20416APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Pra ed Identification
Building Add.:
- PERMIT NO.
0 416
10100 Torre Ave. Unit216 (P2)
.L1
nsrs a // one:
_ VM 4-ve
cno-�a—aNam: Troperties Lie. No;
738-4444
CITY OF CUPERT[N4BUILDING DIVISION
APPLICATION/PERMIT
BUILDINGELFGTRICA4I'LISMBINC-MFfFUMCAL
5/10/90
CATEGORY
,
CONTROL0
Architect/Engineer. Lk. Nm
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Address:
® ® ® `aITy
4
PERMITISSUANCE 12
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that lam licensed under pmvb1.nofChapter9(oo.c
IngwithSMion7000)of Dlvlsion3ofthe Buslnemand ProfesionsCocie, and my
Ilcense is in full form effect.
APPLIANCES -RESIDENTIAL
JOB DESCH11-HON
RCB
PANE '
PANELSand
License Clan Llca
Date Contractor
F'—
201-1000 AMPS
ARCHITECfSDECLARATION
I understand my plana shall W used as public mounds.
OVER I" AMPS
SQ. FT. FLOOR AREA
$/SQ.Fr.
SIGNS ELECTRICAL
Licensed Professional
SPECIAL CIRCUIT/MLSC
OWNER -BUILDER DECLARATION
I hereby affirm that l am exempt from the Contrac[orb License Law for the
and Professions Code: Any city it
following which
countywhlch requlrcsa permit to com[mct, alter, Improve, demol4h,orrepalr
ireRbn7mit to construct,
1 288
a
74.92
TEMP. METER OR POLE INST.
anyatrvclure prim to its Issuance, also requires the applicant for such permit to
file a signed statement that he V licensed pursuant to the provisions of the
POWER DEVICES
'
SyVaNgNG POOL ELECTRIC
OII7LEISSWITCHISFIXTURES
Contradoes License Law (chapter 9(commencing with Section 7000) of Divi-
cion 3 ofthe Business and Profess mu Cade) orthat bob exempt therefromand
the Exists for the alleged exemption. Any violation of Section 70315 by any
applicant fora permit subjects the applicant to a civil penalty of not more than
VALUATION
$96,497.00
_
five F11, as
rcwnerof thepr.
I, as owner of the properly, or employees with wages thele vale
NEW RESIDENTIAL ELECTR SQF7.
STORIES
TYPE CONSTRUCTION
compensation, willdotH.Meheworkandtbe, Is
he r
& net ntact&ended or offered for
Code:
sale ($m. 7064, 0uelnes and Profeslow Cade: The Contractors Licenx Law
does not apply to an owner of property who Wilds or improves thereon, and
who does such work himself orthrough his own employees, provided that such
V—N
OCC.GROUP
RFS. UNITS
improvements are rot intended or offered for sale. If, however, the building or
improvement is sold within one yearofcompldlon, the owner-bugderwlll have
TOTAL:
12-3
I
t Men of proving that he did net Wild or improve for purpose of ole.).
Lj L as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7014, Honduras and Profession Code:
QTY, PLUMBING PERMIT FEE
FLOOD ZONE
APN
PERMIT ISSUANCE 12
The Contractor's License law den not apply to an owner of property who
Wilds or Improves thereon, and who contracts for such projects with a
cgN(adoKe) licensed ponos.t to the Contractor'. License Law.
LJ I am exempt under Sec B & P C for this reasonQ11T9IQF
ALTER -DRAIN &VENT - WATER @,V
FEE SUMMARY
BACK PLOWPROTECT. DEVICE
FEES
DRAINS. FLOOR ROOF, AREA, COND.
SANITARY Y_ N_
RECEIPT M
Owner Date
WORKMAN COMPENSATION DECLARATION
0l hereby affirm that I have a certificate of consent to self -Insure, ora
certificate of Worked Compemation Insurance ora certified copy thereof(Sec.
Lab CJ
pD(•NRpS,I'ER.IRAP
SCHOOLTAX Y_ N_
RECEIPT M
GAS EA.SYSTEM-I 1NC.4OUTLETS
PARK I7E Y N
RECEIPT N
Polis
caman11cy ry
GAS EA, SYS17EM.OVER d(EA)
BUILDING DIVISION FEES
Ifiedcopybhembyfumished.
edified copy V filed with the city inspection division.
CREASE/INDUSML WASTE INTERCEPTOR
PLANCHECK FEE
GREASE TRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
SEWER -SANITARY -STORM EA 2NET
COMPENSATION INSURANCE
(rhlsseatlon need not be completed lithe permit 0 for one hundred dollars
($100)orlm.)
I certify that in the performance of thework forwhich this permit la Issued,
Date ' Recei t#
WATER HEATER W/VENT/ELECTR
ENERGY FEE Y_ N_
WATER SYSTE.'Y1/TRFA•DNG
I shall not employ any person in any manner an as to become subject to the
Workes'Coripemstion Laws of California. Date
PAID
NEW RESIDENTIAL PLM°. SQ}T.
Applicant
NOTICETO APPLICANT: B, after making this Cartlfkate of Exemption, you
should become subyet to the Workers' Compenot Ives provisions of the Labor
Date Revel t#
TOTAL:
UI N
626.0
Code, you must forthwith comply with such Immixton or this permit shall bs
deemed revoked.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
A 7Q
I hereby affirm that thereb a construction lendlngagency for the perform
ante of the work for which this permit is Weed (Sec.3W7, CIv.C.)
Landers Name
Lender's Address
ladifythatlhavereadthiaapphmtionaMrtatethallheabovelnfo ttlon
is current. I agme to comply with all city and county ordinance and Rate laws
TOTAL,
ELECTRIC FEE
PLUMBING FEE44
—44
20
QTY. MECHANICAL PERMIT FEE
MECHANICAL FEE
FEES PAID:
—44—.2&
PERMIT ISSUANCE.
relating to building construction, and hereby authortne representattves of this
city to enter upon the above-mentioned property for Inspection purposes.
(We) agree to save, indemnify an d keep harmless the City of CuPedlno
against liabilities, Pdgmente, avers and expend which may In any wayaccrus
ALTER OR ADD TO MECH.
Date Rxeipt#
AIR HANDLING (IMT CTO 10,(00 CFM)
SUBTOTAL:
%.
against old Cit In ro�u ce of g of this pemnll.
y' s
signaSBcant/Contractor e �
AIR FuhrouNc EMT (OVER tD,IDDCFht).
CONSTRUCTION TAX
EXHAUST HOOD(W/DICT)
CONSTRUCTION TAX PAID:
HAZARDOUS MATEIMASDISCLOSURE
Will the applicant or future building occupant store or handle hazardous
HFATINOUMT(TO100,0DORM
Date Reuel t#
moterbl as defined by the Cupertino Municipal Code, Chapter 9.12, and the
Health and Safety Code Section 25532(a)7
M Yn rrw
Wllltheappllcant or uturebulldurg oceupantuse equipment ordevices
which emelt harardous air contaminants as defined by the Bay Area Air
Qjjalfty Management Distrtd7
yes❑ No
have mad the hazardous mulerialsmquirements under Chapter 6.95 of
the California Health & SafetyCode, Sections 25505,25533 and 25534. T
understand that lithe building does not currently have a tenant, that it is my
HEATING UNIT (OVER 100,00D BTU)
TOTAL:
VENTILATION FAN RFSID )
ISSUANCE DATE
I -� innnno
.� s9s7
BOILER -COMP OHP OR 100,000 BTO
BOILER-COMP(OVER 100,000 BTU)
NEW RESIDENTIAL MECH. SQA -7.
responsibility to not lfy the occvpa in of the requirements which moat be met
prim to lsuance of a Certificate of Occupa nay.
y�
{ally of PIlnA.W"n
ISSUEDBY: d� a;'LI
Owner or authorized agent Data
TOTAL:
OFFICE COPY