20423APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Idemlficatlest
Building Addrees:
PERMIT NO.
20423
10100 Torre Ave. 223 (J1)
.nUnit
rmu ` one:
CITY OF CUPERTIN0.6UILDING DIVISION
APPLICATION / PERMIT
A
5/10/90
eon nectars Name: '°P Llc Noon
—
BUrLDINGELECTRICAL.MU BING•MECHAMCAL
CAT[CORY
CONTROL N
ArchitM/Englnaer. Lk. N.
QTY ELECTRIC PERMIT FEE
PERMIT INFO
Address
---(BUILDING
^
„I `a
�-X '�y �-nt
I'FRh9T755[JANCE 12
LICE.NSEDCONTRACTOR'SunderDECLARATION
I hereby Sattt(irmthatlaiv Bcensedunderprovldoeeodesum.Ccacumen
In i Semon 7000)and daon3ofthe Buslnasand ProleWoneCode, and my
Licalicense is in full some and effect.
DatamClam Cont`
Date GHIITCf
MPLIANCESRESIDENML
JOB DESCRE'rION
RCB
S
PANELS
201.110 AMPS
Am Maniac used
I understand my p6re shag be vend as public recoNa
OVER 1000 AMPS
9Q. FT. FLOOR AREA
5/SQ. FT. .
SIGNSELECTRICAL
Licensed professional
SPECIALCIRCUIT/MISC
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or
countywhlch maleness permit to construct, alter, improve, demolish, oreepair
1,411
7 4.92
TEMP METER OR POLE (NST.
any structure prior to its issuance, a bo requires the applicant for such permit to
file a signed statement that he is licensed pursuant to the provisions of the
Centrmt.e. License Law (Chapter9(commencing with Section 7000) of DWI-
WI-
Mon
Mona of the Business and Prof nsionaCode) or that heb exempt thandromand
the basis for the alleged exemption. My violation of Section 7031,5 by any
appllant fora permit mbjeatsthe applicant to a civil penaltyN not more than
POWER DEVICES
SWIMMING POOL ELECTRIC
OUTLETSSWITCHFS
VALUATION
pFIXTURFS y 10 rJ s 712.00
11tirdeed delta. (SM.
6I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure It not intended or offered for
NEW RESIDENTIAL ELECTR SQ.FT.
STORIES
-
TYPE CONSTRUCTION
V -1V
sale (Sec. 7044, Business ami Professions Code: The Contraeot's Lt.. law
does not apply to an owner of property who be tide or Improves thereon, and
who doessuch work himees ortheaugh his own employe., provided that such
OCC.GROUP
RES. UNITS
Improvements are not Intended or offered for sale. If, however, thebuilding a
Improvement ta sold within one yearofcompietion, the owner-bu0derwill have
TOTAL:
R-3
ttItpued en of proving that he did not build or improve for purpose of sale.).
LJ L as owner of the property, am exclusively, contracting with licensed
contractors to romlmct the project (Sec. 7044, Business and Pradessiom Code:
QTY. PLUMBING PERMIT FEE
FLOOD ZONE
APN
pERMR ISSUANCE
12
The Cont.ctor's License Law does not apply to an owner of property who
Wilds or Improves thereon, and who contracts, for such prpjects with a
cgB(pdor(s)licensed pu.uant to the Contractor's License Law.
I am exempt under Sec on
B A P C for this reas
ALTER -DRAIN k VENT - WATER can)
FEE SUMMARY
BACK FLOW PROTECT DEVICE
OUTSIDE FEES
DRAINS FLOOR ROOF, AREA, COND.
SANITARY Y_ N_
RECEIPT N
Owner - Date
WORKMAN COMPENSATION DECLARATIONp�.ps
[31 hereby affirm that I have a certificate of consent to self-tesum, or a
certificate of Workers' Compensation Insurance or a certified copy thereof(Sea
Polk fab CJ
Policy
PER TRAP
SCHOOLTAX Y N
RECEET M
CAS FA.SYSTEM-1 INC. 0[JTLEfS
PARK FEE Y N
EIN
RECEIPT
Crum any
t
GAS EA. SYSTEM -OVER 4 (EA)
BUILDING DIVISION FEES
lned copybhereby fumished.
ertNed copy b filed with the city inspection division.
GREASE/INDUSTRL WASTE INTERCEPTOR
PLANCHECK FEE
GREASE TRAY
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
IThbnection need not be completed lithe permit b for one hundred dollars
SEWER-SANITARY-STOPM EA. 2110F1'.
Date Recel [#
WATER HEATER W/VENT/ELECTA
,ENERGY FEE Y_ N_
0100)03 lPea')
I certify that in the perfomence of the work for which this peentt Is hsued,
WATER SYSTEM/TREATINGWorkers'
10-11 not employ any person to any nvnner so m to become subf d W the
Compensation Lawcof Calfor is. Date
PAID
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you
should bemon subject to the Wallen' Compevatlon pewlaiom of the Labor
Date BOCCI t#
NEW RESIDENTIAL PLMB. SO.ET.
TOTAL:
BUILDING
Code, you at fmthwlth comply with such provblmu orthb i permit shall be660.50
deemed revoked.
SEISMIC FEE
!�
CONSTRUCTION LENDING AGENCY
I herebyafb"m that there is a construction leading agency for the perform-
Earned ance of the work for which this perIs Issued (Sec 3097, CIV. Q)
Landere Name
Lendef.Address
1 cenilythat I have readthis appliationand statethat theaboveimformatlon47
iscoreact. I agree to comply with all city and county ordlnanoesand stale laws
TOTAL:
ELECTRIC FEE
.-2B-
QTY. MECHANICAL PERMIT FEE
PLUMBING FEE
MECHANICAL FEE
PERMIT ISSUANCE 12
FEES PAID:
. 28-
relating to building construction, and hereby authorize representatives of this
city to enter upon the above-mentioned property for Inspection puTense.
(We)agree to save, ind comity an d keep harmle. the City of Cu ped Ino
against liabilities, )sdgrnaru,cox: nd expenses whlchmayinanywayaccrue
ALTERORADDTOMECH.
Date Recei t#
AIR HANDLING UNIT( TO 10,000 CFM)
SUBTOTAL:
�e
zgahul salsa 4,y Inc enc f the Stan It of this Permit. /
1 /`O
( +YlOate
AIR HANDLING UNIT (OVER 10,000CFM)
CONSTRUCTION TAX
Signature of Applicant/Contractor
a(RALis'r Flow cw/DucT)
CONSTRUCTION TAX PAID:
HAZAR DOUS MATERIMIMSDI SCLOSU RB
Will the applies, at or future budding occupant store or hand le hazarNe dous
material as canned by the Cupertino Municipal Code, Chapter 9.17, and
Ilealth and Safety Code Section 25532(a)7
❑ Yea NN.
Will the applicant or future building occupant use equipment ordevices
Id TINC UNIT 110 100,000 BT11"Date
ReceI t#
-
❑(EATING UNIT (OVER t0D,000 BTI.
TOTAL:
VENTILATION FAN (SINGLE RESID)
ISSUANCE DATE
which emit havrdousair contaminant. as defined bythe Bay Area At,
Quality Management District?
❑ YeaNo
IM1ave read the h.9 us materials requirements under Cha per 6.95 or
the Gilfomla Flea1N k Safety Code, Sediona 25WS, 75533 and 25534. 1
understand that if the building does not currently have a tenant, that It ta my
'
pp4n y
I,�! M I 1 5 1990
BOILER -COMP DFIP OR 100,000 BTU)
BOILER-COMP(OVER 100,0D0 BTU)
NEW RESIDENTIAL MECid. SQ.FT.
responsibility to natty the occvpare of the requbament, which at be met
prior to issuance of a Certificate of Occupancy.City
[
ISSUED BY." Vs, "NV'�'��T..r"7
Owner or authorized agent Date
TOTAL:
OFFICE COPY