20419APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification
Building Address:
PFYMT NO.
20419
10100 Torre Ave. Unit 219 (171.6)
wners `_ C fte one:
CITY OF CUPERTIN0.BUILDING DIVISION-
APPLICATION I PERMIT
BUILDINGFlECTRICA4I'LUMNNGMFL}IAMCAL
5/10/90
c^nnadoiaName: Lie. No:
738-4444
CATEGORY
CONTROLS
Arthiteci/En glxee Lie. No:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
SLUC
Address:
PERMITISSUANCE 12
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed under provisions of Chapter9(mmmrn
APPEANCES-RESIDEM3AL
JOB DESCM-DON
PANELS
Ingwlth Sed1on7000)o(Dlvlsioo3 ofthe Businnsand ProfealonsCode, and my
Bear. Is In full to. and effect
Date ic. #
Lic.Ciass Contractor
Data C r
TRCB
V V W
211-1000AMPS
ARCHITECPS DECLARATION
iunderstand mypkreduebeusedaspubllcrecords.
OVER1000AMPS
SQ. FT. FLOOR AREA
S/SQ.FT.
SIGNS ELECTRICAL
Licensed Professional
SPECIALCIRCUIT/MLSC
OWNER -BUILDER DECLARATION
Ihe.byaf0rmthat i am exempt(rom the Contractor's License Law for the
985
74.92
TEMP METER ORPOLE INST..
following reason.(Bacuon 7031.5, Business and Professions Code: Any city or
countywhich requ Tres a permit to mrutmm
d, alter, improve, deolish, or repair
anystmu mprlortolts Wuance,aborequireetheappliantfor•uchperMtto
file a signed statement that he is licensed pursuant to the provisions of the
POWER DEVICES
SWIMMING POOL ELECTRIC
Cc indices License Law (C"pter9(cemmencing with Section 7000) of Divi-
don3 of Business and Professions Code) he V exempt therefrom
VALUATION
the bash for the alleged exemption. Any violation of Section 70315 by any
applicant for a permit subjecisthe applicant to a civil penalty of net room than
OUTLETS-SWITCHES
$73,796.00
NEW RESIDENTIAL ELECTR SQ.FT.
five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sok
STORIES
73TE CONSTRUCTION
compensation, will do the work and the structure is not intended or offered for
rile (Sce. 7041, Buslws and Pmfessb® Code: The Contrscior's Lt.. Law
V
does not apply to an owner of property who Wilds or Improves thereon, and
whodoessuchworkhlm.Borlhrough Msownemployees, provided that such
Improvements arc not Intended oroffered forsale. If, however, thebuiliing or
TOTAL:
OCC.CROUP
R-3
RES. UNITS
/
Improvement ksold within ore ycarofcompletion, the owner-builderwill have
QTY, PLUMBING PERMIT FEE
t11yLilenof proving that he did not build or improve for purpose of sale.).
LJ I, as courser of the pmpeny, am exclusively mntrae ing with licensed
contractors to comtrod the project(See. 7044, Business and Pcfesatom Cade:
FLOOD ZONE
APN
-
PERMIT ISSUANCE 12
The Contractor's License Law don net apply to an owner of property who
Whin or Improve thereon, and who contracts for such pRopets with a
co
,,1Il1t..[[actor(s)Ikerued pursuant to the Contractor's License Law.
LJ I am exempt under Sec. R & P C for this reason
ALTER -DRAIN & VENT -WATER CPA)
FEE SUMMARY
BACK FLOW PROTFLT. DEVICE
OUTSIDE FEES
DRAINS. FLOOR RODE, AREA COM I,
SANITARY RECEIPT B
Owner Data
WORKMANCOMPFIVSATIONDECLARATION
❑I hereby elflrm that I have • ceniRcate of consent to self -insure, ora
¢nRiate of WorkeWCompereation Insurance or a nnl(led mpy thereof (Sec.
3800, late C.)
FIXTURES- PER TRAP
SCHOOLTAX Y N
RECEIPT Y
GAS FA. SYSTEM -1 WCAOUILEI5
PARK FEE .Y N
N_
RFOFR
CompanPolicyy
omXany
LI gaffified copy Is hereby filed the adl.city
enlfled copy V Ned with the city IrspMlon division.
S GAEA. SYSTEM -OVER 4 (EA)
BUILDING DIVISION ITIS
GREASE/INDUSIRL WASTE INTERCEPTOR
PLANCHECK PEE
GREASETRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
SEINER-SAM.T.ARY-y10gM EA p�T
COMPENSATION INSURANCE
(Thls section neednot be complded tithe permit Worms hundred dollars
Date Receipt#
WATER HEATER W/VENT/E7.FOIR
ENERGYFEE Y_ N_
(5100)mlem.)
I certilythet in the performance of the work forwhich this permit Is issued,
WATER SYSTEM/TREATING
I shall not employ any person in any manner so e to become subbed to the
WmkerACompensation Lawsof Callfomla. Date
PAID
NEW RESIDENTIAL PLMB. SQ.FT.
Applicant
NOTICE TO APPLICANT: It, after making this Certificate of Exemption, you
should become subject to the Worknn' Compensation provisions of the Labor
Dale Receipt
TOTAL:
BUILDING ,,,
522.50
Code, you most fon hwith comply with such provkbru or this permit shall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
I hereby afflrmthat there is a construction lending agency for the perform-
ance of the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name36.63
Lender's Address
1 an i(ythat l have read this application and state that the above Information36.63
bconect. I agree to comply with all city and county ordinances and nate laws
TOTAL:
ELECTRIC FEE
6-.lJ�
QTY. MECHANICAL PERMIT FEEMECHANICAL
PLUMBING FEE
FEE
PERMIT ISSUANCE
12_
FEES PAID:
relating to building coeatmdlor, and hereby authonae representatives of this
city to enter u Pon the above-mentioned property for inspection purposes.
(We) agree to seve, Indemnify an d keep harmless the City of Cu genion
aga out liabilities,judgments, costs and expenses which may In any way accrue
Date Receipt#
'
ALTER OR ADD TO MECH.
AIR HANDLING UNIT (TO 10,000 CFM)
SUBTOTAL:
.S
a slut xi In con ceo he a/ntyrg of this srrd 'l
B_ •I/���lV
r /!o
AIR HANDLING IINR (OVER l0,000CFM)
CONSTRUCTION TAX
a�
Signature of Applicant/Contractor e jrVm
EXHAUST HOOD(W/DUCT)
CONSTRUCTION TAX PAID:
HAZAR DOES MATER SDI SCIOSURE
Will the applies of or future building occupant store or ha ndle hazardous
material as deft red by the Cupertino Municipal Code, Chapter 9.1 2, and the
Health and Safety Code +—Secilon 25532(a)?HEATING
)7
C] Yea u No
HEATING UNIT (TO 100,000 BTU)
Date Recei t#
UNIT (OVER I00,000 BTU)
TOTAL:
637,
VENTILATION FAN (SINGLE RESID)
ISSL;J N BATE
Will the applicant or future building occupant use equipment or devices
which emit hazardous air comarni ants as defined by the Bay Area Air
Quality Management Dl❑❑strid7
4Yea
havenadthehazadosmaterialsrequirementsunderChapter6.95of
%./'1►i�l�LmaO�
(3
f,".AY 1 51990
BOILER -COMP QHPOR 100,000 BTU)
BOILER -COMP (OVER 100,000 BTU)
the Glifomla Health & SafetyCode, Seniors 25505, 25533 and 25531. I
undentand that if the building doe not evenly have a tenant, that it V my
responsibility to notify the occupant of the requirements which must be met
Cid of Cunprtinn
NEW RESIDENTIAL MECH. SQkT.
prior to Issuance of a Certificate of Occupancy.
ISSUED BY: A-. A!"1&✓'[,GI
Owner or authorlred agent Date
TOTAL:
OFFICE COPY