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20415
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY Bulldin Project Identification Building Add.: Pl IT NO. '20415 10100 Torre Ave. Unit 215 (171.7 neve a one. r ro Lies CITY OF CUPERTINO-BUILDING DIVISION APPLICATION / PERMIT A 5/10/90 conuartoesName:. LIc.N.: 738-4444 BUILDINCELECTRICAI PLUMBING-MECIIANICAL CATEGORY CONTROL# ArehltM/Engineer. Lk. Na QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO PLUMB MLL11 Add. SLUG ELELI © [K] N] PERMIT ISSUANCE 12 LICENSED CONTRACTOR'S DECLARATION Ihereby thSMiaflrmth)olamlicrosedhe under Bug rovandPrfessiosCode,mmrnc ingMlimnwh info.forceandeffeon3o(IheBudneuandPro(esslonsCode,mdmy license Is in full force and dice. License Claes Lk. N Date Contractor API'LIANCESRESIDENML JOB DESCRIPTION RCB D ` _ V L PANELS 201-1000AMPS ARCHITECTS DECLARATION I understand my plane shall be used nee public record& OVERI"AMPS SQ. IT. FLOOR AREA $/SQ. FT. ISIGNSELFCTRICAL Licensed Poderskmai SPECULCEtCUT/M6C OWNER -BOLDER DECLARATION I hereby affirmthat I am exempt fromntract the Coor's License law for the 985 74.92 TEMP METER OR POLE INST. following reason. (Section 70315, Business and Professions Code: Any city or county which requires a permit to mnatruct, alter, Improve, demolish, or repair any structure prior to its issua me, also requires the applicant for so& permit to fie a signed statement that he V licensed pursuant to the provisions of the POWER DEVICES SWIMMING FOOL ELECTRIC Cantractula License Law (Chapter 9 (commencing with Section 7000) of Divi- sion3 of the Businessand ProfesslmuCode) orthat he Is eumpttherefxamand VALUATION the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty Una rare than OUTLETSSWITCHES-FIXTURES $73,796.00 five hundred calla. ($S M . F-1 1, nee owner of the property, or my employees with wages as their sole mmpemallon, will do the work and the structure is not Intended or offered for NEW RESIDEMTAL ELECTRSQ'Fr' STORIES TYPE CONSTRUCTION V—N sale (Sec 7016, Sugar. and Pracesloru Code: The Contractors Lt.. law does not apply to an owner of property who Wilde or improves thereon,and dmasuch work Mmvelf or through Ms own employees, provided that such OCC.CROUP RES. UNITS improvements are not Intended oraffered fersale. It howereegthebullding or Improvement(esold withinoneyearofeampletlon, theowner-bu0derwillhave TOTAL: R-3 ` tlt,Lkurdeo of puving that he did not build or Improve fee purpose ofule.). u L as owner of the property, am exclusively mntractlng with licensed rontacton to construct the project (See 7014 Business and Professions Code: QTY. PLUMBING PERMIT FEE FLDODZONE APN PERMIT ISSUANCE 12 The ContnctoJs License Law does out apply to an owner of property who Wilds or improves thereon, and who contracts for such plojects with a a,(g(ador(s) licensed pursuant to the Contractor. License Law. L.� I am exempt under Sec. B 4 P C for this reason ALTER -DRAIN k VFM-WATER (EA) FEE SUMMARY BACK FLOW PROTECT. DEVICE OUTSI DE FEE 5 DRAINS FLOOR ROOF, AREA, COND. SANITARY Y N RECEIPT # Owner Date WORKMAN COMPENSATION DECLARATION Ell hereby affirm that I have a certificate of consent to eel( -Imre, ora anlflcate of Workers'Compenufion Inummeora certlfed mpythemcf(Sec 3800, lab C.) FD(TURFS PER ?RAI' SCHOOLTAX Y_ N_ RECEPT # GAS EA.SYSTEM-1 INCA OUTLETS PARK FEE Y N RECEIPT N C N Com any S GAEA. SYSTEM-OVERd(EA) BUILDING DIVISION FEES (fled copy la hereby Nm(shed. Cert Certified copy is filed with the city Inspection division. GREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECKFEE GREASETRAP CERTIFICATE OF EXEMPFION FROM WORKERS' PAID COMPENSATION INSURANCE (fhlsseRlon need nor W completed if the permit ta forom hundred dollars SEWER.SANITARY-STORM EA. 20017. Date Recei t# WATER HEATER W/VENT/E.ECTR ENERGY FEE Y_ N_ PAID ($1°mlythat a ess.M the performance o(the work forwhkh this permit Is blued, I m I shall not employ Any pereon in any manner ro as to become subject to the Wo la ri Compensation Laws of GBfornle. Date WATER SYSI.FM/TRFATING NEW RESIDENTIAL PLMB. SQFr. ApplicaNOTICE NOTICE co APPLICANT: a after nuking this tatian me of Exemption, you should become subject to the Workers' Compematlon proWlom of the Labor Date Recei t# TOTAL: BUILDING FEE Code, you =at forthwith amply with such provisions or this permit shall be, deemed revoked. CONSTRUCTION LENDING AGENCY SEISMIC FEE 5.18 I herebyaffirmthat there is a construction lendingagency forthe perform- once of the work for which this permit is blued (Sec. 3097, Civ. C.) Lender's Name (end.e.Address. I artily that I have mad this application and state that the above Iscorred.I agree to comply with all city and county ordinances and date laws TOTAL: ELECTRIC FEE �j_Sj� QTY. MECHANICAL PERMIT FEE PLUMBING FEE MECHANICAL PEE PERMIT ISSUANCE - FEES PAID: 36.63 relating to building arutruClon, end hereby authorise representatives ofthis city to enter upon the above-mAntioned property fm Inspection purposes. (We) agree to save, indemnify an d keep harmless the City of Cu Fenlon against ilabiltles,judgments, caste and expenses which may In any way accrue against said11(yp& enc t gr Ing of this perm) ALTERORADDTOMECH. Date Recei t# AIR HANDLING UNIT (TO 10,000 CFM) SUBTOTAL: a AIR HANDLING UNIT (OVER 1o,000cFnl) CONSTRUCTION TAX' Signature of Appllwm/Contactor - ate EXHAUST HOOD(W/DUCT) - CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Wllltheapplicantorfuture building occupant store or handle haaardous HEATING UNIT C170 100,000 BTU) Date Reeel t# material as defined by the Cupertino Munki aI Code, Chapter 9.1 2, and the Health and Safety Code r�a Section 25532(a)? RnYa `] No illippliantorhimm uildingo pantuseequipment ordevices HEATING UNIT (OVER 100,000 BTU TOTAL: VENDLATION FAN (SINGLE RESID) I DATE which cent haeardous air contaminants as defined by the Bay Area Air Qua Ilty his nagestunt District? Yrs N 4FhnvereadtherF1No materials requlremenaunder Chapter 6.95of the California Health A Safety Code, Sections 25505,25533 and 25534. I understand that lithe building does not currently have a tenant, that it is my responsibility to notify the occupant of the requirements which most be rant I� 9JQ as CI}tr cat CBn9TIND BORER -COMP QHP OR 100,000 BTU) BOR E2COMP(OVFRIOO,MUBTU) NEWRESIDENTIALMECH. SQ.Fr. _ prior to Issuance of a Certificate ofOccupa my. l �i ' ISSUED BY; 6 Y`r - Owner or authalmd agent Data TOTAL: OFFICE COPY