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HomeMy WebLinkAbout20364APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-- USE BALL POINT PEN ONLY Building Pro ed Identification emlamg Aaarens: PFRMITNO. 0 3 6 4 - 10100 Torre Ave. Unit 164 (D2.3)' wners name, one:Town A , - Center Properticig CITY OF CUPERTINO-BUILDING DIVISION APPLICATION? PERMIT 5/10/90- Contractor's Name: - Lic. Nee CATEGORY CONTROL 738-4444 EUILDINGELECTMCALML BINGMECHANICAL Architect/Engineer. - Lk. No 'ELECTRIC PERl1•IIT s�FEE ". '. BUICDING•PERMIT;INFO Address: , - PERMITISSUANCE 12 ❑X.. LICENSED CONTRACTOR'S DECLARATION Ihamby affirmthat I am licensed under provisions ofChapter 9(mmmmc ingwlthSedton70(D)of Dfv sion3afthe Busimmand Profes.fonsGode,and my license le In fullforce and Llanse Chea Lie# APPLIANCES -RESIDENTIAL JOB DESC ON 1C RCB , PANELS. PAN©^ UP TO 200 AMPS- Data Coutman, ARCHITECI•S DECLARATION201-10W 'I understand my plans shag be used as public records AMPS OVER 1000 AMPS . SQ. FT, FLOOR AREA $/SQ. FT., SIGNSELECTRICAL Licensed Professional SPECIALCBiCUIT/MISC OWNER -BUILDER DECLARATION I hereby alfirenthat lam exempt fromthe Contractors License law fw the 730 74.92 TEMP METERORPOLE INST. following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure pdorto it Issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the POWER DEVICES SWIMMING POOL ELECTRIC- _ Contractors License Law (Chapter 9 (commencing with Section 7000) of Divi- alon3ofthe Business and Professions Code)orthat he s exempt therefromand -, VALUATION the bass for the alleged exemption. Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a dvilpenally Dint more than OUTLETS -SWITCHES -FIXTURES - $54,692.00 five hundred dollars (S500). ❑ I, as owner of the property, or. my employees with wages as their sole NEW RESIDENTIAL ELECTS 'SQFT.kLRY, TYPE CONSTRUCTION compensation,will do the work. and the structure s not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Lawdoesnotapplytoanownerofproperty Y_N who Wilds or improves thereon, andwho doessuchwork himself orthrough Ne own employees, provlded that suchAES. UNTlS Improvements are not Intended or offered for sale. If, however, the building or s sold within one yearofcompletion, the owner-bu0derwill have it vrdan of rovin that he did not build or Imrove for se ofsale) p g p parpa owner mf the property, (m. 7044,BusinessandProing with IkensedPERMIT LWd the project (Sec, Business and Code:TheContractors TOTAL:Improvement Q'rY: i' PLUtvIBING'PERMIT `API ISSUANCE of pro ert The Contmto es Llanse Law aces h apply tc an owner of property who appl bullae or improves thereon, and wFo contracts (w ouch pLojeds with a pumuant to the Corumdoe'a License Law. LI I am exempt under Sec B & Is C for the reason ALTER-DRAIN&VENT-WATER (EA)cb.ctw(s)11¢nsed BACK FLOW PROTFLT.DEVICE,L7�'iMARY, DRAINS FLOOR ROOF,ARFA, COND. SANITARY Y_ N RECEB'T # - Owner Date WORKMAN COMPENSATION DECLARATION ❑I hereby affirm that I have a certificate of consent to self -insure, ora certlflateofWorked Compsnsatlunlnsuraom or a certified copythereof(Sec. 3800, Lab CJ FIXTURES PER TRAM' SCIdOOL TA% Y_ N_ RECEIPTN# GAS EA.SYSTEM-1 INC.40I11LET5 PARK FEE Y_ N RECEIPT # Policy # Com an GAT. F.A.SYSTEM-OVER 4 (RA) -BUILDING DIVISION FEES rtlfledropyIshedwiththhity Certified copy Is filed with the city inspection dlvslmn. GREASE/INDUSTRL WASTE IN'T'ERCEPTOR PLANCHECK FEE ' GREASE TRAP CERTIFICATE OF EXEMPTION FROM WORKERS" PAID SEWER-SANITARY-SIORMG 200FT COMPENSATION INSURANCE (This air. need not be completed Rthe permit isfor ore hundred dollars ($IW)arles,.) . I rtifythat In the performance ofthework forwhlch this peit is issued, apermit Date Remipt WATER HEATER W/VENT/ELECTR ENERGYFEE Y_ N _ - WATERSYSTEM/TREATING I shall not employ any person In any manner so as to become subject to the Wwkers'Compeneation Laws o(GB(ornla. Date Applicant PAID - Date Recei t# - NEW RESIDENTIAL PLMH._SQFT. NOTICE TO APPLICANT: If, after raking thin Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor TOTAL: - - - (137. Code, you mw at forthwith ..ply with such provslore or thin permit shall beG deemed revoked. CONSTRUCTION LENDING AGENCY SEISMIC FEE 3.85 TOTAL: ELECTRIC FEE 30.25 I hereby affirm that there Is a construction lending agency for the perform- ance of the work for which this permit Is Issued (Sec. 3097, Civ. CJ Lender's Name Lendee.Addm.s - PLUMBING FEE '` .i FIEGHANICALP.ERMIT 7*iFEEi," �, MECHANICAL FEE ' IartifythatI havereadthsapplicationand statethatthealswelnformatlon srorred.I agreeto complywith all cityand county ordinances and gate laws - - PERMIT ISSUANCE - FEES PAID: ALTER OR ADDTO MECH., - relating to building construction, and hereby authorlas repreaentatives of this city to enter upon the alxmr mentioned property for Inspection purposes. TVs) agree to save, Indemnify an d keep harmless the City of Cupertino against liabilities, judgment, aretand expenses which may(n anywayaarue a aiat said CJWJn royy. ence% he esti afthsp ecout S / Ali JJ` - Date Receipt# AIR HANDLING UNIT CTO 10,000 CFM) • SUBTOTAL: S 41.0 AIR HANDLING UNIT (OVER 10,000CFM) CONSTRUCTION TAX Signatures of Applicant`/Contmcmr Dow EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERQ DISCLOSURE Will the applicant or future building occupant store or handle hazardous HEATING UNIT CFO 100,000 BTU) Date Recei t# material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Coder. -S�eaton 25532(a)P - Yes • _I No C -]L Will the applicant ce future building occupant use equipment or devices which emit hazardous, air contaminants as defined by the Bay Area Air Qu a lily Management DisMd7.Al®j 4 Yes No , have read the Fazar oro materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 75505, 25533 and 25534. ] understand that lithe building does not mrrently have a tenant, that it Is my' HEATING UNIT (OVER 100,000 BTU TOTAL: ad VENTILATION FAN (SINGLE RFSID) , .' ISSUANCE DATE - qqIITL 1 f /,1 it q f� I l - 1 V 1990 (1 1 ,. BOILER -COMP OHP DR 100,000 BTU BOILER -COMP (OV ER 100,000 BTU) NEW RESIDENTIAL MECH. SQ.FT. responsibility londify the occupant of the requirements which must be met prior toissuance ofaartificatcofOnvpascy. - ' _ {,'- ,�'I•J Of Cu Bp1,LIBn ISSUED BY, 0 ��- Owner or authorized agent Date TOTAL: OFFICE COPY