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20418APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY Building Pra en Identification - Building Redress: PF1tMTTNO. 0 418 2 10100 Torre Ave. Unit 218 F1.3 ✓2 one. r roperties CITY OF CUPERTINO-BUILDING DIVISION APPLICATION'I PERMIT 5/10/90 Contractors Name: Lic. No: 738-4444 BLDING-ELECTRICALnL BING-MECHAMCAL UI CATEGORY CONTROL Archltea/Engineer. Llc. No: QTY ELECTRIC PERMIT FEEBUILDING PERMIT INFO Address © � © K] PFRMTISSUANCE 12 LICENSEDCONTRACTOR'SRATION Lon [herebyafm70theti that under provisions ChdonC APIo1.IANCESRESIDENTIAL JOB DESCRIPTION PANELS tvIMonsedunderprossand ro Ingwlt Is 1. full form ofdaffect. ofthe BusiriessandProfeasloneCode,and de,and my license Is in fact force ane effect. LlrenseClass LIc.# Date Date Contractor RCB v S -Pb vv- L 2014000AMPS ARCHITECTS DECLARATION I understand my plans shall be used as public records. JOVERIODDAMPS SQ. Fr. FLOOR AREA S/SQ. FT. SIGNSELECTRICAL Licensed Professional SPECIALCIRCUIT/MISC OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License law for the 985 74.92 TEMP. MET OR POLE INST. following reason. 5ection 7111 S, Business and Professions Cade: Any city or countywhich requiresa permit tomrstruct, alter, Improve, demolish, crespair 'anystructure prlorto its iuuanee,alsorequlrnthe applicant forsuch perrotto file a signed statement that he Is licensed pursuant to the provisions of the POWER DEVICES SWIMMING POOL ELECTRIC Conumcmr: License Law (Chapter 9 (commencing with Section 7000) of DiA. slon3 ofthe Businessand Prdemimu Code) orthat he is exempt therefromand VALUATION ' the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fora permit subjecta the applicant to a civil penalty of not more than OUTLE7SSN7TC}IGSEXT[JRES $73,796.00 NEWICMDENTIALELECTR fivehundrcddollan($500). I, as net of the property, or my employees with wages as their sole F] 1, STOW 6q TYPE CONSTRUCTION compensation, will do the work and the structure is na Intended or offered for sale (Sec. 70K Busioen and Pr fassiom Code: The Contractors Llreru , Law V -N docs not apply to an owner of property who Wilds or improves thereon and who does such work himselfortheaugh hhownemployees, provided thatsuch OCC.GROUP RES UNITS Improvements are not intended aroffered for sale. It however, thebuliding or Ewald within e yearofcomplation, the owner -W Bderwill have Improvementon TOTAL: R-3 _ f tlldgZurdenof proving that he did not Wild or improve for purpose of de.). LJ L as owner of the property, am exclusively contracting with licensed contracton to construct the project (See. 70K Business and Professions; Code: QTY. PLUMBING PERMIT FEE FLOOD ZONE APN PERMITISSUANCE 12 The Contractor's License Law does not apply to an owner of property who Wilds or Improves thereon, and who contracts for such pTiecb with a ogp[racta(a) Licensed pursuant to the Contractor's License Law. [_I I am exempt under Sec B & P C for this reason ALTER -DRAIN & VENT -WATER BIM FEE SUMMARY BACK FLAW PROTECT. DEVICE OUTSIDE FEES DRAINS FLOOK ROOF, ARRA, GOND. SANITARY Y N RECEI'T# Owner Data WORKMAN COMPENSATION DECLARATION ❑I hereby affirm that 1 have a certificate of consent to self -insure, or a of Workers'Compevatlonlaurance aracenifled copy thereo((Sec. 3800,,lLab C3 Lab FIXTURES PER TRAP SCIdOOL TAX Y_ N_ RECEIPT# GAEA. SYSTEM -1 INCAOUTLETS S PARK FEE Y N RECEIPT # Polity # Cony CAS EA. SYSTEM -OVER 6 (EA) BUILDING DI VISION FEES Tied copyla hereby famished. enified copy la filed with the city Inspection division, GREASE/INDUSFRL WASTE INTERCEPTOR PLANC14ECK FEE GREASETRAP CERTIFICATE OF ESHIH PTION FROM WORKER S' PAID COMPENSATION INSURANCE (rhisscctlonneed not Wcamplelyd lithe permit t foronehundred dollars De[0 ReCel IM SEWER -SANITARY -MRM FA. NIOFf WATER HEATER W/VENT/ELECTR ENERGY FEE Y_ N_ (5100)orl I Hollyth that N the perfomunce of the work far Which this permit la loved, WATER SYSTEM/TREATING I shall not employ any person In any manner n As to become subject to the Workeri Compeaation laws of California. Date PAID Applicant AM: a after nuking this Certificate is Exemption, you NOnCETO a subject should become subject to the Workers' Com n proof the Labor NEW RESIDENTIAL PLMB. SQ.Fr. Date Recel tN TOTAL: BU 522.50 provi l Code, you rtwst forthwith comply with such proal lea or this permit shall be this p domed revoked. CONSTRUCTION LENDING AGENCY SEISMIC PEE 11 Ihercbyaork forwhichthat tisecomtis Isse ld(Sec. agency 7, Civ. .) perform- Lard of the work forwhlch this permit V blued (Sec. 3097, Civ. CJ Iander: Name Lender'sAddreas I caoifythatl have read thisapplicathmand mtethzttheaWve Information Lsrornst I'gmeto comply with all cityand county ordinances and state laws TOTAL: ELECTRIC FEE PLUMBING FEE QTY. MECHANICAL PERMIT FEE MECHANICAL FEE 36.63 PERMIT ISSUANCE FEES PAID. 36.63 relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property foe inspection Purposes. (We) agree to save, Ind emnlfy an d keep harmless the City of Cu pemino against liabilities, P dgments, cats and expenses which may In any way amus ALIMORADDTOMECH. Date ReCel I� AIR HA NDLING UNIT (to 10,000 CFM) SUBTOTAL: A 37. again said Ci in�aaogv nceo t rent o(this permit., AIR HANDLING UNIT (OVER I B000CFM) CONSTRUCTION TAX Signature of Applicant/Contractor IF lilms EXHAUST HOOD(N/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATER SDISCLOSURE HEATING UNIT (TO 100,000 BTU) Date Recei IN Will theapplcant or future bullring occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 93Z and the Health and Safety Code�--Sooection 2S532(a)7 ❑ Yn No HEATING UNIT (OVER 100,000 BW TOTAL: )'�S VENTILATION FAN (SINGLE RESID) ISS TE Will the applicant orfuture building occupant use equipment ordevices which emit hazardous air contaminants as defined by the Bay Arca Air i lity Management D'utrict7 J1i'//:��t�� BOILER -COMP OTE' OR 10%000 BTU) J Yes �'I Nol Thave read thehazal� us materials requirements underChapter 6.95 of BOILER -COMP (OVER 100,000 BTU) the Celifemia Health & Safety Code, Sections 25505, 25533 and 25536. I understand that lithe building does not mmently have a tenant, that It is my NEW RESIDENTIAL MECH. SQ.IT. responsibility to notify the occupant of the requlrerrents which must be met Cl of COBP,rtIDD. prior to Issuance of a Certificate of Occupa sty.ty. ti ISSUEDB Owner or authorized agent DateTOTAL: OFFICE COPY