20417APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Buildln Pro act Id°miliealon P
Building Address:
PERMITNO.
2 0 4 1 7
ininn Torre Ave. Unit 917 JL
.
Ov,nee ��...vv one:
ti �UC
- s•rr•npri-iac
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION 1 PERMIT
5/10/90
c°ntr.da.Name: Lie. No:
—
BUILDING-ELECTRICALPLUMBING-MECHAMCAL
CATEGORY
CONTROL p
ArehltM/Englmxr. Lie. No:
QTY ELECTRICPERMIT FEE
BUILDING PERMIT INFO
Address:
O 1E 9:1 KI
PERMITISSUANCE
LICENSED CONTRACTOR'S DECLARATION
IFthSyion7Dthat lam Bcenuftheunder Oup salonaof Chapter
ssions9(commac
lnamse ISection forma doffec n3 ofthe BuainasandlsrofeuloneCode,and
license le In lull force and dfect,
APPLIANCFSRESIDENTIAL
]OB DESCRU'TLON
REB
PANELS
License Clava
(—sem
Ctr
o
Date Contractor
r..�j
201-1=AMPS
ARCHITECTS DECLARATION
I understand my plans shall be used a public records.
OVERIMAMPS
SQ. FT. FLOOR AREA
S/SQ. FT.
SIGNS ELECTRICAL
Licensed Professional
SPRCIALCI2CUIT/MLSC
OWNER -BUILDER DECLARATION -
I herebyaffirm that I am exempt from the Contractor's License Law for the
1,411
74.92
TEMP METER OR POLE )NST.
following reason.(5ectlon 70115, Business and Professions Code: Any city or
auntywhichrcqul apes ttocomtmMOtegimpmve,demolish,orrepair
anystmeture prlorto its becance,sleurcqubesthe applicant forsuch permit to
file a signed statement that he is licensed pursuant to the provbloa of the
POWER DEVICES
SWIMMING POOL ELECTRIC
Contneum's LtCome Law (Chapter 9(commencing with Section 7000)of Dlvl-
slon 3 of Ne Business and Professinm Code) orlhat he is exempt therefrom and
VALUATION
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant fora permit subjects the applicant to a civil penalty of not room than
OUTLETSSWITCHES-FIXTURES
$105,712.00
NEW RESIDENTIAL ELECTR —�'�'
five hundred dollars %SOD).
❑ I, as owner of the property, or my employees with wages as their sale
���
TYPE CONSTRUCTION
compensation, will do the work and flu tructure b not intended or offered for
sale (Sec. 7004, Busmen and Professba Code: The Contractors License Law
. V—N
TOTAL:
does not apply to an owner of property who Wilds or Improves thereon,and
who doessuch work himself or through hisown employees, provided that such
Improvemenbare notlntended oroffered forsale. If, however, the buildingor
Improvement bn
soldwlthlnoeyearofcompletioe,the owner-bullderwill have
OCC. CROUP
R-3
RIS UNITS.
/
l
iligkurden of proving that he did not build or Improve for purpose of sale.).
U L as owner of the property, am exclusively contracting with licensed
contractorsto constmd the project (Sec 7014 Businessand Profession Code:
The Contractor's License Law does not apply to an owner of property who
p a, and who contracts for such with a
Wilda or improves thereo pP�s
to the Contractor's License Law.
C7R[I11 amsexmpt under
LII am exempt uMer Sec. B k P C for this rcaaon
QTY, PLUMBING PERMIT FEE
FLOODZONE
APN
PERMIT ISSUANCE
12
ALTER -DRAIN k VENT. WATER (EA)
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
OUTSI DE FEE S
DRAINS. FLOOR ROOF, AREA, COND.
SANITARY ,Y_ N_
RECENT p
Owner Date
WORKMAN COMPENSATION DECLARATION
L —by affirm that I have a m
C3,erertlficate of consent to self -Insure, or
certificate ofWoriorem
Coperaation Innor
unce s arifkd copy thereof(Sec.
olis Lab C.)
Policy
FIX.Il1RES PER TRAP
Sp 100L TAX Y_ N
RFG[a p
CAS EA. SYSTEM -1 INC.d OUTLETS..
PARK FEE Y N
RECEIPT O
GAS EA. SYSTEM-OVER4(EA)
Com an
m a
BUILDING DIVISION FEES
Ned copy is hereby furnished.
Certified copy In filed with the city inspection dlvlston.
CREASE/INDUML WASTE INTERCEPTOR
PLANCHECKFEE
CREASE TRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
'
COMPENSATION INSURANCE
(TMasedioo need notbe complded B the permit Isforon hundred dollars
(5100)orina.)
I certitythat In the pedormanceof the work forwhlch this permit Is Issued,
SEWER -SANITARY -STORM G.200PT.
Date Recei t#
WATER HEATER W/VENT/D.FGTR
ENERGY FEE Y N
WATER SYSTEM/TREATING
I shall not employ any person In any manner an a to become subject to the
Workcrv'Compensstion Laws o(CalBomb. Date
PAID
Applicant
NOTICETO APPLICANT: If, after making this Certificate of Exemption, you
should become subject to the WorkerCompensation providers of the Labor
Date Recei t#
NEWRESIDENTIALPLMB. SQFr.
TOTAL:
BUILDING FEE
660.50
Code, you moat forthwith comply with such provisions or this permit shall be
doomed revoknd.
SEISMIC FEE
1.42
CONSTRUCTION LENDING AGENCY
IherebyaNrmthadherebaantructi.e lendingagenry, fortheperlmrr-
ante of the work for which this permit In issued (Sec. 3097, Civ. C.)
Larder'sName
Lander: Address
l ad lty that l lave read tbb application end state that the above Infomatlmn
bcomect.I agree to comply withal) dtyand countyordinancesand state laws
TOTAL:
ELECTRICFEE
47.28
PLUMBING FEE
4 7 ,28
QTY. MECHANICAL PERMIT FEE
MECHANICAL FEE
67 98
PERMIT ISSUANCE 12
FEES PAID
relating to building comMe lon, and hereby authorise representatives of thio
dtyto enteruponthe above-mentioned property for Inspection purpean.
(We) agree to save, indemnify an d kap harmless the City of Cupertino
agalest liabilities, judgments, costsand expenses which may In anywayacerue
ALTERORADDTOMECH.
Date Recei t#
P
AIR HANDLING UNIT (T010,ODO CFM)
SUBTOTAL:
sgaintaald City}wcyaaa sof gaRnthyg of this permit.
/ //-'ek1c`i{��/�e
AIR HANDLING UNII'(OVER I0,000CFM)
CONSTRUCTIONTAX
Signature of Applicant/Contractor /Jr Mir
EXHAUSTIIOODM/DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUS MATERMSDISCLOSURE
HEATING UNIT (TO 100,ODO BM
Date Recei t#
Will the app0cant or future building occupant atom or handle hazardous
material as defined by the Cupertino Municipal Code, Chapter 9.12, and the
lleelthand Safety Code Section 25532(.)1
f1 Yea Ii No
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
TDIIA
VENTILATION FAN(SINGLE RESID)
ISSUANCE DATE
PAD
Will the applicant or future building occupant use equipment or devices
which emit hazardous air contaminne as defined by the Bay Area Air
lity Management District?
1a�� Yea ❑ No
BOILER -COMP (711' OR 100,1X10 BTU)
BOILER-COMP(OVER100,DOOBM
]have read the hazardous materials requirements under Chapter 6.95 of
the California Health k Safety Code, Sections 25505,25S33 and 25534. I
understand that if the building does not mmently have a tenant, that it b my
J
1 7J
NEW RESIDENTIAL MECH. SQ.FT.
responsibility to notify the occupant of the requirements which must be met
prior to issuance of a Certificate of Occupancy.
/1
CI}11 of CHOP Ono
Jj
ISSUED BY_ CL.
Owner or awhocized agent Data
-
TOTAL
OFFICE COPY