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20408APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY Building Project Identification Building Address: PEKMITNO. 20408 10100 Torre Ave. Unit 208 (171.4) sone"" a^d--►';� one: I ✓ rr j lie —�ion'.N._..,.. Prnl3grt'IPg Contractor's Name: ['�'-�— Lk.Nm CITY OF CUPERTINO-BUILDING DIVISION APPLICATION /PERMIT 5/10/90 — BUILDING -ELECTRICAL PLUMBINGMECHAMCAL CATEGORY CONTROL N Architect/Engineer. Lk. No: QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Add. BLDG ELECI M g PERMITISSUANCE 12 LICENSED CONTRACTOR'S DECLARATION I hereby ei firm that n7OOO)of Di si=3licensd under ftheBuinma dPmf apter9de,anen ingwlt 7000) of Dlvfect. /the BusinesaandProkasionsCode,tnd my MPLIANCFSIrE9DENML JOB DESCRIPTION is in ell licence talo full force and ic.1 License Class Contractor Date Contractor ARCHITECTSDECLARATION I understand my plana shall be used as publlcremNs PANELS RCB D I 201-IOVER I0AMI5 OVER 1000 AMI5 SQ. FT. FLOOR AREA 5/SQ.FT. SIGNS ELFLIRICAL Licensed Professional OWNER -BUILDER DECLARATION I hereby afOrmthat I am exempt from the Contractor's License Law for the 985 74.92 SPECIALCIRCUIT/MISC TRAP. METER OR POLE INST. following reason.(Section 70315, Business and limitation Code: Any dry or ceuntywhich requbes a permit tocomtmd, alter, Mpmve, demolish, orrepalr anystm=mpd.rlolbisauame,alsomqulrestheappBcantforsuchpen tto file a signed statement that he is licensed pursuant to the provisiora of the )OWER DEVICES SWIMMING POOL ELECTRIC Contractor's License Law (Chapter9(conernmelog with Section 7000) of LTM- sion3 of the Business and ProfessionsCode) orthat he is exempt therefromand VALUATION the basis for the alleged exemption. Any violation of Stolon 7031.5 by any applicant for a Parnell subjects the applicant to a civil penalty of net more Ihan OUTLETSSWITCHESEKrURES$T3,796.00 NEWRESTDENTIALELECTR SQ.FI. five hundred doilies ($500f. ❑ 1, as owner of the property, or my employees with wages as their sole STORIES TYPECONSTRUCTION compensation, will do the work and the structure is not Intended or offered for V—N sale (Sec 70K Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who doessuchwork himself orthrough Ws own employees, provided that such OCC.GRDUP RES UMTS improveman4 are not intended or offered fee sale. If, however, the building or TOTAL: R-3 Improvement It sold within one yea rofcompletim, the owner-bullderwlll have ' the he rden of pmving that ha did not build or Improve for purpose of sale.). andcontractingpro with licensed L as owner of the property, em exclusively Business rontranon to construct me project (Sec.704y Business and professions Code: QTY. PLUMBING PERMIT FEE FLOOD7DNE APN PERMIT ISSUANCE � 12 The Contractor's License Law does ret apply to an owner of property who builds or Improves thereon, and who common for such projects with a o tjactods)licensed pursuant to the Contractor. License Law. LJ I am exempt under Sec. B & P C for this rregain. ALTER -DRAIN VEM-WATER (EA) FEE SUMMARY BACK FLOW PROTECTDEVICE FOR ROOF, AREA, COND. DRAINSLO SANITARY RECEET N Owner Date WORKMAN COMPENSATION DECLARATIONF0J(TVRES 711 hereby affiren that I have a certificate of consent to se161naure, ora mnificate of Workers ComperuatlerInsuranc, or a certified mpy thereof(See. 3800, Lab C.) Policy PER TRAP'- SCHOOL TAX Y_ N_ RECEIPT N GAS EA. SYSTEM -1 INCA OUTLETS PARK FEE Y N — RECEIPT N p Company Com GAS EA. SYSTEM -OVER 4 (EA) BUILDING DIVISION FEES Red copy is hereby furnished. ertBled copy is filed with the city lespeatien division. GREASE/INDUSTRL WASTE INTERCEPTOR PLANC14ECKFEE GREASETRAP CERTIFICATE OF IXEM PION FROM WOR KERS' PAID COMPENSATION INSURANCE IThl.ke3km need not be completed lithe permit is for one hundred dollars Date ReceI t# SENEWSAMTARY-STORM EA. XIOFT. WATEt HEATER W/VENT/ELECTR ENERGYFEE Y N ($100)., less.) I rtify that In the performance of lhework forwhlch this permit la ued, certify W WATER SYSMM/TREATING 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of Califemia. Date PAID Applicant NOTICETO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worken'Compere atlon provisions of the Labor Date Recei t# NEW RESIDENTIAL PLMB. SQ.FT. TOTAL: BUILDING Code, you must forthwith comply with such pro itlons orthis permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY SEISMIC FEE 5.18 I herebyefOrm that there is a construction lending agency forthe perform- ance of the work for which this permit is Issued (Sec. 3097, Civ. C.) Lcrdnr'. Name Lceder'a Addreea I certifythat l have readthisapplicalionend statethattheabove Information iscorred.I dgrmto comply with all city and county ordinances and state laws TOTAL: ELECTRIC FEE PLUMBING FEE QTY. MECHANICAL PERMIT FEE MECHANICALFEE PERMITISSUANCE 12 FEES PAID: relating to building constmctlon, and hereby authorize representatives of this city to enter upon the ahovo-mantloraa property for Inspection purposes. (We) agree to save, Indemnify an d keep harmless the City o1 Cu ped Ino against liabilities, tedgmants, mks and expenses which may In any way amus ALIERORADDTOMECH. Date RCCCIPt# AIR HANDLING UNIT (TO IQWO CFM) SUBTOTAL: ago Inst sal, C yincgpaasplen�g of this permit. 1��D Signature of Applicant/Contractor r N J Date AIR HANDLING UNIT (OVER 10,ODOCFM) CONSTRUCTION TAX EXHAUST HOOD(W/DUC'D CONSTRUCTION TAX PAID: HAZARDOUS MA ,S DISCLOS URE HEATING UNIT CTo 100,000 RM _ Date Recei t# Will the a pplicant on future building occupant store or handle hazardou. material as defined by the Cupertino Municipal Code, Chapter 9.1$ and the Health and Safety Code Section M31(a)7 ❑ Yes No Willthe applicant Men building occupant use equipment ordeviccs HEATING UNIT (OVER 100,000 BTU) TOTAL: , VENTILATION PAN (SINGLE RESID) ISSUANCE DATE which emit harardoua air conlamlmnt. as defined by the Bay Arca Air Q etiity Management Distdct7 4Yrs N. havcrcadtheI. usmateriabrequiremenhunderChapler&95 of the Ca vcrnla Health & Safety Code, Sections 25505, 75533 and 25534. 1 understand that if the building does not comely have a tenant, that it is my - App v t _ 'J 1 D 1990 BOILER -COMP DFm OR 100,000 BT(n BDILERCOMP(OVER 100,000BTU) NEW RESIDENTIAL MECH. SQ.FI responsibility to notify the occupant ofthe requirements which must be met , p"la"t. L+suance oft Certificate ofOmpancy. _ of Guoartinn ++Ci ISSUEDBY-.1 I owner or authorlmd agent - Date TOTAL:j OFFICE COPY