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project identification
B"Ildo g Address:
PERMIT NO.
20414
10100 Torre Ave. Unit 214 171.5
wner� . Up one:
-
Pro eC�rties
CITY OF CUPERTIN0.BUILDING DIVISION
APPLICATION / PERMIT
.
5/10/90
Contractor. Name: LIc. No:
738-4444
BUILDINGELECTRICALPLUMBING-MECHANICAL
CAT�ARY
CONTROLX
Architect/Engineer. LIe. No:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Add..:
K K E K
hU1 Z
PFBTISS'UANCE
LICENSED CONTRACTOR'S DECLARATION
ereby a
IhthSedif(Irmthat D)of Di siIfensedheunder Buslcasanns0f Chapter9(commnc
demn3ofthe BuslnnsandlsrofnNon,Code, and my
Ingwe I. I. full fmce and
Become bins farce anddfect.
APPWANCESRESIDENTIAL
JOB DESCRIPTIO
��(}.�(
PANELS
License Clam LIeM
RCB
Date Contractor
— UP TO 20DANTS
201-IODD AMPS
ARCHITECTS DECLARATION
I understand my plana shall be used as public records.
OVER IODO AMPS
SQ. FT. FLOOR AREA
S/SQ. FT.
SIGNS ELECTRICAL
Licensed Professional
51'ECLILCIRCUIT/MISC
OWNER -BUILDER DECLARATION
Ihereby affirm that l am exempt form the Contractor's License law for the
following ream. (Red ion 7031.5, Business and Penfenbm Code: Any city or
muntywhich requlma permit to mmtmd, alter, impmve, demlbh,ormpair
985
74.92
TEMP. METER POLE [NST.
any structure prior to Its Issuance, also requimthe applicant for such permit to
file a signed statement that he It licensed pursuant to the provisions of the
Contradoe. License Law (Chapter 9(commencing with Section 7000) of Diel-
Won 3 of the Business and Professlm aCode) mrlhat he Is exempt therefromand
POWER DEVICES
SWIMMING POOL ELECTRIC
VALUATION
the basis for the alleged exemption. Any violation of Section 703IS by any
applicant for a permit subjectsthe applicant to a civil penalty a not more than
OUTLETS-SWITCHFSHXTURES]
3 , 7 96.00
NEW RESIDENTIAL ELECTR SQ.FT.
five hundred dollars ($500).
M I, as owner of the property, or my employers with wages as their sole
STORIES
TYPE CONSTRUCTION
compensation, will do the work„ and the structure Is not Intended or offered for
sale (Sec. 7044, Butlncm and Profevlow Cade: The Contradoes License Law
V—N
does net apply to an owner of property who build, or Improves therron,and
does such work himself orthrough his own employees, provided that such
OCC.CROIR'
Rf5. UNITS
Improvements are not Intended oroffered for sale. If, however, thebuliding m
improvement hsold withlnoneyearofcompleion,theawner-buRderwill have
TOTAL:
R-3
tllpkurden of proving that he did not build or Improve for purpose of sale.).
"4 as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business and Professions Code:
CITY. PLUMBING PERMIT FEE
FLOOD ZONE
APN
PERMITI.SSUANCE 12
The Contractors License law dun not apply to an owner of property who
Wilds or Improve them., and who contract. for such p5ojeds with a
gatradm(a) Bcenaed pursuant to the Contractors License Law.
lJ I am exempt under Sec. B & P C for this moon
ALTER -DRAIN It VENT - WATER (FA)
FEE SUMMARY
RACY FLOW PROTECT. DEVICE
DRAINS FLOOR ROOF, AREA, COND.
SANITARY Y_ N
RECEIPT' M
Owner Date
WORKMANCOMPENSATIONDECLARATION
QI hereby affirm that I have a certificate of consent to self-inmre, or a
certlflwte of Workers' Compensation lwunnm or a certified copy them[CHec.
Palle lab C.)
X
FIXTURES. PER TRAP
SCHOOL TAX Y_ N_
RECEIPT X
GAS EA.SYSTFMI7NC.40UTLETS
PARK FEE Y N
RFC IPTM
Comp
Company
GAS EA. SYSTEM -OVER 4 (EA)
BUILDING DIVISION FEES
['rC led c0pybhereby (umished.
etlBied copy b tMd with the city Inspection division.
CREASE/INDUSTRL WASTE INTERCEPTOR
PLANCHECKFEE
GRE-ASETRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
(fhlmsection need not be completed lithe permit Is forms, hundred dollar
Date RCCCI t#
SEWER -SANITARY -STORM EA 200FT
WATER HEATER W/VLM/EL[CTR
ENERGYFEE Y_ N_
PAID
(Slm)orlese.)
1 artifythat M the performance of thework forwhlch this permit Ie Issued,
I,hall not employ any person In any manner so as to become subject to the
Workers Compensation Law, of Callfomia. Date
WATER SYS'TEM/TREATING
Applicant
NOTICE TO APPLICANT: If, atter making this Certlfiam of Exemption, you
shwld become subject to the Workem' Compemallon provisions of the Labor
NEWRESIDENTIALPLMB. SQFI'.
Date RC0.'1 f#
TOTAL:
TE
BUILDING
32
Code, you must forthwith comply with much provisions; or this permit shall be
dressed revoked.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
5.18
I hereby affirm that there is a construction lending agency for the perform
ance of the work for which this permit Is issued (Sec. 3097, Civ. C.)
lander. Name
Lender's Addes..
IrdlfythatlhavemadthisappbmtWnand Nawthattheabowinformatim
Is correct.I sgm to comply with all city and county ordinances and state laws
TOTAL:
ELECTRIC FEE
PLUMBING FEE
36 63
QTY. MECHANICAL PERMIT FEE
PERMITISSUANCE 12
MECHANICAL FEB
FEES PAID:
36.63
relating to building construction, and hereby authotlu espreaentallves of this
city to enter upon the above-mentioned property for Inspection purposes.
(We) ages to save, indemnify an d keep harmless the City of Cupertino
against liabilities, judgmms,cwt, and expenses which may in anyway accrue
aga oat said Cnon m esti gof this permit.
yO
ALTER OR ADD TO MUCH.
Date Reeei t#
AIR HANDLING UNIT CFO 10,1100 CFM)
SUBTOTAL'
%.
AIR HANDLING UNIT (OVER I Q000 CFM)
CONSTRUCTION TAX
Signare of AppBanl/Contractor to
tu
D(HAl15T HOOD (W/DIX:n
CONSTRUCTION TAX PAID:
HAZARDOUS MATE SDISCLOSURE
M ottvpan ods, hhandIs 9.IZandoue
Will the applies,fined by the Cupertino
material as dented by the Cupertino Municipal Cody Chapter 9.12, and the
Health and Safely Code Section 75532(x)7
Health
❑ Yes No
HEATING UMT(to 100,0008TN
Date Recei t#
HEATING UNIT (OVER 100,001) BTU)
TOTAL:
VENTILATION FAN (SINGLE RF.SID)
I$S�_AfaATE
device
Wlllthe applicant nimr cute Wilding aavpandby
theequipmentBay Area
which eMtraImmnt airrota Mnantaasdefined by the Ray Area Air
Quality Management DLMct7
4 Yes (-1 No
have read the bars 0u. materials requirerrents under Chapter 6.95 of
BOILER -COMP OHP OR 100,D00 BTU)
BOILER.COMP(OVIR I OO,DOO ST U)
the Ca llfomla Health & Safety Code, Sections 75505, 75533 and 75534. I
understand that lithe building does not currently have m tenant, that it Ismy
i
NEW RESIDENTIAL MECH. SQ.FT.
responsibility to nmtBI"he occepant of the requirements which must be niet
prior to issuance of a Certi Gate ofOentpancy.
p
City np l I p unp.rtlDn
ISSUED BY:
Owner or authorired agent Data
TOTAL:
OFFICE COPY